Development of an Interactive Dashboard to Analyze Cognitive Workload of Surgical Teams During Complex Procedural Care

Abstract

In the surgical setting, team members constantly deal with a high-demand operative environment that requires simultaneously processing a large amount of information. In certain situations, high demands imposed by surgical tasks and other sources may exceed team member’s cognitive capacity, leading to cognitive overload which may place patient safety at risk. In the present study, we describe a novel approach to integrate an objective measure of team member’s cognitive load with procedural, behavioral and contextual data from real-life cardiac surgeries. We used heart rate variability analysis, capturing data simultaneously from multiple team members (surgeon, anesthesiologist and perfusionist) in a real-time and unobtrusive manner. Using audio-video recordings, behavioral coding and a hierarchical surgical process model, we integrated multiple data sources to create an interactive surgical dashboard, enabling the analysis of the cognitive load imposed by specific steps, substeps and/or tasks. The described approach enables us to detect cognitive load fluctuations over time, under specific conditions (e.g. emergencies, teaching) and in situations that are prone to errors. This in-depth understanding of the relationship between cognitive load, task demands and error occurrence is essential for the development of cognitive support systems to recognize and mitigate errors during complex surgical care in the operating room.

Dissecting Cardiac Surgery

“…Two cameras (GoPro Hero 4) were set up with a wide and a narrow field of view to record audio and video of an entire CABG surgery from patient OR arrival until departure. As a result of a previous hierarchical task analysis (HTA), 19,20 video of a CABG procedure was decomposed into 14 steps, including a total of 65 descendant substeps, covering the intraoperative phase from arrival of the patient into the OR until departure to ICU. Informed by this HTA, we edited the recording to create 14 video vignettes illustrating each CABG step.…”

Physiological synchronization and entropy as measures of team cognitive load

“…This visualization interface allows the comparison of HRV streams and entropy levels between different surgical stages and phases. In a previous work [31], our group has developed a similar visual analytic dashboard, enabling the triangulation of individual team member's cognitive load, hierarchical task analysis, video-based behavioral observation analysis and patient data from real-life cardiac surgery. Future studies can integrate these two approaches to report team cognitive load, represented as physiological synchronization, task complexity and other contextual data gathered from behavioral observation analysis.…”

Intelligent Interruption Management System to Enhance Safety and Performance in Complex Surgical and Robotic Procedures

“…[14] Each procedure was segmented in 3 stages, 13-14 steps, 160-180 sub-steps, and approximately 200 tasks. The cardiac surgery process model uses a 4-level hierarchical structure involving four sub(teams): surgeon, anesthesiologist, perfusionist and nurse.…”