Journal of Clinical Monitoring and Computing

, Volume 16, Issue 7, pp 485–491 | Cite as

Specific Elements of a New Hemodynamics Display Improves the Performance of Anesthesiologists

  • George T. Blike
  • Stephen D. Surgenor
  • Kate Whalen
  • Jens Jensen


Objective.We tested the hypothesis that a monitoring display proposed by Blike et al. improves the performance of anesthesiologists. We measured the performance of anesthesiologists using the new display and compared it to their performance with at raditional display. We studied three different displays on how they affected recognition and differentiation of five etiologies ofshock–anaphylaxis, bradycardia, hypovolemia, ischemia and pulmonary embolus. Methods.The participants monitored heartrate, systemic arterial and pulmonary blood pressure, central venous pressure, and cardiac output during five shock states and five non-shock states. The resulting 10 data sets made up ten decision screens, which we presented randomly on a computer monitor to the subjects in one of three different formats (a Single Sensor Single Indicator (SSSI)Numericdisplay; anObjectdisplay; and an Object Minus Shapesdisplay). Subjects used soft-buttons on a computer touch-screen monitor to: a) advance to the next display; b) differentiate a non-shock state from a shock state; and, c) select the etiology of shock state represented by the display (Figure 4). The internal clock and memory of the computer made the collection of data automatic. Results.The subjects recognized a problem more rapidly with the help of a graphical “pointer on a referencescale” in both Objectdisplays, but their accuracy had not improved in comparison to the SSSI Numericdisplay. The shape of the Objectdisplay improved performance of etiology determination compared to the Object Minus Shapesdisplay andSSSI Numericdisplay. Testing (10 trials) was completed in less than 45 minutes. Conclusions.The new display with“emergent features” can improve the diagnostic performance of clinicians.

Anesthesia safety graphic data display object display emergent features ecological interface human factors patient monitoring 


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  1. 1.
    Kohn L, Corrigan J, Donaldson M. To err is human: Building a safer health system, report on medical error and patient safety. Committee on Quality of Health Care in America, Institute of Medicine. National Academy Press, 1999Google Scholar
  2. 2.
    Blike GT, Surgenor SD, Whalen K, A graphical object display improves anesthesiologists' performance on a simulated diagnostic task. J Clin Monit 1999; 5: 37–44Google Scholar
  3. 3.
    Michels P, Westenskow D. An integrated graphic display improves detection and identification of critical events during anesthesia. J Clin Monit 1997; 13: 249–259PubMedCrossRefGoogle Scholar
  4. 4.
    Weinger M, Gurushanthaiah K et al. Visual display format affects the ability of anesthesiologists to detect acute physiologic changes. Anesthesiology 1991; 83: 1184–1193Google Scholar
  5. 5.
    Siegle J, Farrell E, Goldwyn R et al. The surgical implications of physiologic patterns in myocardial infarction shock. Anesthesiology 1991; 72: 126–141Google Scholar
  6. 6.
    Kirlik, A. Requirements for psychological models to support design: Toward ecological task analysis. In: Flach J, Hancock P, Caird J, Vicente K, eds. Global perspectives on the ecology of human-machine systems. Hillsdale, NJ: Lawrence Erlbaum Associates, 1995: 68–120.Google Scholar
  7. 7.
    Rasmussen J, Pejtersen AM, Goodstein LP. Cognitive systems engineering. New York: John Wiley & Sons Inc., 1994.Google Scholar
  8. 8.
    Woods DD. Representation design in the computer medium (Version 4.1, Spring 1994), Personal communication.Google Scholar
  9. 9.
    Wickens CD, Gordon SE, Liu Y. An Introduction to human factors engineering. New York: Addison-Wesley Educational Publishers Inc., 1998.Google Scholar
  10. 10.
    Runciman W, Sellen A et al. Errors, incidents and accidents in anaesthesia. Anaesth Int Care 1993; 21: 506–519Google Scholar
  11. 11.
    Pierce E. A need for greater risk management initiatives, ASA Newsletter 1985Google Scholar
  12. 12.
    Gaba D, Maxwell M, DeAnda A. Anesthetic mishaps — breaking the chain of accident evolution. Anesthesiology 1987; 66: 670–676PubMedGoogle Scholar
  13. 13.
    Emergency Care Research Institute. Deaths during general anesthesia. J Health Care Technol 1985; 1: 155–175Google Scholar
  14. 14.
    Webb RK, Currie M, Morgan C et al. The Australian incident monitoring study: An analysis of 2000 reports. Anaesth Int Care 1993; 21: 520–528Google Scholar
  15. 15.
    Forrest J, Cahalan M et al. Multi-center study of general anesthesia. II. Results. Anesthesiology 1990; 72: 262–268PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • George T. Blike
    • 1
  • Stephen D. Surgenor
    • 1
  • Kate Whalen
    • 1
  • Jens Jensen
    • 2
  1. 1.Department of AnesthesiologyDartmouth-Hitchcock Medical CenterLebanonU.S.A.
  2. 2.Dartmouth Medical Interface LaboratoryLebanonU.S.A.

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