Evaluation of an integrated graphical display to promote acute change detection in ICU patients

ObjectiveThe purpose of this study was to evaluate ICU nurses’ ability to detect patient change using an integrated graphical information display (IGID) versus a conventional tabular ICU patient information display (i.e. electronic chart).DesignUsing participants from two different sites, we conducted a repeated measures simulator-based experiment to assess ICU nurses’ ability to detect abnormal patient variables using a novel IGID versus a conventional tabular information display. Patient scenarios and display presentations were fully counterbalanced.MeasurementsWe measured percent correct detection of abnormal patient variables, nurses’ perceived workload (NASA-TLX), and display usability ratings.Results32 ICU nurses (87% female, median age of 29 years, and median ICU experience of 2.5 years) using the IGID detected more abnormal variables compared to the tabular display [F(1, 119) = 13.0, p < 0.05]. There was a significant main effect of site [F(1, 119) = 14.2], with development site participants doing better. There were no significant differences in nurses’ perceived workload. The IGID display was rated as more usable than the conventional display [F(1, 60) = 31.7].ConclusionOverall, nurses reported more important physiological information with the novel IGID than tabular display. Moreover, the finding of site differences may reflect local influences in work practice and involvement in iterative display design methodology. Information displays developed using user-centered design should accommodate the full diversity of the intended user population across use sites.

► Nurses found the integrated graphical display more usable than their current hospital system.
► Performance improved using the graphical display only at the primary design institution.
► Medical information displays optimized for use at one clinical site may not be as favorable for other clinical sites.
► Health information technology needs to be flexible and configurable to meet local design constraints.