User image mismatch in anaesthesia alarms: a cognitive systems analysis

Abstract

In this study, principles of Cognitive Systems Engineering are used to better understand the human–machine interaction manifesting in the use of anaesthesia alarms. The hypothesis is that the design of the machine incorporates built-in assumptions of the user that are discrepant with the anaesthesiologist's self-assessment, creating ‘user image mismatch’. Mismatch was interpreted by focusing on the ‘user image’ as described from the perspectives of both machine and user. The machine-embedded image was interpreted through document analysis. The user-described image was interpreted through user (anaesthesiologist) interviews. Finally, an analysis was conducted in which the machine-embedded and user-described images were contrasted to identify user image mismatch. It is concluded that analysing user image mismatch expands the focus of attention towards macro-elements in the interaction between man and machine. User image mismatch is interpreted to arise from complexity of algorithm design and incongruity between alarm design and tenets of anaesthesia practice.

Abstract

Practitioner Summary: Cognitive system engineering principles are applied to enhance the understanding of the interaction between anaesthesiologist and alarm. The ‘user image’ is interpreted and contrasted from the perspectives of machine as well as the user. Apparent machine–user mismatch is explored pertaining to specific design features.

Keywords::

• anesthesia alarms
• cognitive systems engineering
• user image
• man–machine interaction
• alarms and warnings

Acknowledgements

The authors are grateful to the members of the Department of Anesthesia at Hamilton Health Sciences who participated in the study. Thanks are extended to Brian Colborne for his assistance with the development of Figures 1 and 2.

Notes

^1. The 2011 Clinical Alarm Summit was convened by the AAMI, the FDA, the Joint Commission, the American College of Clinical Engineering and the ECRI. The publication arising from that summit entitled ‘A siren call to action. Priority issues from the 2011 medical device alarms summit’ can be found at http://www.aami.org/publications/summits/2011_Alarms_Summit_publication.pdf (accessed 13 April 2013).