Visual attention of anaesthetists during simulated critical incidents

Abstract

† Visual attention, as an underlying process of situational awareness (SA), was studied in anaesthetists attending simulated critical incidents. † 20% of the attention was directed to patient monitor; this increased to 30% during critical incidents. † Manual tasks increased from 21% to 25% in experienced anaesthetists and decreased from 20% to 14% in inexperienced anaesthetists. † This small sample study provides important evidence of how experience changes SA of anaesthetists during simulated critical incidents.Background. Situation awareness (SA) is considered to be an important non-technical skill for delivering safe anaesthesia. The spatial distribution of visual attention (VA) is an underlying process for attaining adequate SA. In the present study, a novel technology was used to assess the distribution of VA in anaesthetists delivering anaesthesia. The impact of a critical incident on VA in relation to individual experience is analysed in a descriptive and exploratory manner.Methods. Fifteen anaesthetists induced general anaesthesia in a full-scale simulator while wearing a head-mounted eye-tracking camera system. After an uneventful session, workload was increased in a randomized order by simulation of a critical incident in the second or third session. Eye tracking was used for the assessment of individual's distribution of VA to monitors, patient, and environment. A post hoc video analysis revealed information about the spatial distribution of VA. Descriptive statistics and exploratory analysis were used.Results. Twenty per cent of VA was directed to the patient monitor (30% during critical incident scenarios, P¼0.003). The more experienced anaesthetists (more than 2 yr of work experience) increased the amount of time dedicated to manual tasks from 21% to 25% during critical incidents, whereas the less experienced decreased from 20% to 14% (P¼0.061).Conclusions. Distribution of attention is different during anaesthesia induction with critical incidents compared with uneventful anaesthesia induction. Less experienced anaesthesia providers spend more time on monitoring tasks. Further investigation in confirmatory designs is needed.

Three-Dimensional Vibration-Induced Vestibulo-ocular Reflex Identifies Vertical Semicircular Canal Dehiscence

“…1A). Even though the spatio-temporal resolution of the ViVOR recorded here is higher than the current real-time sampling frequency of 304 Hz capability of 3-D video-oculography (Schulz et al 2011), however with technological advances, these ViVORs might in future be detectable by video-oculography for clinical diagnostic purpose. In addition, the ViVOR eye rotation amplitude in VSCD could be further enhanced by employing temporal summation techniques similar to clicktrains previously shown to enhance the click evoked VOR in SCD by two and half times (Aw et al 2006).…”

Understanding visual attention of teams in dynamic medical settings through vital signs monitor use

“…Mounting additional cameras on the monitors themselves may help us better identify when and how long team members are looking at the monitor. Although eye-tracking technology is commonly used in studies of visual scanning and monitoring [12,17,21,23], we found this technology inadequate for the trauma bay environment for several reasons. First, current eye-tracking technology does not support gaze tracking of multiple people at a time.…”

“…By using eye-tracking equipment, these studies examined search patterns and dwell times of individual participants engaged in visual problem-solving tasks while looking at a single display. A recent study of the distribution of visual attention in anesthesia providers has shown that 30% of visual attention was directed to the vital signs monitor, particularly during crisis situations [23]. Few studies, however, have explored the distribution of visual attention that interdisciplinary medical teams use to gather the information for maintaining situation awareness in dynamic domains such as trauma resuscitation.…”

Validating Eye Tracking as an Objective Assessment Tool in Simulation

“…Studies have shown ETG to be useful in distinct skill assessment in the hospital setting (Ahmidi et al, 2010;Chetwood et al, 2012;Matsumoto et al, 2011;Richstone et al, 2010;Schulz et al, 2011;Voisin, Pinto, Morin-Ducote, Hudson, & Tourassi, 2013) and as an assessment tool in testing novice and expert clinicians (Koh, Park, Wickens, Ong, & Chia, 2011). However, there are no studies testing the validity or reliability of ETG in a simulation setting.…”