A graphical object display improves anesthesiologists' performance on a simulated diagnostic task

Objective. This study tests the hypothesis that a graphical object display (a data display consisting of meaningful shapes) will affect the ability of anesthesiologists to perform a diagnostic task rapidly and correctly. The diagnostic tasks studied were recognition and differentiation of ve etiolog ies of shock - anaphylaxis, bradycardia, myocardial ischemia, hypovolemia, pulmonary embolus. Methods. Data sets consisting of HR, Systemic Arterial B P, Pulmonary Arterial BP, CVP, and Cardiac Output were generated for ve sho ck states and ve non-shock states. The resulting 10 data sets were presente d on a computer monitor to study subjects twice ( rst in an alpha-numeric f ormat and then in the object format) for a total of twenty decision screens . Subjects used soft-buttons on a computer touch-screen monitor to: a) adva nce to the next display; b) differentiate a nonshock state from a shock sta te; and, c) select the etiology of shock state represented by the display ( Figure 2). Data collection was automatic, using the internal clock and memo ry of the computer. Results. Eleven anesthesiologists participated in this study. They completed a total of 3060 diagnostic decisions, half with each display format. Performance measures were time to decision and diagnostic a ccuracy. The object display improved no-shock recognition by 1.0 second and shock etiology determination by 1.4 seconds (p < 0.05). The object display also significantly improved accuracy for shock recognition by 1.4% and eti ology determination by 4.1% (p < 0.05). Testing was completed in a time int erval of <45 min per 10 trials. Conclusions. The primary finding of this st udy was that anesthesiologists using the object display format committed si gnificantly fewer diagnostic errors when interpreting physiologic data. In addition, both the recognition of no-shock and the diagnosis of shock etiol ogy were completed more rapidly when the object display was used. The major limitation of this initial trial is the simplicity of the test. Future inv estigation of the impact of the display on clinical decision making will re quire more realistic clinical scenarios with partial or full simulation to better understand the potential clinical impact.