Identifying intraoperative events in a simulated laparotomy video: a multinational study of inattentional blindness among anesthesiologists

Purpose Medical errors may be occasionally explained by inattentional blindness (IB), i.e., failing to notice an event/object that is in plain sight. We aimed to determine whether age/experience, restfulness/fatigue, and previous exposure to simulation education may affect IB in the anesthetic/surgi...

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Bibliographic Details
Published in:	Canadian journal of anesthesia Vol. 71; no. 9; pp. 1229 - 1237
Main Authors:	Mizubuti, Glenio B., e Lima, Lais H. N., e Lima, Rodrigo M., Ho, Adrienne K., de Cássia Rodrigues, Rita, Cagnolati, Daniel Carlos, dos Santos Júnior, Victório, Belfiore, Elio B. R., Santos, Filipe N. C., Lam, Wai Shun Vincent, Chu, Mandy, Korz, Linda T. C., Szulewski, Adam, McMullen, Michael, Burjorjee, Jessica, Sydor, Devin, Carten, Kathleen, Wang, Louie, Phelan, Rachel, Smethurst, Bethany, Cheng, Camilyn, Hopman, Wilma M., Ho, Anthony M.-H.
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-09-2024 Springer Nature B.V
Subjects:	Anesthesiology Cardiology Critical Care Medicine Hypotension Intensive Laparotomy Medical personnel Medicine Medicine & Public Health Pain Medicine Pediatrics Pneumology/Respiratory System Reports of Original Investigations Simulation inattentional blindness anesthesiology situation awareness simulation
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Summary:	Purpose Medical errors may be occasionally explained by inattentional blindness (IB), i.e., failing to notice an event/object that is in plain sight. We aimed to determine whether age/experience, restfulness/fatigue, and previous exposure to simulation education may affect IB in the anesthetic/surgical setting. Methods In this multicentre/multinational study, a convenience sample of 280 anesthesiologists watched an attention-demanding video of a simulated trauma patient undergoing laparotomy and (independently/anonymously) recorded the abnormalities they noticed. The video contained four expected/common abnormalities (hypotension, tachycardia, hypoxia, hypothermia) and two prominently displayed unexpected/rare events (patient’s head movement, leaky central venous line). We analyzed the participants’ ability to notice the expected/unexpected events (primary outcome) and the proportion of expected/unexpected events according to age group and prior exposure to simulation education (secondary outcomes). Results Anesthesiologists across all ages noticed fewer unexpected/rare events than expected/common ones. Overall, younger anesthesiologists missed fewer common events than older participants did ( P = 0.02). There was no consistent association between age and perception of unexpected/rare events ( P = 0.28), although the youngest cohort (< 30 yr) outperformed the other age groups. Prior simulation education did not affect the proportion of misses for the unexpected/rare events but was associated with fewer misses for the expected/common events. Self-perceived restfulness did not impact perception of events. Conclusion Anesthesiologists noticed fewer unexpected/rare clinical events than expected/common ones in an attention-demanding video of a simulated trauma patient, in keeping with IB. Prior simulation training was associated with an improved ability to notice anticipated/expected events, but did not reduce IB. Our findings may have implications for understanding medical mishaps, and efforts to improve situational awareness, especially in acute perioperative and critical care settings.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0832-610X 1496-8975 1496-8975
DOI:	10.1007/s12630-024-02788-0