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BACKGROUND Patient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring. OBJECTIVE We aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring. METHODS In this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants’ visual fixations of vital signs between the two technologies. RESULTS Participants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, PPP=.04). Study center, profession, gender, and scenario order did not influence the differences between methods. In all four scenarios, the participants visually fixated 9 of 11 vital signs statistically significantly longer using the avatar (all PP CONCLUSIONS This eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar’s body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring.

BACKGROUND: Patient monitoring ensures the safety of patients in perioperative, intensive care and emergency medicine. There are some well-studied issues, such as alarm fatigue and information presentation. For this study, we use a mixed qualitative and quantitative approach to get a global feel for the problems of users with today's state of the art patient monitoring. METHODS: First, we conducted interviews with 120 anesthesiologists (physicians and nurses) asking them about problems they experience with patient monitors. We then coded the answers into topics and subtopics that we present and discuss. In a second study, a field survey with 25 anesthesiologists, we added a quantitative part in which anesthesiologists rated their agree- or disagreement with statements based on the themes identified in the prior analysis on a five-step ordinal rating scale. RESULTS: We have identified the following six main topics: 1. "Alarms," 2. "Artifacts," 3. "Software," 4. "Hardware," 5. "Human Factors," 6. "System Factors," and a total of 17 sub-topics. The quantitative statements raised for each major theme were: 1. “problems with alarm settings complicate the work with patient monitoring.” (96% agreed) 2. “artifacts complicate the assessment of the patient's condition.” (56% agreed) 3. “information overload makes it difficult to get a quick overview of the situation.” (56% agreed) 4. “problems with cables make working with patient monitors tedious.” (88% agreed) 5. “factors related to human performance lead to patient conditions not being perceived on the monitor.” (64% agreed) 6. “Insufficient standardization: Switching back and forth between monitors from different manufacturers makes it difficult to work with patient monitors.” (88% agreed). Non-parametric testing determined all six statements to differ significantly from the neutral opinion. CONCLUSION: This study provides an overview of the problems users face in their work with patient monitoring. The most annoying issues identified were related to alarms, cables and insufficient standardization between different manufacturers. An ideal monitor should, therefore, have an alarm system that reduces false positive alarms to a minimum, works with as few cables as possible and is easy to learn. This paper shows that there is still much room for improvement in patient monitoring systems.

BackgroundPatient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring.ObjectiveWe aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring.MethodsIn this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants’ visual fixations of vital signs between the two technologies.ResultsParticipants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, PConclusionsThis eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar’s body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring.

Background A new patient monitoring technology called Visual Patient, which transforms numerical and waveform data into a virtual model (an avatar) of the monitored patient, has been shown to improve the perception of vital signs compared to conventional patient monitoring. In order to gain a deeper understanding of the opinions of potential future users regarding the new technology, we have analyzed the answers of two large groups of anesthetists using two different study methods. Methods First, we carried out a qualitative analysis guided by the “consolidated criteria for reporting qualitative research” checklist. For this analysis, we interviewed 128 anesthesiologists, asking: “Where do you see advantages in Visual Patient monitoring?” and afterward identified major and minor themes in their answers. In a second study, an online survey with 38 anesthesiologists at two different institutions, we added a quantitative part in which anesthesiologists rated statements based on the themes identified in the prior analysis on an ordinal rating scale. Results We identified four high-level themes: “quick situation recognition,” “intuitiveness,” “unique design characteristics,” and “potential future uses,” and eight subthemes. The quantitative questions raised for each major theme were: 1. “The Visual Patient technology enabled me to get a quick overview of the situation.” (63% of the participants agreed or very much agreed to this statement). 2. “I found the Visual Patient technology to be intuitive and easy to learn.” (82% agreed or very much agreed to this statement). 3. “The visual design features of the Visual Patient technology (e.g., the avatar representation) are not helpful for patient monitoring.” (11% agreed to this statement). 4. “I think the Visual Patient technology might be helpful for non-monitor experts (e.g., surgeons) in the healthcare system.” (53% of the participants agreed or strongly agreed). Conclusion This mixed method study provides evidence that the included anesthesiologists considered the new avatar-based technology to be intuitive and easy to learn and that the technology enabled them to get an overview of the situation quickly. Only a few users considered the avatar presentation to be unhelpful for patient monitoring and about half think it might be useful for non-experts. Electronic supplementary material The online version of this article (10.1186/s12871-018-0650-1) contains supplementary material, which is available to authorized users.

Maintaining situation awareness of monitored patients can be challenging because care providers must continually read and integrate multiple waveforms and numerical vital sign values into a mental model of the patient's situation. We developed and evaluated a technology designed to improve perception of vital sign information by presenting patient status as an animated patient avatar.After step-wise improvement of the avatar, anaesthesia professionals from two hospitals participated in a comparative study of conventional monitoring. Participants observed identical monitoring scenarios via the two technologies for brief time intervals and afterwards recalled patient status.Overall, 150 anaesthesia professionals participated in the validation process and 32 participated in the comparative study, completing 128 scenarios, which allowed for 64 direct comparisons. The avatar's inter-rater reliability was high, with Fleiss' kappa of 0.98 (95% confidence interval 0.96-0.99, P0.001). With the avatar, participants recalled almost twice as many vital signs correctly as with conventional monitoring (9 vs 5, P0.001). Perceived confidence was improved (2=certain vs 1=uncertain, P0.001) and perceived workload lowered (task load index 60 vs 76, P0.001). Participants obtained these results only after watching an educational video explaining the avatar and suggesting quick learnability and potential for real-life usability.This study provides empirical evidence that an animated avatar offers the opportunity to transmit vital sign information significantly more quickly than conventional monitoring and with improved confidence and reduced cognitive effort. This could help care providers gain situation awareness more efficiently.