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At-a-Glance Monitoring: Covert Observations of Anesthesiologists in the Operating Room

Ford, Simon and Birmingham, Elina and King, Ashlee and Lim, Joanne and Ansermino, J. Mark (2010) At-a-Glance Monitoring: Covert Observations of Anesthesiologists in the Operating Room. Anesthesia and Analgesia, 111 (3). pp. 653-658. ISSN 0003-2999.

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Background: Patient monitoring displays are designed to improve patient safety, and yet little is known about how anesthesiologists interact with these displays. Previous studies of clinician behavior used an observer in the operating room, which may have altered behavior. We describe a covert observation technique to determine how often and for how long anesthesiologists actually look at the monitoring display during different segments of the maintenance phase of anesthesia, and to determine whether this changed with more than 1 anesthesia provider or during concomitant activities such as reading. Methods: Five staff anesthesiologists, 2 anesthesia fellows, 3 anesthesia residents, and 2 medical students were covertly videotaped across 10 dual anesthesia provider cases and 10 solo cases. Videotapes were later segmented (5 minutes postinduction [early maintenance], mid-maintenance, and immediately before the drapes came down [late maintenance]) and coded for looking behavior at the patient monitor, anesthesia chart, and other reading material. Results: Anesthesiologists looked at the monitor in 1- to 2-second glances, performed frequently throughout the 3 segments of maintenance anesthesia. Overall, the patient monitor was looked at only 5% of the analyzed time, which is less than has previously been reported. Monitoring behavior was constant across the segments of maintenance anesthesia and was not significantly affected by the number of anesthesia providers or role (trainee vs. senior). In contrast, charting behavior and other reading material viewing changed significantly over the analyzed segments of maintenance anesthesia. Conclusions: The presence of "at-a-glance monitoring" has implications for the design of patient monitoring displays. Displays should be developed to optimize the information obtained from brief glances at the monitor.

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Additional Information:© 2010 International Anesthesia Research Society. Accepted for publication April 24, 2010. Financial Support was provided by the Canadian Institutes of Health Research (salary support for Simon Ford and Joanne Lim) and the Michael Smith Foundation for Health Research (salary support for J. Mark Ansermino).
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Canadian Institutes of Health ResearchUNSPECIFIED
Michael Smith Foundation for Health ResearchUNSPECIFIED
Issue or Number:3
Record Number:CaltechAUTHORS:20100913-093628696
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Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:19890
Deposited By: Tony Diaz
Deposited On:16 Sep 2010 22:01
Last Modified:03 Oct 2019 02:03

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