title: Inattentional blindness and failures to rescue the deteriorating patient in critical care, emergency and perioperative settings: Four case scenarios.
abstract: BACKGROUND
  Failure to identify and respond to clinical deterioration is an important measure of patient safety, hospital performance and quality of care. Although studies have identified the role of patient, system and human factors in failure to rescue events, the role of 'inattentional blindness' as a possible contributing factor has been overlooked.
  
  
  OBJECTIVE
  To explore the nature and possible patient safety implications of inattentional blindness in critical care, emergency and perioperative nursing contexts.
  
  
  METHODS
  Analysis of four case scenarios drawn from a naturalistic inquiry investigating how nurses identify and manage gaps (discontinuities) in care. Data were collected via in-depth interviews from a purposeful sample of 71 nurses, of which 20 were critical care nurses, 19 were emergency nurses and 16 were perioperative nurses. Case scenarios were identified, selected and analysed using inattentional blindness as an interpretive frame.
  
  
  RESULTS
  The four case scenarios presented here suggest that failures to recognise and act upon patient observations suggestive of clinical deterioration could be explained by inattentional blindness. In all but one of the cases reported, vital signs were measured and recorded on a regular basis. However, teams of nurses and doctors failed to 'see' the early signs of clinical deterioration. The high-stress, high-complexity nature of the clinical settings in which these cases occurred coupled with high cognitive workload, noise and frequent interruptions create the conditions for inattentional blindness.
  
  
  CONCLUSIONS
  The case scenarios considered in this report raise the possibility that inattentional blindness is a salient but overlooked human factor in failure to rescue events across the critical care spectrum. Further comparative cross-disciplinary research is warranted to enable a better understanding of the nature and possible patient safety implications of inattentional blindness in critical care nursing contexts.
authors.affiliation: Deakin University, School of Nursing and Midwifery, Locked Bag 20000, Geelong, 3220 Victoria, Australia. Electronic address: angela.jones1@deakin.edu.au.
authors.forename: Angela
authors.initials: A
authors.lastname: Jones
authors.affiliation: Deakin University, School of Nursing and Midwifery, Locked Bag 20000, Geelong, 3220 Victoria, Australia. Electronic address: megan-jane.johnstone@deakin.edu.au.
authors.forename: Megan-Jane
authors.initials: MJ
authors.lastname: Johnstone
mesh_terms: D001288:Attention; D001364:Awareness; D002983:Clinical Competence; D000075902:Clinical Deterioration; D064648:Critical Care Nursing; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D061214:Patient Safety; D055986:Vital Signs
keywords: Critical care unit; Emergency department; Failure to rescue; Health care; Human factors engineering; Inattentional blindness; Nurses; Patient safety; Perioperative