Anesthesiology Control Tower: Feasibility Assessment to Support Translation (ACT-FAST)-a feasibility study protocol

Abstract

Background: Major postoperative morbidity and mortality remain common despite efforts to improve patient outcomes. Health information technologies have the potential to actualize advances in perioperative patient care, but failure to evaluate the usability of these technologies may hinder their implementation and acceptance. This protocol describes the usability testing of an innovative telemedicine-based intra-operative clinical support system, the Anesthesiology Control Tower, in which a team led by an attending anesthesiologist will use a combination of established and novel information technologies to provide evidence-based support to their colleagues in the operating room.

Methods: Two phases of mixed-methods usability testing will be conducted in an iterative manner and will evaluate both the individual components of the Anesthesiology Control Tower and their integration as a whole. Phase I testing will employ two separate "think-aloud" protocol analyses with the two groups of end users. Segments will be coded and analyzed for usability issues. Phase II will involve a qualitative and quantitative in situ usability and feasibility analysis. Results from each phase will inform the revision and improvement of the Control Tower prototype throughout our testing and analysis process. The final prototype will be evaluated in the form of a pragmatic randomized controlled clinical trial.

Discussion: The Anesthesiology Control Tower has the potential to revolutionize the standard of care for perioperative medicine. Through the thorough and iterative usability testing process described in this protocol, we will maximize the usefulness of this novel technology for our clinicians, thus improving our ability to implement this innovation into the model of care for perioperative medicine.

Trial registration: The study that this protocol describes has been registered in clinicaltrials.gov as NCT02830126.

Keywords: Clinician decision support; Feasibility; Health information technology; Human-computer interaction; Telemedicine; Usability.

Fig. 1

AlertWatch Tower Mode census view. From this view, clinicians in the ACT can obtain a brief overview of all the patients in the ORs. Alerts and abnormal physiologic and laboratory parameters are represented by squares and triangles, respectively; checkmarks indicate alerts that must be addressed by the ACT. These groups of alerts are unique to the AW Tower Mode and will be refined based on the results of the present study. Clicking on an OR accesses the detailed information for that OR

Fig. 2

AlertWatch Tower Mode patient display. Organ systems are depicted and labeled with relevant physiologic variables and values. Colors outlining organs indicate normal (green), marginal (yellow), or abnormal function (red). The left side of the display shows patient characteristics and case information. Information regarding the actual patient’s comorbidities can be accessed by selecting the organ system or laboratory study of interest. Text alerts are present on the right-hand side of the screen. The black checkmark at the bottom of the left panel indicates that there is an active alert for the ACT clinicians to address; clicking on the checkmark opens the case review dialogue (Figure 3)

Fig. 3

Case review. This popup window allows physicians in the ACT (ACTors) to document their assessment of alerts and what actions they would recommend. This is a feature of AlertWatch that is unique to the ACT Tower Mode platform. ACTors successfully assess and address an alert by documenting their assessment of the significance of the alert and by documenting what action they would recommend taking, if any