Use of eye-tracking to evaluate human factors in accessing neonatal resuscitation equipment and medications for advanced resuscitation: A simulation study

Abstract

IntroductionEmergency neonatal resuscitation equipment is often organized into “code carts”. Simulation studies previously examined human factors of neonatal code carts and equipment; however, visual attention analysis with eye-tracking might further inform equipment design.ObjectivesTo evaluate human factors of neonatal resuscitation equipment by: (1) comparing epinephrine preparation speed from adult pre-filled syringe vs. medication vial, (2) comparing equipment retrieval times from two carts and (3) utilizing eye-tracking to study visual attention and user experience.MethodsWe conducted a 2-site randomized cross-over simulation study. Site 1 is a perinatal NICU with carts focused on airway management. Site 2 is a surgical NICU with carts improved with compartments and task-based kits. Participants were fitted with eye-tracking glasses then randomized to prepare two epinephrine doses using two methods, starting with an adult epinephrine prefilled syringe or a multiple access vial. Participants then obtained items for 7 tasks from their local cart. Post-simulation, participants completed surveys and semi-structured interviews while viewing eye-tracked video of their performance. Epinephrine preparation times were compared between the two methods. Equipment retrieval times and survey responses were compared between sites. Eye-tracking was analyzed for areas of interest (AOIs) and gaze shifts between AOIs. Interviews were subject to thematic analysis.ResultsForty HCPs participated (20/site). It was faster to draw the first epinephrine dose using the medication vial (29.9s vs. 47.6s, p < 0.001). Time to draw the second dose was similar (21.2s vs. 19s, p = 0.563). It was faster to obtain equipment from the Perinatal cart (164.4s v 228.9s, p < 0.027). Participants at both sites found their carts easy to use. Participants looked at many AOIs (54 for Perinatal vs. 76 for Surgical carts, p < 0.001) with 1 gaze shifts/second for both.Themes for epinephrine preparation include: Facilitators and Threats to Performance, and Discrepancies due to Stimulation Conditions. Themes for code carts include: Facilitators and Threats to Performance, Orienting with Prescan, and Suggestions for Improvement. Suggested cart improvements include: adding prompts, task-based grouping, and positioning small equipment more visibly. Task-based kits were welcomed, but more orientation is needed.ConclusionsEye-tracked simulations provided human factors assessment of emergency neonatal code carts and epinephrine preparation.

Application of eye‐tracking in nursing research: A scoping review

“…Seven studies were related to usability evaluations of mobile applications (Ehrler et al., 2018 ; Staab et al., 2022 ), different medical interface design (Dzisko et al., 2022 ), different code carts (Chen & Law, 2023 ), and different data/process visualization (Marquard et al., 2013 ; Wang & Or, 2020 ; Yoon et al., 2016 ).…”

“…Thirty studies included nursing students as participants. Nineteen studies included not only nurses and nursing students, but also participants outside of these two, involving doctors (Broadbent et al., 2014 ; Chen & Law, 2023 ; Cui et al., 2022 ; Fogarasi et al., 2010 ; Law & Schmolzer, 2020 ; Valek et al., 2022 ), other medical students (Anbro et al., 2020 ; Browning et al., 2016 ; Groepel et al., 2022 ; Matsumoto et al., 2010 ; O'Meara et al., 2015 ; Wagner et al., 2022 ), technical associates & emergency service associates (Henneman et al., 2010 ), respiratory therapists (Chen & Law, 2023 ; Law et al., 2018 ; Law & Schmolzer, 2020 ), administrators (Cui et al., 2022 ). See Appendix S3 – population for details.…”

“…Concurrent think‐aloud refers to encouraging participants to express their feelings and ideas in real time during the experiment while, in retrospective think‐aloud, the participants are shown their own eye‐movement gaze path videos after the experiment and express their thoughts and feelings aloud. In this review, think‐aloud was adopted in seven studies, three of which used retrospective think‐aloud (Al‐Moteri et al., 2022 ; Chen & Law, 2023 ; Yoon et al., 2016 ) and four of which used CTA (Anton et al., 2023 ; Currie et al., 2018 ; Ehrler et al., 2018 ; Henneman, Gawlinski, et al., 2017 ).…”