Discussion
sore, headaches, a reduced cognitive load, dizziness, MR, reductions in mean errors
ADVERSE EFFECTS, AIDS
This single-center, prospective randomized crossover trial found that wearable MR technology improved the performance of clinicians in a simulated environment by reducing error. Specifically, the MR device improved scenario completion rates (100% vs 63.6%; The way in which this technology enhances performance is nuanced and may be further understood by closer examination of specific domains represented by the ICECAP tool. Equipment errors relate to availability, failure or fault of the device, its configuration, participant familiarity with the device, and device selection. Given that the equipment provided was standardized and specific to the interventions that participants were required to perform, there were understandably no significant differences seen between groups within this domain. Communication errors occur when communication has been misleading, absent, not heard, or misheard or if there is significant discord among team members. No significant differences between groups in the number of communication errors captured were seen, although findings from OTAS and T-SAW-C assessments suggested the converse. Additionally, the MR device improved communication among team members. These findings suggest that the MR device may have improved the overall quality of communication among team members but did not reduce the frequency of specific communication errors.However, significant reductions in mean errors per scenario were seen in procedural (0.79 vs 1.52 errors; There were significantly reduced clinical error rates per scenario in the MR-SC group compared with the SC group while simultaneously significantly increasing successful task-completion rates. Improvements in clinical success and reduced clinical safety errors came at the expense of extended completion times, however, when using the MR device. This variation in completion rates and the extended time between MR-SC and SC groups may be accounted for by the number of scenarios that were stopped early in the SC group when participants were unable or unwilling to progress further with the clinical scenario due to inexperience or unfamiliarity with the procedure. Implications of these observations are important for the training and support of front-line clinicians who may require real-time support when learning to perform complex or new tasks. In addition, there is a need for clinicians to feel sufficiently confident in the support that any new technology provides and to perceive that it aids them in safely and competently performing an unfamiliar procedure.Use of the MR platform led to significant improvements in the overall quality of teamwork and interactions for MR-SC vs SC as measured OTAS and T-SAW-C assessment tools. Interestingly, this did not occur because of improvements in the quality of communication, suggesting that holographic computer vision may make a significant contribution to improved team performance. This is likely a product of a reduced cognitive load, as evidenced by improvements in temporal demand and self-reported task performance and reports from participants that they were more confident in making clinical decisions and undertaking procedures.Future MR systems will need to be further adapted for clinical performance. Although there were no reported adverse effects of dizziness or headaches from MR use, some participants reported that prolonged wearing of this headset caused some discomfort or sore eyes. Based on our findings, future iterations of the technology may therefore benefit from improvements in comfort and fit. Integration of MR systems with hospital information and communication technology networks for the real-time visualization of patient clinical data creates technical and data governance challenges that will need to be overcome. Ultimately, however, this analysis suggested that care augmented by MR technology may be superior to standard clinical practice for technical performance and safety, workload, and team performance metrics. Future work should now aim at delivering the seamless integration of the technology into existing systems and processes while simultaneously identifying barriers to its scalability across a range of settings and practice areas.