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Use of a head-mounted patient display in a task driven anaesthesia simulator: a randomised trial
  1. Jacob Henry Cole1,2 and
  2. S Hughey2,3
  1. 1 Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2 Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  3. 3 Anesthesiology and Pain Medicine, US Naval Hospital Okinawa, Okinawa, Japan
  1. Correspondence to Dr Jacob Henry Cole, Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; cole.jacob.h{at}


Introduction Head-mounted displays (HMDs) are becoming increasingly investigated in the realm of healthcare. These devices are worn on the user’s head and display information directly to the eye. This allows for near-constant delivery of information, regardless of user position. Increasing advances in technology have allowed for miniaturisation, increasing sophistication, wireless capability and prolonged battery life, all of which allow for more opportunities for these devices to be used in a clinical setting.

Methods A prospective, randomised, controlled, parallel-group study was conducted. Subjects were randomised to either an HMD group or a non-HMD group. All subjects then underwent a standardised intraoperative care simulation experience consisting of multiple procedures that required completion within a set time limit. During this period, subjects concurrently monitored the physiological state of a simulated patient. Multiple standardised physiological derangements were displayed to the subjects via either the worn HMD or standard monitors. The primary outcome was the time to recognition of these physiological derangements.

Results A total of 39 anaesthesia providers were enrolled in this study. There was a significant decrease in the total time it took them to recognise the simulated physiological derangements in the HMD group (difference of 38.2% (95% CI 20.3% to 56.1%); p=0.011) No significant differences in the time that it took to perform the required simulated procedures were observed. Significantly fewer physiological derangements were overlooked by the HMD group than the control group overall (relative risk reduction 0.78 (95% CI 0.31 to 0.94); p=0.003).

Conclusions Recent advances in HMD technology may be able to produce a functional adjunctive monitoring device that improves the speed with which anaesthesia providers respond to intraoperative events. This benefit comes without increasing distraction from the task. Further studies in true operative environments are needed to validate this technology.

  • biotechnology & bioinformatics
  • anaesthetics
  • information management

Data availability statement

Data are available on reasonable request. All data are available on reasonable request.

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Data availability statement

Data are available on reasonable request. All data are available on reasonable request.

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  • Contributors Both JHC and SH contributed to the conceptualisation, execution, data analysis, manuscript production and editing equally. JHC accepts responsibility for the overall content of this manuscript as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.