Anesthesia personnel’s visual attention regarding patient monitoring in simulated routine and critical incidents. An eye-tracking study.

Background: Cognitive ergonomics design of patient monitoring may reduce human factor errors in high-stress environments. Eye-tracking is a suitable tool to gain insight into the visual interaction of healthcare professionals with patient monitors, which may facilitate their further development. Methods: : This prospective, randomized, high-fidelity simulation study compared anesthesia personnel's visual attention (fixation count and dwell time) to 15 areas of interest on the patient monitor during critical and non-critical anesthesia scenarios. Furthermore, we examined the extent to which participants' experience influenced visual attention and which vital signs displayed on the patient monitor received the most visual attention. We used mixed zero-inflated Poisson regression and mixed linear models to analyze the results. Results: : Analyzing 23 ten-minute scenarios, we found significantly more fixations to the areas of interest on the patient monitor during critical situations (rate ratio of 1.45; 95% CI 1.33 to 1.59; p < 0.001). However, the dwell-time on the areas of interest did not significantly differ between the critical and non-critical scenarios (coefficient of –1.667; 95% CI –4.549 to 1.229; p = 0.27). The professional experience did not significantly influence the visual attention (fixation: rate ratio of 0.88; 95% CI 0.54 to 1.43; p = 0.61 and dwell-time: coefficient of 0.889; 95% CI –1.465 to 3.229; p = 0.27). Regarding vital signs, anesthesia personnel paid the most attention to blood pressure (fixation: mean [SD] of 108 [74.83]; dwell-time: mean [SD] of 27 [15.90] seconds), end-expiratory carbon dioxide (fixation: mean [SD] of 59 [47.39]; dwell-time: mean [SD] of 30 [21.51] seconds), and the electrocardiogram (fixation: mean [SD] of 58 [64.70]; dwell-time: mean [SD] of 15 [14.95] seconds). Conclusions: : Critical anesthesia situations increased anesthesia personnel’s visual interaction with the patient monitor. Furthermore, we found that their visual attention focused mainly on a few vital signs. To assist clinicians in critical situations, manufacturers should optimize monitors to convey necessary information as easily and quickly as possible and optimize the visibility of less frequently observed but equally critical vital signs, especially when they are in an abnormal range.