Ecological Interface Design in Neuro-Critical Care

Neuro-critical care is a data-intensive environment that requires physicians to integrate information \nacross multiple screens, sources, and software. Despite the advances in neuromonitoring techniques, \ninterfaces that allow for viewing and analyzing of historic data are not common. However, historical \ndata is critical to identify patterns important for patient care. Instead, physicians view the trends of a \npatient’s neurophysiological variables by continuously watching the bedside monitor or they rely on \nchecking the paper (or digital) charts for a patient where variables have been recorded periodically \n(usually once an hour). In neuro-critical care, physicians need to understand the historic and current \nstate as well as predict the future state of intracranial pressure (ICP). ICP is the most monitored brain-specific physiologic variable in the Intensive Care Unit (ICU) and is considered a biomarker for \nsecondary brain injury. As a result, ICP would benefit greatly from showing key patterns important to \npatient state and care. \n \nThe ICU is a stressful, dynamic, and time-sensitive environment where the performance of physicians \nand their ability to correctly diagnose and manage patient treatment has a significant impact on \npatient outcomes. Physicians rely on the bedside physiologic monitor to detect changes in physiologic \nvariables. The monitor must provide the information required to understand the patient’s condition so \nphysicians can determine the optimal treatment plan. With the high cognitive demands and complex \nsociotechnical environment of the ICU, an opportunity exists for improved neuro-critical care \nmonitoring to support physicians’ decision-making. Ecological Interface Design (EID) is an approach \nto interface design that has proven effective for complex, sociotechnical, real-time, and dynamic \nsystems. Research suggests that an EID approach combined with user-centered design has a positive \nimpact on performance, especially in unfamiliar scenarios. \n \nThe objective of this research is to explore an EID design approach combined with user-centered \ndesign to enhance the bedside physiologic monitor through the addition of visualizations that help \nsupport physicians' understanding of complex relationships and concepts in neuro-critical care. The \nhope is that providing more-advanced visualizations on the bedside physiologic monitor will lead to \nimproved situation awareness, decreased mental workload, and expertise development acceleration of \nnovice clinicians in the neuro-ICU. \n \nThe work presented in this thesis builds on the Cognitive Work Analysis (CWA) and observations in \nthe ICU already completed by Uereten et al (2020). The design of the visualizations for use on the \nbedside physiologic monitor was highly iterative and involved the inputs from the CWA and \nobservations as well as ongoing feedback and focus areas provided by Dr. Victoria McCredie, our \nclinical collaborator and critical care physician at Toronto Western Hospital. The visualizations were \nevaluated and validated in semi-structured interviews with trainees (fellows) and experts (staff \nphysicians) in neuro-critical care. The semi-structured interviews with trainees were used as a \npreliminary usability assessment of the visualizations and the interviews with staff physicians were \nused to iterate and refine the designs. The results from both sets of interviews were used to create a \nfinal design prototype that is currently being tested in a usability study with trainee physicians \n(January-March 2023).

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