ORIGINAL ARTICLE Penelope Sanderson Jennifer Crawford Annyck Savill Marcus Watson W. John Russell Visual and auditory attention in patient monitoring: a formative analysis Received: 19 February 2003 / Accepted: 19 January 2004 / Published online: 20 April 2004 Ó Springer-Verlag London Limited 2004 Abstract We investigate the effectiveness of sonification (continuous auditory display) for supporting patient monitoring while reducing visual attentional workload in the operating theatre. Non-anaesthetist participants performed a simple continuous arithmetic task while monitoring the status of a simulated anaesthetised pa- tient, reporting the status of vital signs when asked. Patient data were available either on a monitoring screen behind the participant, or were partially or completely sonified. Video captured when, how often and for how long participants turned to look at the screen. Partici- pants gave the most accurate responses with visual dis- plays, the fastest responses with sonification and the slowest responses when sonification was added to visual displays. A formative analysis identifying the constraints under which participants timeshare the arithmetic and monitoring tasks provided a context for interpreting the video data. It is evident from the pattern of their visual attention that participants are sensitive to events with different but overlapping temporal rhythms. Keywords Anaesthesia Formative analysis Sonification Video analysis 1 Introduction Over the last decade, several researchers have suggested that sonification—the representation of relations in data by relations in sounds—might help anaesthetists moni- tor patients in the operating room (Fitch and Kramer 1994; Watson et al. 1999; Loeb and Fitch 2000, 2002; Watson and Sanderson 2004; Seagull et al. 2001). A sonification of basic patient vital signs could let the anaesthetist engage in ‘‘eyes-free’’ patient monitoring while doing other tasks, so extending the benefits of the pulse oximetry sonification that is already in the oper- ating room. In this study we examine the ‘‘eyes-free’’ benefit of sonification by supplementing a comparison of different modalities of presentation for patient vital signs with a video analysis of participant visual attention. Researchers have developed patient monitoring son- ifications using various combinations of heart rate (HR), oxygenation (O 2 ), blood pressure (BP), respiration rate (RR), tidal volume (VT) and end-tidal carbon dioxide (ETCO 2 ), amongst others. Fitch and Kramer (1994) and Loeb and Fitch (2000, 2002) have demonstrated that listeners can detect and identify anaesthesia problems with sonifications of six or eight vital signs. Effectively designed sonification could even lessen the dependence on traditional alarms (Seagull and Sanderson 2001; Woods 1995; Watson et al. 2004). Tasks often compete for the anaesthetist’s attention in the operating room (OR). To date, Watson and Sanderson (2004) and Seagull et al. (2001) are the only researchers to have examined patient monitoring per- formance with sonification under dual task conditions. Seagull et al. (2001) found that non-medically qualified participants performed a visually presented manual tracking task better when they were monitoring with a sonification than with a visual display or combined vi- sual/sonification display. Regardless of whether they were also tracking, however, the participants could de- tect changes in patient vital signs faster with the visual display than with the sonification. In contrast, Watson and Sanderson (2004) demonstrated that sonification let anaesthetists retain a high patient monitoring accuracy with a slight performance benefit for a timeshared arithmetic task. A non-anaesthetist group, however, appeared to trade off performance between patient monitoring and timeshared tasks, much as Seagull et al.’s (2001) participants had. These results presumably P. Sanderson (&) J. Crawford A. Savill M. Watson ARC Key Centre for Human Factors and Applied Cognitive Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia E-mail: psanderson@humanfactors.uq.edu.au W. J. Russell Department of Anaesthesia and Intensive Care, The University of Adelaide, Adelaide, SA, 5005, Australia Cogn Tech Work (2004) 6: 172–185 DOI 10.1007/s10111-004-0159-x