Evaluation of a Mobile App for Guiding Pediatric Cardiac Arrest Resuscitation : Mixed Methods Study (Preprint)

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BACKGROUND Pediatric cardiac arrests are time-sensitive events requiring effective team communication, situational awareness, and rapid decision-making. To support resuscitation teams, we developed InterFACE-AR, a digital system designed to improve adherence to American Heart Association’s Pediatric Advanced Life Support guidelines. One key component, the Guiding Pad tablet app, is a bedside cognitive aid that enables nurses to document team actions and resuscitation events in real time while providing algorithm-based prompts to guide the team’s next step in the care pathway. OBJECTIVE This study aimed to evaluate the usability of the Guiding Pad app by assessing its effectiveness, efficiency, and user satisfaction (aesthetic, ease of use, and clarity of content). We also identified usability problems and proposed design improvements. METHODS Usability tests were conducted among pediatric emergency nurses who completed a simulated pediatric cardiac arrest scenario using the Guiding Pad. Participants were asked to perform 27 predefined tasks while verbalizing their thought process using the think-aloud method. Following the scenario, they completed the Post-Study System Usability Questionnaire (PSSUQ) and participated in a semi-structured interview. Data sources included audio and screen recordings, questionnaire responses, and interview notes. Quantitative outcomes were task completion and success rates, task duration, number of clicks, and PSSUQ scores. Qualitative outcomes were usability problems identified during task performance and feedback from interviews. RESULTS On average, tasks were completed in 11.75 seconds (SD 8.35) and 2.06 clicks (median 1.36). Of the 27 predefined tasks, 21 (77.78%) were fully completed, while completion rates for the remaining tasks ranged from 67% to 93%. The mean overall PSSUQ score was 2.38 out of 7, with lower values reflecting higher satisfaction. A total of 20 usability problems were identified, most of which related to guidance issues such as insufficient prompting, suboptimal grouping of items, and legibility concerns. CONCLUSIONS The Guiding Pad was generally well received and demonstrated overall acceptability and supported task performance in a pediatric resuscitation scenario. However, several usability issues were identified that warrant further refinement. Addressing these limitations may enhance the app’s effectiveness, efficiency, and user satisfaction, thereby strengthening its suitability for real-world clinical use.

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