Background: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development.
Objective: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups.
Methods: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups.
Results: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring.
Conclusions: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine.
Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study.

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A Holistic and Collaborative Approach to Audible Alarm Design

Sound-driven design is an emerging, human-centered design practice informed by technology and listening in the multisensory dimension of interaction. In this paper we present a discourse analysis approach aimed at qualitatively understanding the constituent concepts of such a practice, by means of semi-structured interviews with sound designers, design researchers, engineers and expert users in the context of critical care. Preliminary results show that sound-driven design is inherently embodied, situated, and participatory, that the four categories of interviewees equally contribute to the definition of the design problem, and yet that a clear, shared arena is still missing.

/pdf/conceptualising-sound-driven-design-an-exploratory-discourse-4bb5t26my5.pdf

Conceptualising sound-driven design: an exploratory discourse analysis

In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive strategy based on soundscape design approach that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience. Future research directions are presented to tackle the knowledge deficits in designing for critical care soundscapes that cater for patient sleep. The need for scientifically-informed design interventions for improving patient sleep experience in critical care is highlighted. The value of the soundscape design approach for resolving other sound-induced problems in critical care and how the approach allows for patient-centred innovation that is beyond the immediate sound issue are further discussed.

https://www.mdpi.com/2414-4088/3/2/36/pdf

Better Sleep Experience for the Critically Ill: A Comprehensive Strategy for Designing Hospital Soundscapes

Sound design is increasingly diversifying into many areas beyond its traditional domains in film, television, radio or theatre. This leads to sound designers being confronted with a multitude of design and development processes. The related methodologies have an impact on how problems are framed and what is considered an ideal path to achieve their solutions. From this a need for an educated discourse in sound design education and professional practice arises. This article investigates the creative process from the perspective of an emerging generation of sound designers. The first part of the paper outlines concepts and models of the design process in various fields of practice. The second part is devoted to an interpretive comparative analysis of sound design process visualizations created by sound design students with a professional background. Apart from gaining a better understanding of the creative process of the sound designers, the goal of this work is to contribute to a better integration of the sound design craft into contemporary design process methodologies, ultimately leading to an empowerment of the sound designer in complex, dynamic and interdisciplinary project settings.

How do you sound design?: an exploratory investigation of sound design process visualizations

Today’s intensive care units (ICUs) pose a design dilemma considering the use of technology and its psychological effects on the inhabitants of the ICU. While the ICUs are designed to be technologically advanced in order to ensure patient safe recovery, the very technology that ICUs rely on threatens patients’ as well as clinicians’ wellbeing. Especially the system behind patient monitoring and the consequent alarm management needs to be reconsidered from the human perspective to prevent any occurrences of clinician alarm fatigue and post-traumatic stress syndrome observed in patients as well as their visitors. Moreover, advancements in patient monitoring technology, medical informatics, and societal developments offer new possibilities to give patient data a central role specifically in alarm management and clinician workflow in the ICUs in general. In this chapter, we envision a data-driven product-service system for patient monitoring in the future critical care context. Our design ideas and future vision are based on a critical review of the literature in patient monitoring, trend analysis, and technological developments in medical care, followed by a stakeholder analysis, the design of a future vision concept and scenario that we validated with expert interviews.

Dilip Birdja

Papers

A Holistic and Collaborative Approach to Audible Alarm Design

Alarm in the ICU! Envisioning Patient Monitoring and Alarm Management in Future Intensive Care Units

Better Sleep Experience for the Critically Ill: A Comprehensive Strategy for Designing Hospital Soundscapes