Mediating ICU patient situation-awareness with visual and tactile notifications

Abstract

Healthcare providers in hospital intensive care units (ICUs) maintain patient situation awareness by following task management and communication practices. They create and manipulate several paper-based and digital information sources, with the overall aim to constantly inform themselves and their colleagues of dynamically evolving patient conditions. However, when increased communication means that healthcare providers potentially interrupt each other, enhanced patient-situation awareness comes at a price. Prior research discusses both the use of technology to support increased communication and its unintended consequence of (wanted and unwanted) notification interruptions. Using qualitative research techniques, I investigated work practices that enhance the patient-situation awareness of physicians, fellows, residents, nurses, students, and pharmacists in a medical ICU. I used the Locales Framework to understand the observed task management and communication work practices. In this study, paper notes were observed to act as transitional artifacts that are later digitized to organize and coordinate tasks, goals, and patient-centric information at a team and organizational level. Non digital information is often not immediately digitized, and only select information is communicated between certain ICU team members through synchronous mechanisms such as face-to-face or telephone conversations. Thus, although ICU providers are exceptionally skilled at working together to improve a critically ill patient’s condition, the use of paper-based artifacts and synchronous communication mechanisms induces several interruptions while contextually situating a clinical team for patient care. In this dissertation, I also designed and evaluated a mobile health technology tool, known as PANI (Patient-centered Notes and Information Manager), guided by the Locales framework and the participatory involvement of ICU healthcare providers as co designers. PANI-supported task management induces minimal interruptions by: (1) rapidly generating, managing, and sharing clinical notes and action-items among clinicians and (2) supporting the collaboration and communication needs of clinicians through a novel visual and tactile notification system. The long-term contribution of this research suggests guidelines for designing mobile health technology interventions that enhance ICU patient situation-awareness and reduce unwanted interruptions to clinical workflow.