Visual Patient Avatar Display to Improve Situational Awareness and Critical Patient Monitoring: Innovation Brief

Investigating the value of avatar-based monitoring in real clinical settings and determine whether it will enhance patient safety.

Background:
Continuous patient monitoring is essential in anesthesia, intensive care medicine, and emergency medicine. Maintaining adequate situation awareness is crucial for patient safety. Anesthesiologists in the operating room are continuously receiving critical and rapidly changing information from the anesthesia monitors, machines and from the surgical field. Frequent alarms about changing patient conditions can be overwhelming and become tuned out if they are deemed to be frequently insignificant. Moreover, when the anesthesia clinician vision is focused on the surgical field, they may not immediately notice a critical visual display on the monitor screen. The audio alarms may have been silenced or drowned by loud, noisy operating room environment. Researchers in Zurich in collaboration with Philips have developed a visual display of a patient avatar than can be seen by the anesthesiologist peripheral vision and can improve situational awareness about a critically changing patient condition.

The Problem:
Failures in situation awareness contribute to over 65% of anesthesia complications. Situational awareness requires integrating multiple sources of information and recognizing their predictive significance into the near future and is essential to preempt and successfully manage emergencies. When monitoring patients, consistently maintaining an elevated level of situational awareness can be challenging. Clinicians must continually read and integrate multiple waveforms and numerical vital sign values into a mental model of the patient’s condition. Current number-based and waveform-based monitoring are not ideal for quick human cognitive processing. There are additional problematic aspects such as alarm fatigue and limited peripheral vision perception. The optimization of the work environment, patient monitor displays, and EMR systems can help clinicians more rapidly recognize deteriorating and critical conditions. The use of cognitive aids and checklists can help with decision making during stressful crisis management situations^1,4,6.

Innovative Solution:
Investigators in Switzerland evaluated a technology designed to improve perception of vital sign information by presenting patient status as an animated patient avatar1,6. The new patient monitoring technology, called Visual Patient, transforms numerical and waveform data into a virtual model (an avatar) of the monitored patient. The Visual Patient was designed to help caregivers gain situation awareness quickly. The information is presented as a large, colorful, moving graphic object which can be easily perceived using peripheral vision. Visual Patient Technology was shown to improve vital signs perception compared to conventional monitoring displays, in the operating rooms, in intensive care units, and on central station monitors. Therefore, caregivers are more able to perceive and quickly detect abnormal patient conditions independent of acoustic alarms^2,5.

Early Studies:
In high-fidelity testing, the animated avatar transmitted vital sign information faster than conventional monitoring and with reduced cognitive effort. This could help care providers confidently gain situation awareness more efficiently resulting in rapid intervention and improved critical task performance during crisis situations^1,6.

The avatar-based display was superior to a standard numeric display for peripheral vision. Optimal information transmission seems best with a combination of auditory and avatar-based monitoring. In central-station multiple patient monitoring, clinical providers reported improved vital sign visibility with perceived workload reduction⁴.

A split-screen monitor layout, displaying both conventional data/waveforms and the avatar, improved situation awareness and increased the probability of rapidly recognizing the correct cause of emergency situations⁵.

Surveyed anesthesiologists considered the new avatar-based technology to be intuitive, easy to learn, and accessible, enabling them to quickly get an overview of the situation3.

Further studies need to investigate the value of avatar-based monitoring in real clinical settings and determine whether it will enhance patient safety.

Figure 1: The patient monitoring modalities. (a) Conventional monitoring. (b) Avatar-only view. (c) Split-screen view with conventional monitoring on the left side and the avatar on the right sight of the screen. (d) Schematic explanation of the avatar-based monitoring, Visual Patient (not used during the simulations). CO2, carbon dioxide. Image from Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study.

Figure 2: The Visual-Patient-avatar before (A) and after (B) the redesign process. CVP: central venous pressure, ECG: electrocardiogram, etCO2: end-tidal carbon dioxide, SpO2: peripheral oxygen saturation. When the body temperature is within the normal range, neither ice crystals nor heatwaves are visible. Image from Improving Visual-Patient-Avatar Design Prior to Its Clinical Release: A Mixed Qualitative and Quantitative Study.

References:

1. Tscholl, David W., et al. "User perceptions of avatar-based patient monitoring: a mixed qualitative and quantitative study." BMC anesthesiology 18.1 (2018): 1-11.

2. Wetli, Doreen J., et al. "Improving Visual-Patient-Avatar Design Prior to Its Clinical Release: A Mixed Qualitative and Quantitative Study." Diagnostics 12.2 (2022): 555.

3. Garot, Olivier, et al. "Avatar-based versus conventional vital sign display in a central monitor for monitoring multiple patients: a multicenter computer-based laboratory study." BMC medical informatics and decision making 20.1 (2020): 1-10.

4. Pfarr, Juliane, et al. "Avatar-based patient monitoring with peripheral vision: a multicenter comparative eye-tracking study." Journal of medical Internet research 21.7 (2019): e13041.

5. Roche, Tadzio R., et al. "Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study." British journal of anaesthesia 126.5 (2021): 1046-1054.

6. Tscholl, David W., et al. "Using an animated patient avatar to improve perception of vital sign information by anaesthesia professionals." British Journal of Anaesthesia 121.3 (2018): 662-671.