title: Visual attention of anaesthetists during simulated critical incidents.
abstract: BACKGROUND
  Situation awareness (SA) is considered to be an important non-technical skill for delivering safe anaesthesia. The spatial distribution of visual attention (VA) is an underlying process for attaining adequate SA. In the present study, a novel technology was used to assess the distribution of VA in anaesthetists delivering anaesthesia. The impact of a critical incident on VA in relation to individual experience is analysed in a descriptive and exploratory manner.
  
  
  METHODS
  Fifteen anaesthetists induced general anaesthesia in a full-scale simulator while wearing a head-mounted eye-tracking camera system. After an uneventful session, workload was increased in a randomized order by simulation of a critical incident in the second or third session. Eye tracking was used for the assessment of individual's distribution of VA to monitors, patient, and environment. A post hoc video analysis revealed information about the spatial distribution of VA. Descriptive statistics and exploratory analysis were used.
  
  
  RESULTS
  Twenty per cent of VA was directed to the patient monitor (30% during critical incident scenarios, P=0.003). The more experienced anaesthetists (more than 2 yr of work experience) increased the amount of time dedicated to manual tasks from 21% to 25% during critical incidents, whereas the less experienced decreased from 20% to 14% (P=0.061).
  
  
  CONCLUSIONS
  Distribution of attention is different during anaesthesia induction with critical incidents compared with uneventful anaesthesia induction. Less experienced anaesthesia providers spend more time on monitoring tasks. Further investigation in confirmatory designs is needed.
authors.affiliation: Department of Anaesthesiology, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany. anaesth.sekretariat@lrz.tum.de
authors.forename: C M
authors.initials: CM
authors.lastname: Schulz
authors.forename: E
authors.initials: E
authors.lastname: Schneider
authors.forename: L
authors.initials: L
authors.lastname: Fritz
authors.forename: J
authors.initials: J
authors.lastname: Vockeroth
authors.forename: A
authors.initials: A
authors.lastname: Hapfelmeier
authors.forename: T
authors.initials: T
authors.lastname: Brandt
authors.forename: E F
authors.initials: EF
authors.lastname: Kochs
authors.forename: G
authors.initials: G
authors.lastname: Schneider
mesh_terms: D000707:Anaphylaxis / Q000628:therapy; D000768:Anesthesia, General / Q000592:standards*; D001288:Attention / Q000502:physiology*; D001364:Awareness / Q000502:physiology; D002983:Clinical Competence; D004812:Epidemiologic Methods; D053483:Eye Movement Measurements; D005260:Female; D005858:Germany; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D016343:Monitoring, Intraoperative / Q000592:standards; D016544:Patient Simulation; D011597:Psychomotor Performance; D013028:Space Perception / Q000502:physiology*; D013647:Task Performance and Analysis; D016526:Workload