Evaluation of attention, perception, and stress levels of clinical cardiovascular perfusionists during cardiac operations: a pilot study

Merkle, Frank; Kurtovic, Dino; Starck, Christoph; Pawelke, Cynthia; Gierig, Sina; Falk, Volkmar

doi:10.1177/0267659119828563

Cited by 16 publications

(31 citation statements)

References 13 publications

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“…[20][21][22] In biomedicine, eye-tracking techniques have mostly been used to understand factors associated with interpretation of radiology studies, identification of medication allergies, reading progress notes in the EHR, and physician attention during cardiopulmonary bypass. [23][24][25][26] Pupillometry, however, remains underused in medical research despite its promising capabilities. The degree of pupillary constriction during a task is a validated biomarker for fatigue and alertness.…”

Section: Introductionmentioning

confidence: 99%

Association of Electronic Health Record Use With Physician Fatigue and Efficiency

et al. 2020

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IMPORTANCE The use of electronic health records (EHRs) is directly associated with physician burnout. An underlying factor associated with burnout may be EHR-related fatigue owing to insufficient user-centered interface design and suboptimal usability. OBJECTIVE To examine the association between EHR use and fatigue, as measured by pupillometry, and efficiency, as measured by mouse clicks, time, and number of EHR screens, among intensive care unit (ICU) physicians completing a simulation activity in a prominent EHR. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, simulation-based EHR usability assessment of a leading EHR system was conducted from March 20 to April 5, 2018, among 25 ICU physicians and physician trainees at a southeastern US academic medical center. Participants completed 4 simulation patient cases in the EHR that involved information retrieval and task execution while wearing eye-tracking glasses. Fatigue was quantified through continuous eye pupil data; EHR efficiency was characterized through task completion time, mouse clicks, and EHR screen visits. Data were analyzed from June 1, 2018, to August 31, 2019. MAIN OUTCOMES AND MEASURES Primary outcomes were physician fatigue, measured by pupillometry (with lower scores indicating greater fatigue), and EHR efficiency, measured by task completion times, number of mouse clicks, and number of screens visited during EHR simulation. RESULTS The 25 ICU physicians (13 women; mean [SD] age, 33.2 [6.1] years) who completed a simulation exercise involving 4 patient cases (mean [SD] completion time, 34:43 [11:41] minutes) recorded a total of 14 hours and 27 minutes of EHR activity. All physician participants experienced physiological fatigue at least once during the exercise, and 20 of 25 participants (80%) experienced physiological fatigue within the first 22 minutes of EHR use.

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Section: Introductionmentioning

confidence: 99%

Association of Electronic Health Record Use With Physician Fatigue and Efficiency

et al. 2020

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“…A more experienced perfusionist looked at more areas during an operation than a beginner. Merkle et al 6 could not reproduce this finding. Instead, they showed a wide variety in attention allocation among perfusionists during five phases from the start of the CPB to coming off the bypass.…”

Section: Discussionmentioning

confidence: 86%

“…The fixations were determined using the Tobii I-VT filter (minimum fixation duration of 60 ms; fixation threshold of 30°/s). From 29 defined areas of interest (AOIs), which are relevant for the work of the perfusionist, 7 AOIs were defined to be mainly relevant for the two incidents 6 (see Figure 1). Only the AOIs relevant for the pO 2 drop were evaluated (AOIs 1-4 in Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…AOIs relevant for the scenario handling the pO 2 decrease are framed in red: oxygenation monitor (1), gas blender (2), arterial pump (3) and arterial pump head (4). The AOIs relevant for the scenario handling the venous return are framed in green: arterial pump (3), arterial pump head (4), venous reservoir (5), venous occluder (6) and venous line (7). Figure 1).…”

Section: Measures Used To Test the Hypotheses And Statistical Analysesmentioning

confidence: 99%

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Simulation in perfusion: evaluating the efficacy of a specific training with eye-tracking

et al. 2020

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Background: With the aim of integrating simulation training into the training of perfusionists, we examined whether the participants were able to transfer a specific learning content to the same and different situations and assessed their feedback on the simulation training. Eye-tracking was tested as a measure and supplemented by additional measures. Methods: A 2 × 2 mixed design was used, with test time (pre- and post-test) and training group (same and different content training) as factors. In the pre- and post-test, the participant had to handle a critical situation on the cardiopulmonary bypass, namely, a drop in arterial partial oxygen pressure. Between the two test times, the participant practised under guidance the handling of either the same critical situation (Group 1) or a different one, that is, impaired venous return (Group 2). Dependent measures were fixations of the eyes on specific areas of interest on the heart-lung machine, measures of latency and subjective assessments. Moreover, participants gave feedback on the simulation training. Results: Fixation analyses showed that the training led to an increased gaze on areas of interest relevant to the drop in arterial partial oxygen pressure in both groups, with a significant increase only for Group 1. The surveys revealed a great interest in the integration of simulation training into education. Conclusion: In combination with other measures, eye-tracking is suitable for the evaluation of simulation training. Due to the positive training effects and positive participant feedback, the integration of simulation into the training of perfusionists is advocated. Concerning transfer of learning content, more research is needed.

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“…In preparation for this, individual perfusionist behavior and stress levels were evaluated in the clinical environment. 4…”

Section: Introductionmentioning

confidence: 99%

Simulation-based training of critical events during cardiopulmonary bypass: importance of a critical events checklist

et al. 2020

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Objectives: Evaluation of critical events training for clinical perfusionists is necessary to improve this educational approach. Critical events checklists are effective in reducing clinical complications, but should be tested in a simulation environment first. Individual behavior and stress response of clinical perfusionists during simulated critical events on cardiopulmonary bypass have not been evaluated yet. This study focuses on the evaluation of critical events training and critical events checklists in simulated cardiopulmonary bypass. Methods: A total of 19 clinical perfusionists from a single hospital took part in two simulated critical event scenarios. Clinical perfusionist behavior and physiological responses were recorded using eye tracking, heart rate variability, video, and audio. In addition, workloads were determined and participants were interviewed. Results: Relevant areas of interest were identified for each simulation phase. During critical event detection and subsequent decision-making, areas of interest hits and fixation durations varied with the use of a critical events checklist. Times to decision were shorter, decision quality was higher, and temporal workload was increased when the checklist was used. Evaluation of selected heart rate variability measures revealed a good correlation with pupil diameters. Conclusion: Evaluation of critical events during simulated cardiopulmonary bypass shows that the scenario is realistic and relevant for clinical practice. Integrating a critical events checklist improves the probability of correct decision-making and shortens the correct decision time. Temporal workload is increased when using a checklist. Eye tracking and heart rate variability are well suited to evaluate participants’ behaviors and stress levels. All participants welcomed simulation training for critical incidents.

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Evaluation of attention, perception, and stress levels of clinical cardiovascular perfusionists during cardiac operations: a pilot study

Cited by 16 publications

References 13 publications

Association of Electronic Health Record Use With Physician Fatigue and Efficiency

Association of Electronic Health Record Use With Physician Fatigue and Efficiency

Simulation in perfusion: evaluating the efficacy of a specific training with eye-tracking

Simulation-based training of critical events during cardiopulmonary bypass: importance of a critical events checklist

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