An exploratory clinical evaluation of a head-worn display based multiple-patient monitoring application: impact on supervising anesthesiologists’ situation awareness



Supervising anesthesiologists overseeing several operating rooms must be aware of the status of multiple patients, so they can consult with the anesthetist in single operating rooms or respond quickly to critical events. However, maintaining good situation awareness can be challenging when away from patient bedsides or a central monitoring station. In this proof-of-concept study, we evaluated the potential of a head-worn display that showed multiple patients’ vital signs and alarms to improve supervising anesthesiologists’ situation awareness.


Eight supervising anesthesiologists each monitored the vital signs of patients in six operating rooms for 3 h with the head-worn display, and for another 3 h without the head-worn display. In interviews with each anesthesiologist, we assessed in which situations the head-worn display was used and whether the continuous availability of the vital signs improved situation awareness. We also measured situation awareness quantitatively from six of the eight anesthesiologists, by instructing them to press a button whenever they noticed a patient alarm.


The median number of patient alarms occurring was similar when the anesthesiologists monitored with the head-worn display (42.0) and without the head-worn display (40.5). However, the anesthesiologists noticed significantly more patient alarms with the head-worn display (66.7%) than without (7.1%), P = 0.028, and they reported improved situation awareness with the head-worn display. The head-worn display helped the anesthesiologists to perceive and comprehend patients’ current status and to anticipate future developments. A negative effect of the head-worn display was its tendency to distract during demanding procedures.


Head-worn displays can improve supervising anesthesiologists’ situation awareness in multiple-patient monitoring situations. The anesthesiologists who participated in the study expressed enthusiasm about monitoring patients with a head-worn display and wished to use and evaluate it further.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Azuma RT. A survey of augmented reality. Presence: Teleoper Virtual Environ. 1997;6(4):355–85.

    Article  Google Scholar 

  2. 2.

    Cakmakci O, Rolland J. Head-worn displays: a review. J Displ Technol. 2006;2(3):199–216.

    Article  Google Scholar 

  3. 3.

    Liu D, Jenkins SA, Sanderson PM. Patient monitoring with head-mounted displays. Curr Opin Anesthesiol. 2009;22(6):796–803.

    Article  Google Scholar 

  4. 4.

    Muensterer OJ, Lacher M, Zoeller C, Bronstein M, Kübler J. Google glass in pediatric surgery: an exploratory study. Int J Surg. 2014;12(4):281–9.

    Article  PubMed  Google Scholar 

  5. 5.

    Yoon JW, Chen RE, Han PK, Si P, Freeman WD, Pirris SM. Technical feasibility and safety of an intraoperative head-up display device during spine instrumentation. Int J Med Robot. 2017;13(3):e1770.

    Article  Google Scholar 

  6. 6.

    Kolodzey L, Grantcharov PD, Rivas H, Schijven MP, Grantcharov TP. Wearable technology in the operating room: a systematic review. BMJ Innov. 2017;3(1):55–63.

    Article  Google Scholar 

  7. 7.

    Dougherty B, Badawy MS. Using google glass in nonsurgical medical settings: systematic review. JMIR Mhealth Uhealth. 2017;5(10):e159.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Endsley MR. Toward a theory of situation awareness in dynamic systems. Hum Factors. 1995;37(1):32–64.

    Article  Google Scholar 

  9. 9.

    Gaba DM, Howard SK, Small SD. Situation awareness in anesthesiology. Hum Factors. 1995;37(1):20–31.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Schulz CM, Endsley MR, Kochs EF, Gelb AW, Wagner KJ. Situation awareness in anesthesia concept and research. Anesthesiology. 2013;118(3):729–42.

    Article  PubMed  Google Scholar 

  11. 11.

    van Ettinger M, Lipton J, Nelwan S, van Dam T, van der Putten N. (2010) Multimedia paging for clinical alarms on mobile platforms. Proceedings of the Conference on Computing in Cardiology. p. 57–60.

  12. 12.

    McFarlane DC, Doig AK, Agutter JA, Brewer LM, Syroid ND, Mittu R. Faster clinical response to the onset of adverse events: a wearable metacognitive attention aid for nurse triage of clinical alarms. PLoS ONE. 2018;13(5):e0197157.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Görges M, Westenskow DR, Markewitz BA. Evaluation of an integrated intensive care unit monitoring display by critical care fellow physicians. J Clin Monit Comput. 2012;26(6):429–36.

    Article  PubMed  Google Scholar 

  14. 14.

    Pascale MT, Sanderson P, Liu D, Mohamed I, Brecknell B, Loeb RG. The impact of head-worn displays on strategic alarm management and situation awareness. Hum Fact. 2019.

    Article  Google Scholar 

  15. 15.

    Yang XJ, Wickens CD, Park T, Fong L, Siah KTH. Effects of information access cost and accountability on medical residents’ information retrieval strategy and performance during prehandover preparation: evidence from interview and simulation study. Hum Factors. 2015;57(8):1459–71.

    Article  PubMed  Google Scholar 

  16. 16.

    Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Adv Crit Care. 2013;24(4):378–86.

    Article  Google Scholar 

  17. 17.

    Schlosser P, Grundgeiger T, Happel O. (2018) Multiple patient monitoring in the operating room using a head-mounted display. Proceedings of the CHI Conference extended abstracts on human factors in computing systems. p. 1–6.

  18. 18.

    Jonides J. Voluntary versus automatic control over the mind’s eye’s movement. Atten Perform IX. 1981;9:187–203.

    Google Scholar 

  19. 19.

    Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Article  Google Scholar 

  20. 20.

    Boyatzis RE. Transforming qualitative information: thematic analysis and code development. Thousand Oaks: Sage Publications, Inc; 1998.

    Google Scholar 

  21. 21.

    Patton MQ. Qualitative evaluation and research methods. 2nd ed. Thousand Oaks: Sage Publications, Inc; 1990.

    Google Scholar 

  22. 22.

    Sanderson P. The multimodal world of medical monitoring displays. Appl Ergon. 2006;37(4):501–12.

    Article  PubMed  Google Scholar 

  23. 23.

    Durso FT, Hackworth CA, Truitt TR, Crutchfield J, Nikolic D, Manning CA. Situation awareness as a predictor of performance for en route air traffic controllers. Air Traffic Control Q. 1998;6(1):1–20.

    Article  Google Scholar 

  24. 24.

    McDaniel MA, Einstein GO. Prospective memory: an overview and synthesis of an emerging field. Thousand Oaks: Sage Publications, Inc; 2007.

    Google Scholar 

  25. 25.

    Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010;19(1):28–34.

    Article  PubMed  Google Scholar 

Download references


The authors thank Dr. Michael Neumann, Dr. Frank Kobelt, and the other members of the SMI team of the University Hospital of Würzburg who helped to integrate the HWD into the hospital’s IT systems for their great support.


The authors declare that they have not received any funding for their research.

Author information



Corresponding author

Correspondence to Paul D. Schlosser.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The hospital’s ethics committee was informed about the study and on 13 December 2017 we received a waiver that no ethics clearance was required.

Informed consent

was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schlosser, P.D., Grundgeiger, T., Sanderson, P.M. et al. An exploratory clinical evaluation of a head-worn display based multiple-patient monitoring application: impact on supervising anesthesiologists’ situation awareness. J Clin Monit Comput 33, 1119–1127 (2019).

Download citation


  • Patient monitoring
  • Remote monitoring
  • Head-worn display
  • Situation awareness