500 - Use of Eye-Tracking to Evaluate Human Factors in Accessing Neonatal Resuscitation Equipment And Medications For Advanced Resuscitation: A Simulation Study

Saturday, April 23, 2022

3:30 PM – 6:00 PM US MT

Poster Number: 500
Publication Number: 500.232

Linda Gai Rui Chen, 51, Edmonton, AB, Canada; Brenda Hiu Yan Law, University of Alberta, Edmonton, AB, Canada

Presenting Author(s)

Brenda Hiu Yan H. Law, MD, MSc (she/her/hers)

Assistant Professor
University of Alberta Faculty of Medicine and Dentistry
Edmonton, Alberta, Canada

Background: Neonatal resuscitation equipment is often grouped in different “Code Carts” at different institutions. Simulation have examined human factors of this equipment; however, multi-modal studies might further inform equipment design.

Objective: Using simulations with eye-tracking, surveys, and interviews, we aim to evaluate 1) epinephrine preparation and 2) locating/obtaining items from carts.

Design/Methods: This was a two-site randomized crossover simulation study. Site 1 is a level 3 NICU with carts for standard neonatal resuscitation. Site 2 is a level 3/4 surgical NICU, with carts for peri-operative infants, with more compartments and task-based kits. Healthcare providers (HCPs) donned eye-tracking glasses (Tobii Glasses 2, Tobii Technology, Inc) then drew 4 epinephrine doses with 2 methods, randomized to start with adult prefilled syringes or multiple access vials. HCPs then obtained items for 7 tasks (Intubation, PIV start, UVC insert, epinephrine, adenosine push, thoracocentesis, and NG insert). Finally, HCPs completed surveys and semi-structured interviews while viewing their eye-tracked videos. Epinephrine preparation times were compared. Time to obtain items and survey responses were compared between carts. Areas of interest (AOIs) and gaze shifts between AOIs were obtained from eye-tracking to quantify visual search complexity. Interviews were subject to thematic analysis.

Results: Forty HCPs participated (20/site). It was faster to draw 2 epinephrine doses from vials than with prefilled syringes (median 52.8s vs 64.3s, p< 0.001). It was faster to obtain items from Site 1’s cart (164.4s vs 228.9s, p=0.027). Most (88%) found the carts easy to use. Visual searches were complex; HCPs looked at median of 54 distinct AOIs for Site 1 and 76 AOIs for Site 2 (p < 0.001), with ~1 gaze shifts/sec for both. Site 2’s cart had more compartments, adding to search time.

Themes for epinephrine included: Facilitators and Threats to Performance, and Discrepancies due to Stimulation Conditions. Themes for the carts included: Facilitators and Threats to Performance, Suggestions, Orienting with Prescan and Discrepancies due to Simulation Conditions. Some HCPs found the prefilled syringe complex and did workarounds. HCPs suggested prompts to differentiate look-a-like items, grouping items by task, and positioning small items more visibly.Conclusion(s): Eye-tracked simulations provided a human factors assessment of neonatal code carts, identifying strengths and targets for improvement. Adult prefilled epinephrine syringes were complex to use for neonatal doses. Visual searches were complex.
Table 1

Table 1. Summary of Results
Table 2

Table 2. Summary of Interview Themes and Sub-themes