Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 22, 2018
Open Peer Review Period: Jan 2, 2019 - Jan 23, 2019
Date Accepted: Feb 9, 2019
(closed for review but you can still tweet)
A Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management: Results of the User-Centered Design Process
ABSTRACT
Background:
Stressful situations during intraoperative emergencies have a negative impact on human cognitive functions. Consequently, task performance may decrease and patient safety may be compromised. Cognitive aids can counteract these effects and support anesthesiologists in their crisis management. The Professional Association of German Anesthesiologists (BDA) set up a project to develop a comprehensive set of digital cognitive aids for intraoperative emergencies. A parallel development for several software platforms as well as stationary and mobile devices will accommodate the inhomogeneity of the IT infrastructure within German anesthesia departments.
Objective:
This publication provides a detailed overview of how the task of developing a digital cognitive aid for intraoperative crisis management in anesthesia was addressed that meets user requirements, is highly user-friendly, and easy to navigate.
Methods:
A user-centered design (UCD) process was conducted to identify, specify, and supplement the requirements for a digital cognitive aid. The study covered the following four aspects: analysis of the context of use, specification of user requirements, development of design solutions, evaluation of design solutions. Three prototypes were developed and evaluated by end-users of the application. Following each evaluation, the new requirements were prioritized and used for redesign. For the first and third prototype the System Usability Scale (SUS) score was determined. The second prototype was evaluated with an extensive online-questionnaire. The evaluation of the third prototype included a think aloud protocol.
Results:
The chosen methods enabled successful and comprehensive collection of requirements and helped to improve the design of the application step by step. The first prototype achieved an average SUS score of 74 (SD=12), indicating good usability. The second prototype included the following main revisions: two-column layout, initial selection of patient type (infant, adult, parturient), four offered search options, option to check off completed action steps. Its evaluation identified the following major revision points: add quick selection for resuscitation checklists, design the top bar and tabs slightly larger, add more pictograms to the text. The third prototype achieved an average SUS score of 77 (SD=15). The evaluation of the think aloud protocol revealed a good intuitiveness of the application and identified a missing home button as the main issue.
Conclusions:
Anesthesiology – as an acute medical field – is particularly characterized by its high demands on decision-making and action in uncertain, dynamic, or time-critical situations. The integration of usability aspects is essential for everyday and emergency suitability. The UCD process allowed us to develop a prototypical digital cognitive aid, exhibiting high usability and user satisfaction in the demanding environment of anesthesiological emergencies. Both aspects are essential to increase the acceptance of the application in later stages. The study approach, combining many different methods for determining user requirements, may be useful for other implementation projects in a highly demanding environment.
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.