Eye-tracking during simulation-based neonatal airway management

Wagner, Michael; Gröpel, Peter; Bibl, Katharina; Olischar, Monika; Auerbach, Marc; Gross, Isabel T

doi:10.1038/s41390-019-0571-9

Cited by 31 publications

(21 citation statements)

References 26 publications

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“…Foglia studied 24 providers interacting with a respiratory function monitor during simulated neonatal resuscitation and found that users were willing to wear the glasses and looked at exhaled tidal volume more than any other RFM parameter (88). In a similar study Wagner found that providers use of glasses was acceptable and their use enhanced understanding of providers' gaze and perspective during simulated neonatal airway management (87). One study has assessed visual attention of neonatal team leaders during delivery room resuscitation of preterm infants using eye tracking glasses, documenting the time spent gazing at the infant and at the monitor (89).…”

Section: High Fidelity Vs Low Fidelity Simulationmentioning

confidence: 99%

“…Enhanced technological advances have seen the introduction of eye tracking software as a potential aid in both simulation training (87,88) and in delivery room care (89). Foglia studied 24 providers interacting with a respiratory function monitor during simulated neonatal resuscitation and found that users were willing to wear the glasses and looked at exhaled tidal volume more than any other RFM parameter (88).…”

Section: High Fidelity Vs Low Fidelity Simulationmentioning

confidence: 99%

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Simulation in Neonatal Resuscitation

Garvey

Dempsey

2020

Front. Pediatr.

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Approximately 1 in 10 newborns will require basic resuscitation interventions at birth. Some infants progress to require more advanced measures including the provision of positive pressure ventilation, chest compressions, intubation and administration of volume/cardiac medications. Although advanced resuscitation is infrequent, it is crucial that personnel adequately trained in these techniques are available to provide such resuscitative measures. In 2000, Louis Halmalek et al. called for a "New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment." This was one of the first articles to highlight simulation as a method of teaching newborn resuscitation. The last decades have seen an exponential growth in the area of simulation in newborn care, in particular in newborn resuscitation and stabilization. Simulation is best defined as an instructional strategy "used to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner." Simulation training has now become an important point of how we structure training and deliver improved healthcare to patients. Some of the key aspects of simulation training include feedback, deliberate practice, outcome measurement, retention of skills and curriculum integration. The term "Train to win" is often used in sporting parlance to define how great teams succeed. The major difference between sports teams is that generally their game day comes once a week, whereas in newborn resuscitation every day is potentially "game day." In this review we aim to summarize the current evidence on the use of simulation based education and training in neonatal resuscitation, with particular emphasis on the evidence supporting its effectiveness. We will also highlight recent advances in the development of simulation based medical education in the context of newborn resuscitation to ensure we "train to win."

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Section: High Fidelity Vs Low Fidelity Simulationmentioning

confidence: 99%

Section: High Fidelity Vs Low Fidelity Simulationmentioning

confidence: 99%

Simulation in Neonatal Resuscitation

Garvey

Dempsey

2020

Front. Pediatr.

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“…One advantage of this study is that it is one of the first to examine visual attention in a real-life situation in an ICU by using eye tracking [18]. A few studies have used eye tracking in critical situations, but these were simulated [6,7,[10][11][12][13][14][15][19][20][21][22][23]. Eye tracking can also be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision-making and electronic health record usability [21].…”

Section: Discussionmentioning

confidence: 99%

Use of eye tracking in analyzing distribution of visual attention among critical care nurses in daily professional life: an observational study

Hofmaenner

Herling

Klinzing

et al. 2020

J Clin Monit Comput

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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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“…Reply to: Differences in intubators' visual attention during neonatal endotracheal intubation Thank you for the thoughtful letter reflecting on the differences between our observational study on visual attention during endotracheal intubation 1 and the simulation study by Wagner et al 2 In addition to the reasons cited by Gröpel et al, there may be other reason why visual attention differ between simulated and real endotracheal intubations. First, team composition and teamwork may have a significant impact how our intubators perform and how they divided their visual attention.…”

Section: Letter To the Editormentioning

confidence: 97%

Reply to: Differences in intubators' visual attention during neonatal endotracheal intubation

Law

Schmölzer

2020

Resuscitation

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Letter to the EditorReply to: Differences in intubators' visual attention during neonatal endotracheal intubation Thank you for the thoughtful letter reflecting on the differences between our observational study on visual attention during endotracheal intubation 1 and the simulation study by Wagner et al. 2 In addition to the reasons cited by Gröpel et al., there may be other reason why visual attention differ between simulated and real endotracheal intubations. First, team composition and teamwork may have a significant impact how our intubators perform and how they divided their visual attention. At our institution, endotracheal intubation is a team effort, with many tasks delegated to team members other than the intubator. Specifically, equipment preparation is delegated to respiratory therapists, and medication preparation delegated to nurses. This allows our intubators to focus more on the infant and less on the equipment.Another possible explanation is that much of the information obtained from patient observation may be difficult to duplicate in simulation. Even using hi-fidelity manikins, participants may not feel that they obtain the same amount of information from the manikin then they would from an actual patient. In our observations, intubators paid particular attention to the respiratory effort of the infant, evidence of adequate mask ventilation through chest raise, and examined for signs of efficacy of muscle relaxation. In a study comparing visual attention in simulated vs. actual anesthetic cases, a similar observation was made where anesthetists focused less on the manikin then they did on actual patients. 3 Both simulation and real-life studies provide valuable information on human factors related to critical healthcare tasks such as endotracheal intubations. Furthermore, as we move towards using simulation as a training tool, it is imperative that we gain an understanding in the differences in HCP behaviors during simulated vs. real clinical tasks. As opportunities to practice real life neonatal endotracheal intubation decrease, simulation play a crucial role in providing a controlled, safe, and reproducible environment for both training and research.

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Eye-tracking during simulation-based neonatal airway management

Cited by 31 publications

References 26 publications

Simulation in Neonatal Resuscitation

Simulation in Neonatal Resuscitation

Use of eye tracking in analyzing distribution of visual attention among critical care nurses in daily professional life: an observational study

Reply to: Differences in intubators' visual attention during neonatal endotracheal intubation

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