Transitioning to Remote User-Centered Design Activities in the Emergency Medical Field During a Pandemic.

During the COVID-19 pandemic, we had to transition our user-centered research and design activities in the emergency medical domain of trauma resuscitation from in-person settings to online environments. This transition required that we replicate the in-person interactions remotely while maintaining the critical social connection and the exchange of ideas with medical providers. In this paper, we describe how we designed and conducted four user-centered design activities from our homes: participatory design workshops, near-live simulation sessions, usability evaluation sessions, and interviews and design walkthroughs. We discuss the differences we observed in our interactions with participants in remote sessions, as well as the differences in the interactions among the research team members. From this experience, we draw several lessons and outline the best practices for remotely conducting user-centered design activities that have been traditionally held in person.

Understanding Digital Checklist Use Through Team Communication.

Introducing technology support in a complex, team-based work setting requires a study of teamwork effects on technology use. In this paper, we present our initial analysis of team communications in a trauma resuscitation setting, where we deployed a digital checklist to support trauma team leaders in guiding patient care. By analyzing speech transcripts, checklist interaction logs, and videos of 15 resuscitations, we identified several tensions that arose from the use of a checklist in a team-based process with multi-step tasks. The tensions included incorrect markings of in-progress tasks as completed, failure to mark completed tasks due to missed communications, failure to record planned tasks, and difficulties in recording dynamic values. From these findings, we discuss design implications for checklist design for dynamic, team-based activities.

Checklist Design Reconsidered: Understanding Checklist Compliance and Timing of Interactions.

We examine the association between user interactions with a checklist and task performance in a time-critical medical setting. By comparing 98 logs from a digital checklist for trauma resuscitation with activity logs generated by video review, we identified three non-compliant checklist use behaviors: failure to check items for completed tasks, falsely checking items when tasks were not performed, and inaccurately checking items for incomplete tasks. Using video review, we found that user perceptions of task completion were often misaligned with clinical practices that guided activity coding, thereby contributing to non-compliant check-offs. Our analysis of associations between different contexts and the timing of check-offs showed longer delays when (1) checklist users were absent during patient arrival, (2) patients had penetrating injuries, and (3) resuscitations were assigned to the highest acuity. We discuss opportunities for reconsidering checklist designs to reduce non-compliant checklist use.

Comparing the Effects of Paper and Digital Checklists on Team Performance in Time-Critical Work.

This mixed-methods study examines the effects of a tablet-based checklist system on team performance during a dynamic and safety-critical process of trauma resuscitation. We compared team performance from 47 resuscitations that used a paper checklist to that from 47 cases with a digital checklist to determine if digitizing a checklist led to improvements in task completion rates and in how fast the tasks were initiated for 18 most critical assessment and treatment tasks. We also compared if the checklist compliance increased with the digital design. We found that using the digital checklist led to more frequent completions of the initial airway assessment task but fewer completions of ear and lower extremities exams. We did not observe any significant differences in time to task performance, but found increased compliance with the checklist. Although improvements in team performance with the digital checklist were minor, our findings are important because they showed no adverse effects as a result of the digital checklist introduction. We conclude by discussing the takeaways and implications of these results for effective digitization of medical work.

Design In The "Medical" Wild: Challenges Of Technology Deployment.

We describe the challenges of deploying a digital checklist for medical emergencies during an in-the-wild design and evaluation study. The in-the-wild approach allowed for many design iterations to meet the requirements of a safety-critical setting, while also providing lessons for designing in the wild. We faced two major challenges: working with research coordinators as study mediators and adapting training strategies to busy user schedules. We discuss these challenges and approaches to addressing them.

Designing and Optimizing Digital Applications for Medical Emergencies.

In this ongoing study, we aim to redesign an existing dynamic digital checklist application (app) for trauma resuscitations in a regional trauma center. The design followed an iterative, user-centered approach. Trauma team physician leaders and research coordinators at the center participated in a survey and usability study to provide feedback for improving the user interface. Proper optimization of the user experience is necessary for future adoption of the digital checklist. This study lays the groundwork for in situ use and evaluation of the checklist by trauma team members.

Design In The Wild: Lessons From Researcher Participation In Design Of Emerging Technology.

We describe a pilot study of designing and evaluating a digital checklist for medical emergencies based on participation of medical-expert researchers who used the checklist during actual trauma resuscitations. The participation of the researchers revealed challenges and insights for designing in the wild, as well as next steps for using our emerging technology in real scenarios.

Exploring Design Opportunities for a Context-Adaptive Medical Checklist Through Technology Probe Approach.

This paper explores the workflow and use of an interactive medical checklist for trauma resuscitation-an emerging technology developed for trauma team leaders to support decision making and task coordination among team members. We used a technology probe approach and ethnographic methods, including video review, interviews, and content analysis of checklist logs, to examine how team leaders use the checklist probe during live resuscitations. We found that team leaders of various experience levels use the technology differently. Some leaders frequently glance at the checklist and take notes during task performance, while others place the checklist on a stand and only interact with the checklist when checking items. We compared checklist timestamps to task activities and found that most items are checked off after tasks are performed. We conclude by discussing design implications and new design opportunities for a future dynamic, adaptive checklist.

Design Challenges in Converting a Paper Checklist to Digital Format for Dynamic Medical Settings.

We describe a mobile digital checklist that we designed and developed for trauma resuscitation-a dynamic, fast-paced medical process of treating severely injured patients. The checklist design was informed by our analysis of user interactions with a paper checklist that was introduced to improve team performance during resuscitations. The design process followed an iterative approach and involved several medical experts. We discuss design challenges in converting a paper checklist to its digital counterpart, as well as our approaches for addressing those challenges. While we show that using a digital checklist during a fast-paced medical event is feasible, we also recognize several design constraints, including limited display size, difficulties in entering notes about the medical process and patient, and difficulties in replicating user experience with paper checklists.

Stimulated release of cholesterol from liposomal membranes by a PEGylated phospholipid.

PEGylated phospholipids are commonly used to increase the blood-circulation time of liposomes by providing a steric barrier around them. This paper documents a fundamentally new property of these lipids-an ability to stimulate the release of cholesterol from phospholipid membranes. Evidence for such stimulation has been obtained by measuring the transport of dehydroergosterol (DHE), a fluorescent simulant of cholesterol, from donor liposomes made from 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC), 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[methoxy(polyethylene glycol)-2000 (DSPE-PEG(2000)), and DHE to acceptor liposomes made from POPC, 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoglycerol (POPG), and cholesterol. The potential of PEGylated lipids to serve as novel cholesterol-lowering agents is briefly discussed.