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Buehler PK, Wendel-Garcia PD, Müller M, Schmidt MT, Schuepbach RA, Lohmeyer Q, Hofmaenner DA. Where do ICU trainees really look? An eye-tracking analysis of gaze patterns during central venous catheter insertion. J Vasc Access 2024:11297298241258628. [PMID: 38856000 DOI: 10.1177/11297298241258628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND There is limited knowledge about gaze patterns of intensive care unit (ICU) trainee doctors during the insertion of a central venous catheter (CVC). The primary objective of this study was to examine visual patterns exhibited by ICU trainee doctors during CVC insertion. Additionally, the study investigated whether differences in gaze patterns could be identified between more and less experienced trainee doctors. METHODS In a real-life, prospective observational study conducted at the interdisciplinary ICU at the University Hospital Zurich, Switzerland, ICU trainee doctors underwent eye-tracking during CVC insertion in a real ICU patient. Using mixed-effects model analyses, the primary outcomes were dwell time, first fixation duration, revisits, fixation count, and average fixation time on different areas of interest (AOI). Secondary outcomes were above eye-tracking outcome measures stratified according to experience level of participants. RESULTS Eighteen participants were included, of whom 10 were inexperienced and eight more experienced. Dwell time was highest for CVC preparation table (p = 0.02), jugular vein on ultrasound image (p < 0.001) and cervical puncture location (p < 0.001). Concerning experience, dwell time and revisits on jugular vein on ultrasound image (p = 0.02 and p = 0.04, respectively) and cervical puncture location (p = 0.004 and p = 0.01, respectively) were decreased in more experienced ICU trainees. CONCLUSIONS Various AOIs have distinct significance for ICU trainee doctors during CVC insertion. Experienced participants exhibited different gaze behavior, requiring less attention for preparation and handling tasks, emphasizing the importance of hand-eye coordination.
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Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- Center of Intensive Care Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Mattia Müller
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marc T Schmidt
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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Buehler PK, Wendel-Garcia PD, Hofmaenner DA. Eye-tracking as a tool to evaluate defibrillator handling. Resusc Plus 2024; 17:100566. [PMID: 38586863 PMCID: PMC10995637 DOI: 10.1016/j.resplu.2024.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Philipp K. Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel A. Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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Buehler PK, Wendel-Garcia PD, Hofmaenner DA. Eye-tracking during newborn intubations. Pediatr Res 2023:10.1038/s41390-023-02630-1. [PMID: 37117819 PMCID: PMC10382304 DOI: 10.1038/s41390-023-02630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
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Valek R, Wendel-Garcia PD, Schuepbach RA, Buehler PK, Hofmaenner DA. Eye-tracking to observe compliance with hand hygiene in the intensive care unit: a randomized feasibility study. J Hosp Infect 2023; 131:148-155. [PMID: 36243174 DOI: 10.1016/j.jhin.2022.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Healthcare-associated infections are associated with increased patient mortality. Hand hygiene is the most effective method to reduce these infections. Despite simplification of this easy intervention, compliance with hand disinfection remains low. Current assessment of hand hygiene is mainly based on observation by hygiene specialists. The aim of this study was to investigate additional benefits of eye-tracking during the analysis of hand hygiene compliance of healthcare professionals in the intensive care unit. METHODS In a simulated, randomized crossover study conducted at the interdisciplinary intensive care unit at University Hospital Zurich, Switzerland, doctors and nurses underwent eye-tracking and completed two everyday tasks (injection of 10 μg norepinephrine via a central venous line, blood removal from the central line) in two scenarios where the locations of alcoholic dispensers differed ('in-sight' and 'out-of-sight'). The primary outcomes were dwell time, revisits, first fixation duration and average fixation duration on three areas of interest (central venous line, alcohol dispenser, protective glove box) for both scenarios. Compliance with hand hygiene guidelines was analysed. FINDINGS Forty-nine participants (35 nurses, 14 doctors) were included in this study. Eye-tracking provided additional useful information compared with conventional observations. Dwell time, revisits, first fixation duration and average fixation duration did not differ between the two scenarios for all areas of interest. Overall compliance with recommended hand hygiene measures was low in both doctors (mean 20%) and nurses (mean 42.9%). CONCLUSION Compared with conventional observations, eye-tracking offered additional helpful insights and provided an in-depth analysis of gaze patterns during the recording of hand hygiene compliance in the intensive care unit.
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Affiliation(s)
- R Valek
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - P D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - R A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - P K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - D A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
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Lohmeyer Q, Schiess C, Wendel Garcia PD, Petry H, Strauch E, Dietsche A, Schuepbach RA, Buehler PK, Hofmaenner DA. Effects of tall man lettering on the visual behaviour of critical care nurses while identifying syringe drug labels: a randomised in situ simulation. BMJ Qual Saf 2023; 32:26-33. [PMID: 35260415 PMCID: PMC9811086 DOI: 10.1136/bmjqs-2021-014438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients in intensive care units are prone to the occurrence of medication errors. Look-alike, sound-alike drugs with similar drug names can lead to medication errors and therefore endanger patient safety. Capitalisation of distinct text parts in drug names might facilitate differentiation of medication labels. The aim of this study was to test whether the use of such 'tall man' lettering (TML) reduces the error rate and to examine effects on the visual attention of critical care nurses while identifying syringe labels. METHODS This was a prospective, randomised in situ simulation conducted at the University Hospital Zurich, Zurich, Switzerland. Under observation by eye tracking, 30 nurses were given 10 successive tasks involving the presentation of a drug name and its selection from a dedicated set of 10 labelled syringes that included look-alike and sound-alike drug names, half of which had TML-coded labels.Error rate as well as dwell time, fixation count, fixation duration and revisits were analysed using a linear mixed-effects model analysis to compare TML-coded with non-TML-coded labels. RESULTS TML coding of syringe labels led to a significant decrease in the error rate (from 5.3% (8 of 150 in non-TML-coded sets) to 0.7% (1 of 150 in TML-coded sets), p<0.05). Eye tracking further showed that TML affects visual attention, resulting in longer dwell time (p<0.01), more and longer fixations (p<0.05 and p<0.01, respectively) on the drug name as well as more frequent revisits (p<0.01) compared with non-TML-coded labels. Detailed analysis revealed that these effects were stronger for labels using TML in the mid-to-end position of the drug name. CONCLUSIONS TML in drug names changes visual attention while identifying syringe labels and supports critical care nurses in preventing medication errors.
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Affiliation(s)
- Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Cornel Schiess
- Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Zurich, Switzerland
| | | | - Heidi Petry
- Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Zurich, Switzerland
| | - Eric Strauch
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Andreas Dietsche
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Reto A. Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp K. Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Daniel A. Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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Hofmaenner DA, Buehler PK. The impact of eye-tracking on patient safety in critical care. J Clin Monit Comput 2022; 36:1577-1579. [PMID: 35438366 DOI: 10.1007/s10877-022-00844-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Patient safety has become a high priority in health care. The recognition, prevention and reduction of human errors are crucial for patient care. Diverse approaches to analyze roots of errors exist, however they all bear relevant limitations. In contrast, the technology of eye-tracking offers objective and measurable parameters linked to eye movements, allowing temporal and spatial assessment of visual patterns. Diverse studies in critical care have proved the usefulness of eye-tracking to analyze real-life scenarios. These insights could contribute to increased patient safety.
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Affiliation(s)
- Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
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Buehler PK, Herling A, Bienefeld N, Klinzing S, Wegner S, Wendel Garcia PD, Karbach M, Lohmeyer Q, Schaubmayr E, Schuepbach RA, Hofmaenner DA. Differing Visual Behavior Between Inexperienced and Experienced Critical Care Nurses While Using a Closed-Loop Ventilation System-A Prospective Observational Study. Front Med (Lausanne) 2021; 8:681321. [PMID: 34568356 PMCID: PMC8455837 DOI: 10.3389/fmed.2021.681321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Closed-loop ventilation modes are increasingly being used in intensive care units to ensure more automaticity. Little is known about the visual behavior of health professionals using these ventilation modes. The aim of this study was to analyze gaze patterns of intensive care nurses while ventilating a patient in the closed-loop mode with Intellivent adaptive support ventilation® (I-ASV) and to compare inexperienced with experienced nurses. Materials and Methods: Intensive care nurses underwent eye-tracking during daily care of a patient ventilated in the closed-loop ventilation mode. Five specific areas of interest were predefined (ventilator settings, ventilation curves, numeric values, oxygenation Intellivent, ventilation Intellivent). The main independent variable and primary outcome was dwell time. Secondary outcomes were revisits, average fixation time, first fixation and fixation count on areas of interest in a targeted tracking-time of 60 min. Gaze patterns were compared between I-ASV inexperienced (n = 12) and experienced (n = 16) nurses. Results: In total, 28 participants were included. Overall, dwell time was longer for ventilator settings and numeric values compared to the other areas of interest. Similar results could be obtained for the secondary outcomes. Visual fixation of oxygenation Intellivent and ventilation Intellivent was low. However, dwell time, average fixation time and first fixation on oxygenation Intellivent were longer in experienced compared to inexperienced intensive care nurses. Discussion: Gaze patterns of intensive care nurses were mainly focused on numeric values and settings. Areas of interest related to traditional mechanical ventilation retain high significance for intensive care nurses, despite use of closed-loop mode. More visual attention to oxygenation Intellivent and ventilation Intellivent in experienced nurses implies more routine and familiarity with closed-loop modes in this group. The findings imply the need for constant training and education with new tools in critical care, especially for inexperienced professionals.
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Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Anique Herling
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Bienefeld
- Department of Management, Technology, and Economics, Work & Organizational Psychology, ETH Zurich, Zurich, Switzerland
| | - Stephanie Klinzing
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Wegner
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | | | - Michael Karbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Elisabeth Schaubmayr
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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Cavaliere F, Biancofiore G, Bignami E, DE Robertis E, Giannini A, Grasso S, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2020: critical care. Minerva Anestesiol 2021; 87:124-133. [PMID: 33538419 DOI: 10.23736/s0375-9393.20.15495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome Italy -
| | - Gianni Biancofiore
- Department of Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo DE Robertis
- Section of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital - ASST Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grasso
- Section of Anesthesiology and Intensive Care, Department of Emergency and Organ Transplantation, Polyclinic Hospital, Aldo Moro University, Bari, Italy
| | - Marco Piastra
- Unit of Pediatric Intensive Care and Trauma Center, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Department of Emergency-Urgency and Organ Transplantation, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, University of Sassari, Sassari, Italy
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Hofmaenner DA, Herling A, Klinzing S, Wegner S, Lohmeyer Q, Schuepbach RA, Buehler PK. Use of eye tracking in analyzing distribution of visual attention among critical care nurses in daily professional life: an observational study. J Clin Monit Comput 2020; 35:1511-1518. [PMID: 33296061 PMCID: PMC7724778 DOI: 10.1007/s10877-020-00628-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
Patient safety is a priority in healthcare, yet it is unclear how sources of errors should best be analyzed. Eye tracking is a tool used to monitor gaze patterns in medicine. The aim of this study was to analyze the distribution of visual attention among critical care nurses performing non-simulated, routine patient care on invasively ventilated patients in an ICU. ICU nurses were tracked bedside in daily practice. Eight specific areas of interest were pre-defined (respirator, drug preparation, medication, patient data management system, patient, monitor, communication and equipment/perfusors). Main independent variable and primary outcome was dwell time, secondary outcomes were hit ratio, revisits, fixation count and average fixation time on areas of interest in a targeted tracking-time of 60 min. 28 ICU nurses were analyzed and the average tracking time was 65.5 min. Dwell time was significantly higher for the respirator (12.7% of total dwell time), patient data management system (23.7% of total dwell time) and patient (33.4% of total dwell time) compared to the other areas of interest. A similar distribution was observed for fixation count (respirator 13.3%, patient data management system 25.8% and patient 31.3%). Average fixation time and revisits of the respirator were markedly elevated. Apart from the respirator, average fixation time was highest for the patient data management system, communication and equipment/perfusors. Eye tracking is helpful to analyze the distribution of visual attention of critical care nurses. It demonstrates that the respirator, the patient data management system and the patient form cornerstones in the treatment of critically ill patients. This offers insights into complex work patterns in critical care and the possibility of improving work flows, avoiding human error and maximizing patient safety.
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Affiliation(s)
- Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
| | - Anique Herling
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Stephanie Klinzing
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Stephan Wegner
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
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Bodet-Contentin L, Ehrmann S. Promises and challenges of eye-tracking technology to evaluate the care process in the ICU. Minerva Anestesiol 2020; 86:1123-1125. [DOI: 10.23736/s0375-9393.20.14886-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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