Spatially Integrated Electronic Health Record Prototype Improves Usability and Reduces Cognitive Load for Intensive Care Nurses: A Randomized Crossover Trial

This study evaluated the effect of a Spatial Awareness Integrated Electronic Health Record (SAI-EHR) prototype on efficiency, usability, and cognitive workload among intensive care nurses performing standardized documentation tasks, compared with a traditional linear flowsheet-style interface (LID-EHR). A randomized, two-period crossover simulation was conducted with 36 intensive care unit (ICU) nurses who completed two standardized scenarios. Primary outcomes were documentation efficiency (time to complete a fixed task), usability (System Usability Scale [SUS]), and cognitive workload (NASA Task Load Index [NASA-TLX]). Secondary outcomes included accuracy and Technology Acceptance Model (TAM) measures of Perceived Usefulness (TAM-PU) and Behavioral Intention (TAM-BI). Analyses used linear mixed-effects models. Within-participant effect sizes were calculated using Cohen's d. SAI-EHR reduced documentation time by 177 seconds (27% faster; p < 0.001, d = 0.88) per task. NASA-TLX workload scores were 51.3% lower with SAI-EHR compared with the LID-EHR (18.44 vs. 37.82; p < 0.001, d = 0.73). Accuracy was 6.3% higher with SAI-EHR (98.70 vs. 92.86%; p < 0.001, d = 0.68). SUS and perceived usefulness scores favored SAI-EHR but did not differ significantly (SUS: 77.99 vs. 71.60; TAM-PU: 3.72 vs. 3.38). TAM-BI was substantially higher for SAI-EHR (25.5% increase; Δ = 0.96; 95% confidence interval [CI]: 0.55–1.36; p < 0.001, d = 0.72). Lower cognitive workload was associated with a stronger intention to adopt (r = −0.64; p < 0.001). An SAI-EHR prototype mirroring ICU room layout enabled faster, more accurate documentation with lower perceived workload than a linear flowsheet interface. Stated intention to adopt was higher and inversely associated with workload; differences in SUS and TAM perceived usefulness scores favored the spatial interface but did not reach statistical significance in this sample. Findings support spatial awareness integration as a workload-reducing design principle, while formal usability and usefulness comparisons warrant a larger-sample evaluation.