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

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.

Effects of tall man lettering on the visual behaviour of critical care nurses while identifying syringe drug labels: a randomised in situ simulation

“…9 However, despite being recommended by several institutions such as the German Interdisciplinary Association for Intensive Care and Emergency Medicine, 10 to date, the evidence on the use of TML remains unclear, in part conflicting and mostly based on conventional observation studies. 8 11-14 Eye tracking as a gaze analysis technique has been used in hospitals to assess visual patterns in different real-life and simulated study settings [15][16][17][18][19][20][21][22][23] ; it has clear potential to help investigate and understand the effect of TML in drug labels.…”

“…Exclusion criteria were visual disturbances including lack of stereoscopic vision, monocular vision and achromatopsia. Based on comparable eye tracking studies, [15][16][17][18][19][20][21][22][23] a participant number of 20-30 was considered adequate and targeted. Prior to the eye tracking data collection, the recruited participants were randomised as illustrated in figure 1.…”

“…Eye tracking as a gaze analysis technique has been used in hospitals to assess visual patterns in different real-life and simulated study settings15–23; it has clear potential to help investigate and understand the effect of TML in drug labels.…”

Novice nurses’ attention to task-relevant stimuli during practice

“…Hofmaenner et al studied visual attention amongst critical care nurses during practice with a focus on "dwell time" on key elements of the critical care environment such as the respirator, patient data management system, and patient. [14] While this study did not incorporate measures of performance levels or outcomes of care, it did incorporate a measure of time that nurses focused on key elements of the environment, as in the current study. Similarly, Buehler et al compared experienced and novice nurses' gaze related to the ventilator in a critical care setting and found group differences in gaze time concerning aspects of oxygenation.…”

Differing Visual Behavior Between Inexperienced and Experienced Critical Care Nurses While Using a Closed-Loop Ventilation System—A Prospective Observational Study

“…Eye-tracking is a tool that enables monitoring of gaze patterns and visual attention. It has been used to analyze various professional scenarios in the medical field, including ICUs (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and might be beneficial in gaining a more profound understanding of the operation of closed-loop ventilation modes.…”