STANFORD HCI GROUP & AIM LAB Interactive Cognitive Aids For Critical Events In Anesthesia Crisis Teams The interaction aspects of crisis computing—support- ing highly trained teams as they respond to emergen- cies—have been underexplored in the user interface community. In medicine, operating rooms are informa- tion-dense with many sensors and output displays. This represents an extreme point in the space of interaction contexts, with a high complexity in teams and tasks. Unlike single-user office work, crisis response may be paced, operated under risky emergency conditions, in- volve multi-tasking with people and equipment, and be team-based. They arise in professions that involve vola- tile, uncertain, complex and ambiguous tasks and may take the form of cognitive aids such as checklists that support task performance and reduce errors. While paper checklists are valuable, they are static, slow to access, and show both too much and too little information. Medical Design Insights Dynamic Checklists: iCogAid Simulation & Evaluation We designed a narrative simulation approach with two adjacent monitors: one (laptop) for the scenario and one (large screen) for the dynamic checklists. To induce additional load, participants had to complete a color-matching dual task, requiring them to shift atten- tion back and forth. In the paper condition, laminated aids were given to the participants to place on a tray connected to the dual task station. Stanford HCI / Jesse Cirimele, Leslie Wu, Jon Bassen, Kristen Leach, Stuart Card, Scott Klemmer {cirimele, lwu2, krleach, scard, srk, hanrahan}@cs.stanford.edu Stanford Anesthesia Informatics & Media Lab / Larry Chu, Kyle Harrison {lchu, kharriso}@stanford.edu From top: Slide simulator question and count-down timer, guided response, lab setup for study. Clockwise from top: Stanford Medical Simulator Facility, aid prototype in simulator facility, multi-display testing in AIM lab, and high-fidelity simulator mannequin. photos cc-by http://www.flickr.com/photos/stanfordedtech Complex Perilous Domains photo cc-by http://www.flickr.com/photos/stanfordedtech Cognitive Aids for treatment and diagnosis in the real world: 1. handwritten paper taped to the wall 2. Stanford AIM lab cog- nitive aid and 3. a dynamic, interactive cognitive aid prototype. Observation in Stanford’s Medical Simulator Facil- ity (30+ hours) informed the design process. We ob- served cognitive failures in remembering procedures, drug timing & dose counts, fixation and tunnel vision in a diagnosis, incorrect equipment configurations. In response, we introduce the Dynamic Procedure Aids approach. Dynamic Procedure Aids address four key problems in checklist usage: Ready access to the aids Rapid assimilation of their content Professional acceptance of use in medical procedures Limited attention available to their users. From top: Asystole aid with active epinephrine dose timer, expansion of more detailed follow-up procedures. We are currently prototyping head-mounted displays that investigate ways of cueing action and adapting ex- isting cognitive aids. These display may be able to better capture attention during emergencies, although provide challenges to supporting a consistent, shared mental model across a team. Rapid Assimilation Heatmaps of visual search on aids. (left) Dynamic Proce- dure Aids averaged 5.7 second response times. (right) ex- isting aids from Gawande et all averaged 9.8 seconds. Need Key Concept Design Instantiation(s) How it Addresses the Problem Ready Access Hard to find; Hard to share Shared Display: Make aids visible to team through large-screen display. DESIGN SHIFT: Paper -> Multiple shared displays Mirror display and interaction across multiple large-screens and tablets Provides shared context, facilitates finding check- list, provides more detail Rapid Assimilation: Too slow; Hard to multitask with pa- tient care Steps-at-a-Glance: Procedure step processable in one multitasking cycle. Focus on what to do now in abbreviated context. Simplify Display. Speed reading and search. DESIGN SHIFT: Text -> Object/State + Information mapping Reformulation of step to be findable and readable in small bursts. Object/Action, compressible checklist language. Progressive aid protocols. Faster read, skim, search due to: - reduction in number of words - stereotyped syntax - Information mapping Processable in small time units for multitasking Professional Acceptance: Mixed acceptance leading to less use Resources-at a-Glance: Reframe checklists as part of a larger, resource management system. DESIGN SHIFT: Checklist -> Resource Management Rapid access to team names, sup- plies, calculators, reference Allow aid to transition from routine to crisis, display additional resources Provides incentive to use system, familiarizes and habituates practitioners Limited Attention: Narrow, scarce at- tention under stress Attention Aids: Direct interface focus dynamically DESIGN SHIFT: Attention regulator -> Attention Aid Focus+Context Automated drug timers and atten- tional prompts Cognitive aid serves as attentional aid
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STANFORD HCI GROUP & AIM LAB
Interactive Cognitive Aids For Critical Events In Anesthesia
Crisis TeamsThe interaction aspects of crisis computing—support-ing highly trained teams as they respond to emergen-cies—have been underexplored in the user interface community. In medicine, operating rooms are informa-tion-dense with many sensors and output displays. This represents an extreme point in the space of interaction contexts, with a high complexity in teams and tasks.
Unlike single-user office work, crisis response may be paced, operated under risky emergency conditions, in-volve multi-tasking with people and equipment, and be team-based. They arise in professions that involve vola-tile, uncertain, complex and ambiguous tasks and may take the form of cognitive aids such as checklists that support task performance and reduce errors.
While paper checklists are valuable, they are static, slow to access, and show both too much and too little information.
Medical Design Insights Dynamic Checklists: iCogAid Simulation & Evaluation
We designed a narrative simulation approach with two adjacent monitors: one (laptop) for the scenario and one (large screen) for the dynamic checklists. To induce additional load, participants had to complete a color-matching dual task, requiring them to shift atten-tion back and forth. In the paper condition, laminated aids were given to the participants to place on a tray connected to the dual task station.
Stanford HCI / Jesse Cirimele, Leslie Wu, Jon Bassen, Kristen Leach, Stuart Card, Scott Klemmer{cirimele, lwu2, krleach, scard, srk, hanrahan}@cs.stanford.edu
Stanford Anesthesia Informatics & Media Lab / Larry Chu, Kyle Harrison{lchu, kharriso}@stanford.edu
From top: Slide simulator question and count-down timer, guided response, lab setup for study.
Clockwise from top: Stanford Medical Simulator Facility, aid prototype in simulator facility, multi-display testing in AIM lab, and high-fidelity simulator mannequin.
photos cc-by http://www.flickr.com/photos/stanfordedtech
Complex Perilous Domains
photo cc-by http://www.flickr.com/photos/stanfordedtech
Cognitive Aids for treatment and diagnosis in the real world: 1. handwritten paper taped to the wall 2. Stanford AIM lab cog-nitive aid and 3. a dynamic, interactive cognitive aid prototype.
Observation in Stanford’s Medical Simulator Facil-ity (30+ hours) informed the design process. We ob-served cognitive failures in remembering procedures, drug timing & dose counts, fixation and tunnel vision in a diagnosis, incorrect equipment configurations.
In response, we introduce the Dynamic Procedure Aids approach. Dynamic Procedure Aids address four key problems in checklist usage:
Ready access to the aidsRapid assimilation of their contentProfessional acceptance of use in medical proceduresLimited attention available to their users.
From top: Asystole aid with active epinephrine dose timer, expansion of more detailed follow-up procedures.
We are currently prototyping head-mounted displays that investigate ways of cueing action and adapting ex-isting cognitive aids. These display may be able to better capture attention during emergencies, although provide challenges to supporting a consistent, shared mental model across a team.
Rapid Assimilation
Heatmaps of visual search on aids. (left) Dynamic Proce-dure Aids averaged 5.7 second response times. (right) ex-isting aids from Gawande et all averaged 9.8 seconds.
Need Key Concept Design Instantiation(s) How it Addresses the ProblemReady AccessHard to find; Hard to share
Shared Display:Make aids visible to team through large-screen display.
DESIGN SHIFT:Paper -> Multiple shared displays
Mirror display and interaction across multiple large-screens and tablets
Provides shared context, facilitates finding check-list, provides more detail
RapidAssimilation:Too slow; Hard to multitask with pa-tient care
Steps-at-a-Glance:Procedure step processable in one multitasking cycle. Focus on what to do now in abbreviated context. Simplify Display. Speed reading and search.
DESIGN SHIFT:Text -> Object/State + Information mapping
Reformulation of step to be findable and readable in small bursts.Object/Action, compressible checklist language.Progressive aid protocols.
Faster read, skim, search due to:- reduction in number of words - stereotyped syntax - Information mappingProcessable in small time units for multitasking
Professional Acceptance:Mixed acceptance leading to less use
Resources-at a-Glance:Reframe checklists as part of a larger, resource management system.
DESIGN SHIFT:Checklist -> Resource Management
Rapid access to team names, sup-plies, calculators, referenceAllow aid to transition from routine to crisis, display additional resources
Provides incentive to use system, familiarizes and habituates practitioners
LimitedAttention:Narrow, scarce at-tention under stress
Attention Aids:Direct interface focus dynamically
DESIGN SHIFT:Attention regulator -> Attention AidFocus+Context
Automated drug timers and atten-tional prompts
Cognitive aid serves as attentional aid
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