It’s not you, it’s the design - common problems with patient monitoring reported by anesthesiologists: a mixed qualitative and quantitative study.

BACKGROUND Patient monitoring is critical for perioperative patient safety as anesthesiologists routinely make crucial therapeutic decisions of the information displayed on patient monitors. Research has shown that today's patient monitoring provides room for improvement regarding known issues such as information overload and alarm fatigue. The rationale for this study was to learn more about the problems anesthesiologists face with patient monitors and to provide improvement suggestions for next-generation patient monitoring. METHODS We conducted a two-center qualitative and quantitative study. First, we interviewed 120 anesthesiologists (physicians and nurses) about the topic: "Common problems with patient monitoring in your daily work." Through deductive and inductive coding, we identified themes and subthemes from the interviews. Secondly, we conducted a field survey with a separate group of 25 anesthesiologists who rated their agree- or disagreement with central statements based on the themes identified from the interviews. RESULTS We identified the following six main topics: 1. "Alarms," 2. "Artifacts," 3. "Software," 4. "Hardware," 5. "Human Factors," 6. "System Factors," and 17 sub-topics. The central statements based on each major theme were: 1. “problems with alarm settings complicate the work with patient monitoring.” (96% agreed) 2. “artifacts complicate the assessment of the patient's condition.” (56% agreed) 3. “information overload makes it difficult to get a quick overview of the situation.” (56% agreed) 4. “problems with cables make working with patient monitors tedious.” (88% agreed) 5. “factors related to human performance lead to patient conditions not being perceived on the monitor.” (64% agreed) 6. “Insufficient standardization: Switching back and forth between monitors from different manufacturers makes it difficult to work with patient monitors.” (88% agreed). All statements differed significantly from the neutral opinion. CONCLUSION This study provides an overview of the problems anesthesiologists face with patient monitoring. Some of the issues identified were previously less known, such as problems with monitor cables (e.g., entanglement and worn connectors), human factors (e.g., fatigue and distractions), and systemic factors (e.g., insufficient standardization between manufacturers). According to our findings, an ideal monitor should reduce false positive alarms to a minimum, use as few cables as possible, and be easy to interpret.