Abstract

Previous studies have shown that the use of clinical decision support systems can help clinicians perform tasks beyond their usual scope of practice. The Augmented Reality Surgical Assist Manager (ARSAM) was developed to assist combat medics with emergency surgical interventions, such as the Cricothyrotomy (Cric) and Chest Tube (CT) insertion. Using mixed reality technology combined with instructional text, pictures, videos, and holographic overlays, ARSAM enhances the ability of medical personnel to perform surgical procedures. This manuscript presents results of a study conducted to evaluate ARSAM’s overall usability in a simulated environment for two lifesaving surgical interventions, Cric and CT insertion. ARSAM was designed and tested using the Microsoft HoloLens 2 platform. Clinical content was created using various military resources, which were reviewed by medical subject matter experts. Participants were recruited from the staff working within our medical center. No medical experience was required. Following training, participants were asked to perform simulated Cric and CT procedures using ARSAM. Notes and videos were taken throughout the procedures. Participants completed a System Usability Scale (SUS) survey and a custom Participant Usability Survey following each procedure. After both tasks were performed, a Post-Simulation Survey was completed, and responses were used to guide after-action discussion. ARSAM achieved mean overall SUS scores of 74.5/100 on Cric and 79/100 on CT insertion, indicating strong usability. Participants reported that ARSAM contained accurate medical information, however, 9 aspects of the software potentially needed improvement. Concerns centered around unfamiliarity with the system, potential crashes or system instability, and difficulty with voice recognition in noisy environments. Our study demonstrates the potential for ARSAM to improve performance in two emergency interventions. Although users found the clinical decision support software to be acceptable in its current state, feedback was obtained to increase usability and likelihood of adoption.

Keywords:Mixed reality; Decision support; Thoracostomy; Cricothyrotomy; Surgical guidance

Abbreviations: AR: Augmented Reality, ARSAM: Augmented Reality Surgical Assist Manager, CDSS: Clinical Decision Support Systems, CT: Chest Tube, Cric: Cricothyroidotomy, LSCO: Large Scale Combat Operations, SUS: System Usability Scale