JMIR Publications

ABSTRACT

Background:

Pediatric cardiopulmonary resuscitation (CPR) is a highly complex and time-critical process that demands precise team coordination and strict adherence to Pediatric Advanced Life Support (PALS) guidelines. In real-world practice, adherence often deteriorates due to cognitive overload, fragmented communication, and disruption of information flow under stress. Although digital cognitive aids have shown potential to improve adherence, existing tools are often limited to single tasks, lack team-wide integration, or fail to adapt in real time to dynamic clinical environments.

Objective:

This study aimed to design and evaluate InterFACE (Interconnected and Focused Mobile Applications on Patient Care Environment), an integrated, augmented reality (AR)–enabled digital health system developed to support real-time PALS adherence and enhance team coordination during pediatric resuscitation.

Methods:

A structured, mixed-methods, user-centered design process was employed. Persona development and spatial analysis characterized the needs and positions of key resuscitation roles. A three-round Delphi process with experts identified critical information elements for display. Iterative user experience (UX) prototyping was performed, followed by simulation-based evaluations of three system components: (1) TeamScreen, a wall-mounted team display providing a shared overview of the resuscitation process; (2) Guiding Pad, a tablet-based app for documentation and algorithm navigation; and (3) AR head-mounted displays (HMDs) for team leaders and medication nurses, delivering role-specific, context-aware guidance. Usability was assessed with standardized instruments, including the System Usability Scale (SUS), Technology Acceptance Model (TAM), and User Experience Questionnaire (UEQ).

Results:

The Delphi study achieved consensus on 20 core information elements, distributed across the three interfaces. Usability testing demonstrated high acceptance across all modalities. The Guiding Pad supported effective navigation of resuscitation algorithms with a 78–100% task completion rate. The TeamScreen achieved an overall task success rate of 81%, improving situational awareness despite some confusion in high-density regions. AR HMDs received favorable evaluations, with SUS scores rated “Good” to “Excellent,” and UEQ ratings indicating high intuitiveness, stimulation, and attractiveness. Participants consistently described InterFACE as intuitive, useful for real-time decision-making, and supportive of team synchronization. Reported challenges included interface complexity, incomplete integration with patient monitors, and potential cognitive load from simultaneous information streams.

Conclusions:

InterFACE represents a significant advancement in digital cognitive aids by combining shared displays, tablets, and AR guidance into a synchronized, role-specific ecosystem. The system shows promise in enhancing adherence to PALS, reducing cognitive load, and improving team coordination in simulated pediatric resuscitations. While results demonstrate strong usability and acceptance, further research is needed to evaluate clinical effectiveness in real-world settings, including randomized controlled trials, integration with hospital information systems via FHIR standards, and potential AI-driven decision support to optimize adaptability and long-term skill retention.