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Almost half of the preventable deaths in emergency care can be associated with a medical delay. Understanding how clinicians experience delays can lead to improved alert designs to increase delay awareness and mitigation. In this paper, we present the findings from an iterative user-centered design process involving 48 clinicians to develop a prototype alert system for supporting delay awareness in complex medical teamwork such as trauma resuscitation. We used semi-structured interviews and card-sorting workshops to identify the most common delays and elicit design requirements for the prototype alert system. We then conducted a survey to refine the alert designs, followed by near-live, video-guided simulations to investigate clinicians' reactions to the alerts. We contribute to CSCW by designing a prototype alert system to support delay awareness in time-critical, complex teamwork and identifying four mechanisms through which teams mitigate delays.

 

We describe an analysis of speech during time-critical, team-based medical work and its potential to indicate process delays. We analyzed speech intention and sentence types during 39 trauma resuscitations with delays in one of three major lifesaving interventions: intravenous/intraosseous (IV/IO) line insertion, cardiopulmonary and resuscitation (CPR), and intubation. We found a significant difference in patterns of speech during delays vs. speech during non-delayed work. The speech intention during CPR delays, however, differed from the other LSIs, suggesting that context of speech must be considered. These findings will inform the design of a clinical decision support system (CDSS) that will use multiple sensor modalities to alert medical teams to delays in real time. We conclude with design implications and challenges associated with speech-based activity recognition in complex medical processes. 

Abstract Biological and biomedical research is increasingly conducted in large, interdisciplinary collaborations to address problems with significant societal impact, such as reducing antibiotic resistance, identifying disease sub-types, and identifying genes that control for drought tolerance in plants. Many of these projects are data driven and involve the collection and analysis of biological data at a large-scale. As a result, life-science projects, which are frequently diverse, large and geographically dispersed, have created unique challenges for collaboration and training. We examine the communication and collaboration challenges in multidisciplinary research through an interview study with 20 life-science researchers. Our results show that both the inclusion of multiple disciplines and differences in work culture influence collaboration in life science. Using these results, we discuss opportunities and implications for designing solutions to better support collaborative tasks and workflows of life scientists. In particular, we show that life science research is increasingly conducted in large, multi-institutional collaborations, and these large groups rely on “mutual respect” and collaboration. However, we found that the interdisciplinary nature of these projects cause technical language barriers and differences in methodology affect trust. We use these findings to guide our recommendations for technology to support life science. We also present recommendations for life science research training programs and note the necessity for incorporating training in project management, multiple language, and discipline culture. 

Decision support alerts have the potential to assist clinicians in determining appropriate interventions for critically injured patients. The design of these alerts is critical because it can impact their adoption and effectiveness. In this late-breaking work, we explore how decision support alerts should be designed for cognitive aids used in time- and safety-critical medical events. We conducted interviews with 11 trauma team leaders to elicit their thoughts and reactions to potential alert designs. From the findings, we contribute three implications for designing alerts for cognitive aids that support team-based, time-critical decision making and discuss how these implications can be further explored in future work. 

In clinical settings, most automatic recognition systems use visual or sensory data to recognize activities. These systems cannot recognize activities that rely on verbal assessment, lack visual cues, or do not use medical devices. We examined speech-based activity and activity-stage recognition in a clinical domain, making the following contributions. (1) We collected a high-quality dataset representing common activities and activity stages during actual trauma resuscitation events-the initial evaluation and treatment of critically injured patients. (2) We introduced a novel multimodal network based on audio signal and a set of keywords that does not require a high-performing automatic speech recognition (ASR) engine. (3) We designed novel contextual modules to capture dynamic dependencies in team conversations about activities and stages during a complex workflow. (4) We introduced a data augmentation method, which simulates team communication by combining selected utterances and their audio clips, and showed that this method contributed to performance improvement in our data-limited scenario. In offline experiments, our proposed context-aware multimodal model achieved F1-scores of 73.2±0.8% and 78.1±1.1% for activity and activity-stage recognition, respectively. In online experiments, the performance declined about 10% for both recognition types when using utterance-level segmentation of the ASR output. The performance declined about 15% when we omitted the utterance-level segmentation. Our experiments showed the feasibility of speech-based activity and activity-stage recognition during dynamic clinical events.

 

Designing computerized approaches to support complex teamwork requires an understanding of how activity-related information is relayed among team members. In this paper, we focus on verbal communication and describe a speech-based model that we developed for tracking activity progression during time-critical teamwork. We situated our study in the emergency medical domain of trauma resuscitation and transcribed speech from 104 audio recordings of actual resuscitations. Using the transcripts, we first studied the nature of speech during 34 clinically relevant activities. From this analysis, we identified 11 communicative events across three different stages of activity performance-before, during, and after. For each activity, we created sequential ordering of the communicative events using the concept of narrative schemas. The final speech-based model emerged by extracting and aggregating generalized aspects of the 34 schemas. We evaluated the model performance by using 17 new transcripts and found that the model reliably recognized an activity stage in 98% of activity-related conversation instances. We conclude by discussing these results, their implications for designing computerized approaches that support complex teamwork, and their generalizability to other safety-critical domains. 

We describe an initial analysis of speech during team-based medical scenarios and its potential to indicate process delays in an emergency medical setting. We analyzed the speech of trauma resuscitation teams in cases with delayed intravenous/intraosseous (IV/IO) line placement, a significant contributor to delays during life-saving interventions. The insights gained from this analysis will inform the design of a clinical decision support system (CDSS) that will use multiple sensor modalities to alert medical teams to errors in real time. We contribute to the literature by determining how the intention of each speech line and the sentence can support real-time, automatic detection of delays during time-critical team activities.