Integrated information display to support ICU nurses at the bedside: ethnographic observation, design, and evaluation

Preventable adverse events are one of the leading causes of hospitalized patient deaths. Many of these adverse events occur in Intensive Care Units (ICUs) where nurses often work under cognitive, perceptual, and physical overloads. Contributing to these overloads are spatially separated devices which display treatment relevant information such as orders, monitoring information, and equipment status on numerous displays. If essential information of these separate devices was integrated into a single display at the bedside, nurses could potentially reduce their workload and improve their awareness of the patients' treatment plans and physiological status. We conducted a set of three studies for the purpose of designing an efficient and effective ICU display. We observed ICU nurses during their shifts and found that task-relevant information was often presented in the wrong format, unavailable at the point of care or laborious to obtain. Additionally, nurses were sometimes unaware of significant changes in their patient's status and equipment operation. Based on nurses' feedback, we designed an integrated information display that presents all of the information that nurses need at the patient bedside. Nurses selected a display based on the information organization of existing patient monitors, with added medication management and team communication features. The evaluation of paper-based prototypes of both the integrated display and existing ICU displays showed that nurses could answer questions about the patient's status and treatment faster (p<<0.05) and more accurately (p<<0.05) using the integrated display. The number of adverse events in the ICU could potentially be reduced by integrated displays, but to implement them into clinical practice will require significant engineering efforts.