Effect of monitor positioning on visual attention and situation awareness during neonatal resuscitation: a randomised simulation study

Abstract

ObjectivesTo compare situation awareness (SA), visual attention (VA) and protocol adherence in simulated neonatal resuscitations using two different monitor positions.DesignRandomised controlled simulation study.SettingsSimulation lab at the Royal Alexandra Hospital, Edmonton, Canada.ParticipantsHealthcare providers (HCPs) with Neonatal Resuscitation Program (NRP) certification within the last 2 years and trained in neonatal endotracheal intubations.InterventionHCPs were randomised to either central (eye-level on the radiant warmer) or peripheral (above eye-level, wall-mounted) monitor positions. Each led a complex resuscitation with a high-fidelity mannequin and a standardised assistant. To measure SA, situation awareness global assessment tool (SAGAT) was used, where simulations were paused at three predetermined points, with five questions asked each pause. Videos were analysed for SAGAT and adherence to a NRP checklist. Eye-tracking glasses recorded participants’ VA.Main outcome measureThe main outcome was SA as measured by composite SAGAT score. Secondary outcomes included VA and adherence to NRP checklist.ResultsThirty simulations were performed; 29 were completed per protocol and analysed. Twenty-two eye-tracking recordings were of sufficient quality and analysed. Median composite SAGAT was 11.5/15 central versus 11/15 peripheral, p=0.56. Checklist scores 46/50 central versus 46/50 peripheral, p=0.75. Most VA was directed at the mannequin (30.6% central vs 34.1% peripheral, p=0.76), and the monitor (28.7% central vs 20.5% peripheral, p=0.06).ConclusionsSimulation, SAGAT and eye-tracking can be used to evaluate human factors of neonatal resuscitation. During simulated neonatal resuscitation, monitor position did not affect SA, VA or protocol adherence.

The Validity of the SEEV Model as a Process Measure of Situation Awareness: The Example of a Simulated Endotracheal Intubation

“…The present SEEV model findings support previous research investigating the association of eye tracking metrics and situation awareness measures ( Law et al, 2020 ; Moore & Gugerty, 2010 ). Similar to Moore and Gugerty (2010) , SA level 1 was associated with model fit but, also similar to Moore and Gugerty (2010) , the explained variance was small.…”

“…To complement our analysis, we also investigated the association of observed PDTs in phase 5 with the perception scores, as in previous research ( Law et al, 2020 ; Moore & Gugerty, 2010 ). As summarized in Table 4 , the PDT on the AOI group patient showed significant negative correlations with global situation perception ( r s = −.341) and environmental perception ( r s = −.322).…”

“…In the context of healthcare, Law et al (2020) manipulated the position of the patient monitor during a simulated neonatal resuscitation. As a secondary analysis, Law et al. (2020) reported a nonsignificant correlation of r s = .39 ( p = .07) between a composite SAGAT score (SA levels 1–3) with the percentage of visual attention on the patient monitor.…”

“…By investigating the correlation of the SEEV model fit and SAGAT score, we contribute to and extend the above research in several ways. First, previous research with actual domain experts (e.g., Law et al, 2020 ; Moore & Gugerty, 2010 ) was limited in relation to sample size ( N = 11–29). The present sample includes 61 qualified anesthesiologists.…”

Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis

“…These studies should assess long-term neurodevelopmental outcomes. Studies are also required to determine whether an RFM adds to the attentional and cognitive demands on healthcare providers or diverts attention away from the infant 40–44. It is unclear whether specialised training is required to maximise the benefit of an RFM 43…”