From Distraction to Action: Revolutionary Approaches to Anesthesia Vigilance in the Operative Room

BY THE AMD TEAM
Published on Oct 1st, 2023 | 6-MIN READ

Series Context

This is the third installment in our 5-part series discussing ergonomics pillars for performance in the operating room (OR). Our previous blog post uncovered how workload analysis, augmented by AI, can enhance OR efficiency. In our next post, we will explore Critical Incidents in OR performance. Today, we dive deep into the realm of Attention Studies and their pivotal role in enhancing anesthesia monitoring and overall OR performance.

The Keystone of Vigilance in Anesthesia

In the intricate complexity of the OR, vigilance stands as a cardinal virtue, especially for anesthesiologists. The significance of this concept is underlined by its inclusion in the official seal of the American Society of Anesthesiologists. (American Society of Anesthesiologists (ASA) (asahq.org)) Vigilance serves to:

Recognize subtle signs and details that could drastically affect patient outcomes.
Maintain a consistent level of awareness that minimizes errors and enhances patient safety.

The Stories We Can't Ignore

An anesthesiologist carefully positioned a patient in steep Trendelenburg. As the OR lights dim, and focus shifts to electronic medical record documentation, a robotic arm inadvertently puts severe pressure on the patient’s eye.
An anesthesia provider steps away from his workstation to find an IV pump, only to return and find the IV line full of air.
A jovial conversation between an anesthesiologist and a surgeon distracts from the capnography monitor, which shows a sudden and dangerous increase in the patient’s CO2 levels.
A sleep-deprived anesthesia resident drifts to micro naps while monitoring a patient under TIVA during a long spine case under the microscope.
- A young Certified Registered Nurse Anesthetist (CRNA) checking her personal social media accounts while the surgeon is about to clamp a major vessel.
- An Anesthesia Assistant (AA) doing a neuro intervention with invasive monitoring, not aware of the height level of the pressure transducers reading false values.
Each of these situations had the potential to escalate into a grave complication. And each underscores the non-negotiable need for vigilance.

The Balancing Act: Workload and Experience

While vigilance is pivotal, it’s often influenced by external factors. High-workload situations, such as the induction phases of anesthesia, can divert an anesthesiologist’s attention away from monitors. Additionally, clinicians with less experience may struggle to balance new task demands during these high-stakes periods.

Technology to the Rescue: Learning from Other Safety-Critical Industries to Improve OR Vigilance

In industries where vigilance is a cornerstone of safety—such as nuclear plants, aviation, and rail—technological interventions have long been in place to monitor and enhance alertness. From real-time dashboard alerts in aircraft cockpits to multi-modal alarms in control rooms of nuclear facilities, the principle is consistent: technology serves to both measure and maintain a human operator’s state of alertness. Drawing inspiration from these sectors, the operating room can similarly benefit from advanced technology, particularly Artificial Intelligence (AI), in upholding the highest levels of vigilance.

In the medical setting, even with the most meticulously designed ergonomic devices, the human factor of distractibility and mental fatigue will inevitably come into play. That’s where AI can serve as a powerful adjunct. By employing real-time analytics, AI can gauge a practitioner’s eye movements, response times, and interactions with medical devices, and offer immediate, actionable feedback aimed at improving vigilance. Advanced eye-tracking technologies and response-time analysis software can be woven into a centralized AI system that parses this high-frequency data.

But it doesn’t stop there; AI can also drive dynamic adjustments in real-time. Imagine a system where AI algorithms, upon detecting signs of declining attention levels or increasing cognitive load, could trigger prioritized, contextual alerts or even recommend micro-breaks to recalibrate focus. By doing so, AI enables a closed-loop system where both technological design and human factors work in synergy to reach new heights in OR vigilance.

Learning Points

Auditory vs. Visual Vigilance: Response times for visual signals are generally longer than those for auditory signals, making the design of intraoperative anesthesia displays crucial.
Monitor-Watching Behavior: Frequent, brief glances at the monitors are the norm for anesthesiologists, and this holds true for both trainees and supervisors.
Situational Impacts: An event like anaphylaxis during induction can significantly increase the time spent on patient monitoring.

Simulators’ Role: High-fidelity simulators can reproduce real-life monitoring behaviors, offering a robust training platform.

Key Takeaways

Vigilance as a Cornerstone: Its importance can’t be overstated but is subject to influences like workload and experience.
Methodological Diversity: Multiple tools are available for studying vigilance, each with unique advantages and disadvantages.

Design for Brief Glances: Anesthesia displays should be designed to cater to the brief, frequent glances that anesthesiologists give to monitors.

Coming Up

Stay tuned for our next blog post, where we will dissect the role of Team Dynamics in maximizing OR efficiency and performance.

At Angel Medical Devices, we remain committed to revolutionizing OR standards through continual research and innovation. We invite you to join us on this transformative journey.