Graphical User Interface (GUI), Cardiorespiratory Insufficiency (CRI)

Semi-structured moderator guide used by the expert focus group methodologist to facilitate discussions during the study.

Welcome! My name is [facilitator], I will be facilitating today’s discussion. I am assisted by [name of researcher], in case I get stuck on any of the technical aspects of the project we are showing you, and [name of researcher], who will be my notetaker and tech support. They will not be participating in the discussion.

Thank you so much for being here. You have been invited to participate in this focus group because you are: A licensed clinician (nurse, physician, physicians’ assistant, or nurse practitioner) who has past or present experience caring for hospitalized patients at risk of cardiorespiratory insufficiency (CRI).

Today we will explore your experiences with identifying patients at risk for CRI, by using new technology in clinical workflow practices. We will be getting your feedback about a graphical user interface (GUI) prototype. This GUI may help clinicians better recognize patients approaching CRI, and provides a user interface for our machine learning models to predict future instability risk.

While we have some things in common, we also have differences – where we come from, the experiences we have had. That should not prevent you all from participating today. I want to hear from everyone. I am not here to judge you, and there is no right or wrong answer to any of the questions I will be asking. I will respect you and I know that you will be respectful of each other, even if you have a different reaction/opinion, or disagree.

We’ll be talking for about an hour, and one of my jobs is to make sure we stick to that timeline. Our discussion will be recorded using the Zoom recording features; before we proceed with analysis, the video portion of the recording will be deleted. And once the recording is transcribed, it will be destroyed so your answers cannot be connected with you.

The transcripts will be deidentified and stored in a secure location before, during, and after the final analysis. The results of this discussion will be published for research purposes. By remaining in the room, you give your consent to be recorded and to have your comments included in any reports or manuscripts that come out of this work. Without attribution, of course.

Any questions about that? Feel free to get up and stretch if you want, drink your water, … Okay – Let’s begin. I’d like to start by having you tell us your name and where you work. Thanks! Now we are going to show you what a future GUI might look like. [name of researcher], please start share screen.

What you are looking at comes from continuous monitoring data collected from the patient cardiorespiratory monitor.

Data include vital signs (heart rate, respiratory rate, blood pressure, and pulse oximetry) that can be viewed at 60 second, 5 minutes, 1, 2, 12, and 24-hour intervals.

Calculations applied to the vital sign data help the machine build predictions about which patients will become unstable, and those who will never become unstable in the future. The score that results from these calculations can help clinicians determine if a patient needs to be evaluated more closely to assess their situation, and if nursing/medical intervention is warranted. When the line and risk score is green, it means the patient has no instability risk based on their vital sign patterns so far. Yellow means at risk for mild instability, the patient should be evaluated, and may require intervention, but the risk is not urgent. Red means there is risk for serious instability requiring intervention and perhaps escalation of care. The box between the current risk and the index value itself shows their future trajectory for risk if they stay on the current course of vital sign patterns. That purple line shows risk as it is projected for the next hour (the grid marks are in 15-minute increments). So, any questions about that before we move on?

Screen Present: 1How do you currently figure out which patients will experience cardiorespiratory insufficiency (CRI)? 2What do you think about the GUI screen you are looking at? What is your reaction? 3Are there things you would change on the GUI screen to make it more helpful, informative, usable? 4What would keep you from taking advantage of this technology? 5What would make you feel more comfortable using this technology? 6How would having a tool like this make you feel? PROBE: about CRI specifically; confident or doubtful that they would be able to prevent a future CRI; stress them out…

Without the GUI Screen Present: 7Do you see this GUI supporting your future informed decision making? Do you think people will use it? Tell me about that.