Smooth or Stepped? Laboratory Comparison of Enhanced Sonifications for Monitoring Patient Oxygen Saturation

Renae Collett, Isaac Salisbury, Robert G. Loeb, Penelope M. Sanderson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The pulse oximeter (PO) provides anesthesiologists with continuous visual and auditory information about a patient’s oxygen saturation (SpO2). However, anesthesiologists’ attention is often diverted from visual displays, and clinicians may inaccurately judge SpO2 values when relying on conventional PO auditory tones. We tested whether participants could identify SpO2 value (e.g., “97%”) better with acoustic enhancements that identified three discrete clinical ranges by either changing abruptly at two threshold values (stepped-effects) or changing incrementally with each percentage value of SpO2 (smooth-effects). Method: In all, 79 nonclinicians participated in a between-subjects experiment that compared performance of participants using the stepped-effects display with those who used the smooth-effects display. In both conditions, participants heard sequences of 72 tones whose pitch directly correlated to SpO2 value, and whose value could change incrementally. Primary outcome was percentage of responses that correctly identified the absolute SpO2 percentage, ±1, of the last pulse tone in each sequence. Results: Participants using the stepped-effects auditory tones identified absolute SpO2 percentage more accurately (M = 53.7%) than participants using the smooth-effects tones (M = 47.9%, p =.038). Identification of range and detection of transitions between ranges showed even stronger advantages for the stepped-effects display (p <.005). Conclusion: The stepped-effects display has more pronounced auditory cues at SpO2 range transitions, from which participants can better infer absolute SpO2 values. Further development of a smooth-effects display for this purpose is not necessary.

Original languageEnglish (US)
Pages (from-to)124-137
Number of pages14
JournalHuman Factors
Issue number1
StatePublished - Feb 1 2020
Externally publishedYes


  • auditory displays
  • heterogeneity principle
  • oxygen saturation
  • patient monitoring
  • pulse oximetry
  • sonification

ASJC Scopus subject areas

  • Human Factors and Ergonomics
  • Applied Psychology
  • Behavioral Neuroscience


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