Open AccessVisual Attention of Anesthesia Providers in Simulated Anesthesia Emergencies Using Conventional Number-Based and Avatar-Based Patient Monitoring: Prospective Eye-Tracking Study
Author(s) -
Arsène Ljubenovic,
Sadiq Said,
Julia Braun,
Bastian Grande,
Michaela Kolbe,
Donat R. Spahn,
Christoph B. Nöthiger,
David W. Tscholl,
Tadzio R. Roche
Publication year - 2022
Publication title -
jmir serious games
Language(s) - English
Resource type - Journals
ISSN - 2291-9279
DOI - 10.2196/35642
Subject(s) - eye tracking , situation awareness , patient safety , perioperative , fixation (population genetics) , visual attention , task (project management) , eye surgery , medicine , avatar , medical emergency , computer science , surgery , health care , cognition , artificial intelligence , human–computer interaction , psychiatry , population , environmental health , management , economic growth , engineering , economics , aerospace engineering
Background Inadequate situational awareness accounts for two-thirds of preventable complications in anesthesia. An essential tool for situational awareness in the perioperative setting is the patient monitor. However, the conventional monitor has several weaknesses. Avatar-based patient monitoring may address these shortcomings and promote situation awareness, a prerequisite for good decision making. Objective The spatial distribution of visual attention is a fundamental process for achieving adequate situation awareness and thus a potential quantifiable surrogate for situation awareness. Moreover, measuring visual attention with a head-mounted eye-tracker may provide insights into usage and acceptance of the new avatar-based patient monitoring modality. Methods This prospective eye-tracking study compared anesthesia providers' visual attention on conventional and avatar-based patient monitors during simulated critical anesthesia events. We defined visual attention, measured as fixation count and dwell time, as our primary outcome. We correlated visual attention with the potential confounders: performance in managing simulated critical anesthesia events (task performance), work experience, and profession. We used mixed linear models to analyze the results. Results Fifty-two teams performed 156 simulations. After a manual quality check of the eye-tracking footage, we excluded 57 simulations due to technical problems and quality issues. Participants had a median of 198 (IQR 92.5-317.5) fixations on the patient monitor with a median dwell time of 30.2 (IQR 14.9-51.3) seconds. We found no significant difference in participants' visual attention when using avatar-based patient monitoring or conventional patient monitoring. However, we found that with each percentage point of better task performance, the number of fixations decreased by about 1.39 (coefficient –1.39; 95% CI –2.44 to –0.34; P=.02), and the dwell time diminished by 0.23 seconds (coefficient –0.23; 95% CI: –0.4 to –0.06; P=.01). Conclusions Using eye tracking, we found no significant difference in visual attention when anesthesia providers used avatar-based monitoring or conventional patient monitoring in simulated critical anesthesia events. However, we identified visual attention in conjunction with task performance as a surrogate for situational awareness.