Human factors analysis of the CardioQuick Patch®: A novel engineering solution to the problem of electrode misplacement during 12-lead electrocardiogram acquisition.
The CardioQuick Patch® (CQP) has been developed to assist operators in accurately positioning precordial electrodes during 12-lead electrocardiogram (ECG) acquisition. This study describes the CQP design and assesses the device in comparison to conventional electrode application.



Twenty ECG technicians were recruited and a total of 60 ECG acquisitions were performed on the same patient model over four phases: (1) all participants applied single electrodes to the patient; (2) all participants were then re-trained on electrode placement and on how to use the CQP; (3) participants were randomly divided into two groups, the standard group applied single electrodes and the CQP group used the CQP; (4) after a one day interval, the same participants returned to carry out the same procedure on the same patient (measuring intra-practitioner variability). Accuracy was measured with reference to pre-marked correct locations using ultra violet ink. NASA-TLK was used to measure cognitive workload and the Systematic Usability Scale (SUS) was used to quantify the usability of the CQP.



There was a large difference between the minimum time taken to complete each approach (CQP=38.58s vs. 65.96s). The standard group exhibited significant levels of electrode placement error (V1=25.35mm±29.33, V2=18.1mm±24.49, V3=38.65mm±15.57, V4=37.73mm±12.14, V5=35.75mm±15.61, V6=44.15mm±14.32). The CQP group had statistically greater accuracy when placing five of the six electrodes (V1=6.68mm±8.53 [p<0.001], V2=8.8mm±9.64 [p=0.122], V3=6.83mm±8.99 [p<0.001], V4=14.90mm±11.76 [p<0.001], V5=8.63mm±10.70 [p<0.001], V6=18.13mm±14.37 [p<0.001]). There was less intra-practitioner variability when using the CQP on the same patient model. NASA TLX revealed that the CQP did increase the cognitive workload (CQP group=16.51%±8.11 vs. 12.22%±8.07 [p=0.251]). The CQP also achieved a high SUS score of 91±7.28.



The CQP significantly improved the reproducibility and accuracy of placing precordial electrodes V1, V3-V6 with little additional cognitive effort, and with a high degree of usability.
Ulster University, Northern Ireland, UK. Electronic address: rb.bond@ulster.ac.uk.
Raymond R
RR
Bond
Ulster University, Northern Ireland, UK.
Dewar D
DD
Finlay
Ulster University, Northern Ireland, UK.
James
J
McLaughlin
Ulster University, Northern Ireland, UK.
Daniel
D
Guldenring
Ulster University, Northern Ireland, UK.
Andrew
A
Cairns
Ulster University, Northern Ireland, UK.
Alan
A
Kennedy
eNNOVEA Medical, Columbus, OH.
Robert
R
Deans
Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Division of Cardiovascular Medicine, Cleveland, OH.
Albert L
AL
Waldo
Altnagelvin Hospital, Department of Cardiology, Western Health and Social Care Trust, Londonderry, Northern Ireland, UK.
Aaron
A
Peace
D000328:Adult; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000517:prevention & control*; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods*; D004566:Electrodes; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006804:Ergonomics / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008328:Man-Machine Systems; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
CardioQuickPatch; ECG; Electrode misplacement; Engineering solution; Ergonomics; Human factors; Humandevice interaction; Medical error; Patient safety