Gt. Blike et al., A graphical object display improves anesthesiologists' performance on a simulated diagnostic task, J CLIN M C, 15(1), 1999, pp. 37-44
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.