It's not you, it's the design - common problems with patient monitoring reported by anesthesiologists: a mixed qualitative and quantitative study

Abstract

Background: Patient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions from the information displayed on patient monitors. Previous research has shown that today's patient monitoring has room for improvement in areas such as information overload and alarm fatigue. The rationale of this study was to learn more about the problems anesthesiologists face in patient monitoring and to derive improvement suggestions for next-generation patient monitors.

Methods: We conducted a two-center qualitative/quantitative study. Initially, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: common problems with patient monitoring in your daily work. Through deductive and inductive coding, we identified major topics and sub themes from the interviews. In a second step, a field survey, a separate group of 25 anesthesiologists rated their agree- or disagreement with central statements created for all identified major topics.

Results: We identified the following six main topics: 1. "Alarms," 2. "Artifacts," 3. "Software," 4. "Hardware," 5. "Human Factors," 6. "System Factors," and 17 sub themes. The central statements rated for the major topics were: 1. "problems with alarm settings complicate patient monitoring." (56% agreed) 2. "artifacts complicate the assessment of the situation." (64% agreed) 3. "information overload makes it difficult to get an overview quickly." (56% agreed) 4. "problems with cables complicate working with patient monitors." (92% agreed) 5. "factors related to human performance lead to critical information not being perceived." (88% agreed) 6. "Switching between monitors from different manufacturers is difficult." (88% agreed). The ratings of all statements differed significantly from neutral (all p < 0.03).

Conclusion: This study provides an overview of the problems anesthesiologists face in patient monitoring. Some of the issues, to our knowledge, were not previously identified as common problems in patient monitoring, e.g., hardware problems (e.g., cable entanglement and worn connectors), human factor aspects (e.g., fatigue and distractions), and systemic factor aspects (e.g., insufficient standardization between manufacturers). An ideal monitor should transfer the relevant patient monitoring information as efficiently as possible, prevent false positive alarms, and use technologies designed to improve the problems in patient monitoring.

Keywords: Patient monitoring; Patient safety; Qualitative research; Signal processing; Situation awareness.

Fig. 1

A word cloud created from the participants’ answers to visualize the most common topics. This word cloud was created with Wordle.net. All words were written in lowercase, and commonly occurring English words (e.g., the, is, and, to) were hidden

Fig. 2

The coding tree with major topics and sub themes, with participant numbers and percentages. We identified the terms underlined in blue by deductive coding based on word counting and the rest by inductive, free coding. We interviewed 120 individual anesthesia experts

Fig. 3

Presentation of the results of the field survey as donut charts with the number of participants who chose a particular category. We used the Wilcoxon signed rank test to evaluate whether the sample medians were significantly different from neutral. IQR = Interquartile range. 0 = strongly disagree, 1 = disagree, 2 = neutral, 3 = agree, 4 = strongly agree. N = 25

Fig. 4

The fact that too many alarms are a common problem is illustrated by the fact that the most worn button on our patient monitors is the “all alarms off” button