Information Improves Risk Management during a Crisis

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Information Improves Risk Management during a
Crisis
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Problem Solving During Obstructed Endotracheal
Tube Crisis
Rudolph J, Doctoral Dissertation, Boston Univ,
Sept, 2003
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Most Critical Pulmonary Events to Detect and
Treat

• Pulmonary embolism
• Pulmonary edema
• Tension pneumothorax
• ARDS
• Obstructed tube
• Bronchospasm

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Operator Under Stress

• Reduce information intake
• Focus on a restricted number of cues
• Those of greatest perceived importance
• Fixation on a single informational source
• Decreased sensory-perceptual capacities
• Failure of information assimilation
• Degraded decision-making, response execution

Hancock P, Operator Stress and Display
Design Ergonomics in Design, p 13, Spr 2003
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v
Paw
Paw Airway pressure measured at the mouth V
flow measured at the mouth R1 resistance of
airways C1 compliance due to alveolar gas
compression L inertia due to mass of the column
of gas in the airways R2-C2 represent lung and
chest wall properties
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Methods

• Study Design
• 2 (display condition) X 6 (scenarios)
• Subjects
• 19 total
• CA2, CA3, faculty
• (Department of Anesthesiology, University of Utah
  and University of Arizona)
• Environment
• METI (METI, Sarasota, FL.) patient simulator at
  the University of Utah and University of Arizona
• Pulmonary display shown on 17 monitor in
  addition to current OR equipment

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Methods (cont.)

• Training
• 10 min training on METI and on pulmonary display
  for both conditions
• Pulmonary Display

• TV
• FiO2
• ETCO2
• upper airway resistance

• lower airway resistance
• iPEEP
• lung compliance

• Task
• play the role of an attending anesthesiologist
  who was called by a resident
• think aloud through out the scenario
• treat the patient as a first priority rather than
  teach the resident

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OETT
Endobronchial Intubation
Bronchospasm
Intrinsic PEEP
Normal
Hypoventilation
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Treat
Treat
Diagnose
Diagnose
Wachter B, PhD Dissertation, Univ of Utah, Dec
2003
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Advanced Patient Monitoring Displays Tools for
Continuous Informing

• Integrated visual displays reveal higher-order
  properties of patient state and speed in
  responding to events, but
• their benefits under an intensely timeshared load
  is unknown.

(Anesth Analg 20051011618)
Penelope M. Sanderson,
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Methods

• 2 Study conditions
• Display Pulmonary display laptop to collect
  pulmonary measured data CO2SMO NOVAMETRIX
• Control laptop to collect pulmonary measured
  data CO2SMO NOVAMETRIX
• Study subjects
• Attendings
• Fellows
• Nurses
• Respiratory Therapists
• Residents
• Selected 2 ventilated patients from ICU (10 hours
  x 11 days, 8 patients)

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Methods (cont.)

• Observed
• Who enter room
• Why enter room
• What pulmonary interventions
• Number of times looked at display
• How many ventilator alarms sounded
• Which ventilator alarm sounded
• Data capture method
• Clipboard
• Pocket PC PDA

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Methods (cont.)

• Collected
• Pulmonary measured data via CO2SMO device
  (NOVAMETRIX)
• Data capture method
• Laptop computer with serial port interface
• Questionnaire
• Participating subjects at the end of each day

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Agutter J, Anesth Analg. 2003 97(5)1403-13
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Elv(t) left ventricular elastance Emax left
ventricle end systolic elastance (index for
contractility) EN(tN) normalized
elastance Plv(t) left ventricular
pressure Vlv(t) left ventricular volume LVEDV
left ventricle end diastolic volume (index for
preload) Rav aortic valve resistance Rao
resistance in large arteries Rsv total
peripheral resistance (systemic vascular
resistance) Cap compliance in the proximal
arteries Cad compliance in the distal arteries
L inertia of blood flow Flv(t) left
ventricular blood flow
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Recognition Time

• Recognize and Treat MI
• With Display 333 min
• Without Display 617 min
• p lt .001
• Recognize LV Failure
• With Display 213 min
• Without Display 500 min
• p lt .02

Agutter J, STA Proceedings, Jan 2004
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