Shaped by design: how user-interface design influences medical decision making : the role of monitoring equipment in anesthetic practice

Objective: The aim of this research is to uncover, via a comprehensive cross study analysis, data patterns that could potentially point to a positive correlation between two main variables: anesthetic monitoring equipment and anesthetic decision making. Of particular interest is the equipment's monitor screen and the extent to which its user interface design influences anesthetic situation awareness (SA) and hence, decision making. It is hypothesized that poor anesthetic diagnosis from inadequate SA may be largely attributable to patient data displays lacking in human factors design considerations. Methods: A systematic search was conducted of existing empirical studies pertaining to patient physiologic monitoring that spanned across interrelated domains, namely, ergonomics, medical informatics, visual computing, cognitive psychology, human factors, clinical monitoring, intensive care medicine, and intelligent systems etc. all published in scholarly research journals between 1970 to August 2012. Anesthetic-related keywords were queried i.e. anesthetic mishaps, patient physiological data displays, anesthetic vigilance etc. (found in Appendix A). This approach yielded a few thousand results, of which 65 empirical studies were pulled. Further extraction of articles having direct connection to the use of data displays within the anesthetic context produced a total of 20 empirical studies. These studies were grouped under two broad categories of Monitoring and Monitors whereby factors directly contributing to the studies' results were identified with the aim to find emerging themes that provide insights involving interface design and medical decision making. Results: There is a direct correlation between user-interface design and decision making. The situation awareness (SA) required for decision making heavily relies upon data displays oriented towards information extraction and integration. In the systematic assessment of empirical studies, it is undeniable how strikingly prominent visual attributes show up as contributing factors to subjects' enhanced performance in the studies. Conclusions: How and to what users direct their perceptual and cognitive resources necessarily influence their perception of the environment, and by extension, their development of situation awareness (SA). Although patient monitoring equipment employed in anesthetic practice has proven to be indispensable in quality patient care, graphical representations of patient data is still far from optimal in the clinical setting. User-interfaces that lend decision support to facilitate SA and subsequent decision making is critical in crisis management.