User image mismatch in anaesthesia alarms: a cognitive systems analysis

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. 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.