attention can be correlated with individual SA,
but this remains unclear. 16
Data displays
In the OR, the anaesthetist monitors up to
32 real-time variables while performing many
other tasks (for example, intubation, administration
of anaesthetic gases and drugs, insertion of
intravascular catheters, communication with the
surgeon etc). This large workload can lead to deficits
in performance. Failures in detecting changes in the
patient’s situation can lead to critical incidents;
therefore, effective information display is essential.
Patient monitors provide relevant information
required for establishing accurate SA, 3 and
improving the design of the displays in a way that
facilitates the extraction of time-critical events
can avoid harmful patient outcomes. 17 In
traditional displays, single pieces of information,
each derived from a single sensor, are presented;
the anaesthetist then must then integrate all this
information to obtain an accurate picture of the
patient’s state. This is time consuming and
involves a high cognitive demand. Therefore,
a recent and growing field of study concerning
the improvement of monitor displays has been
developed. The use of graphical objects, that
integrate different variables and facilitate rapid
visual perception of the patient’s situation, have
the potential to improve clinical performance by
reducing detection times for critical events and
increasing the anaesthetist’s SA. 17,18
Conclusions
The OR is a complex and critical environment
where conditions may change in a short period of
time. The knowledge and improvement of SA can
increase the performance in this domain and,
therefore, provide better patient outcomes.
To accomplish this common goal, all members of
the surgical team must perform their roles with
full understanding of the situation. Training and
experience can provide the skills and behaviours
that influence the achievement of good SA. It is
widely recognised that critical event management
in patient simulators is a potentially beneficial
tool: however, there are still no sufficient
methods to objectively determine its
effectiveness. SA can also be improved through
effective data presentation and, so far, several
promising studies on OR displays have been
presented but further research is needed.
behavioural markers of SA (for example
Anaesthetists’ Non-Technical Skills scale, Ottawa
Global Rating Scale). The SA Rating Technique
is less intrusive but was found to have no
correlation with measured SA using SAGAT. 3,15
Rating techniques using behavioural markers are
applicable in clinical settings but they are
intended to assess non-technical skills in general
and are not designed to specifically assess SA. 3
Performance-based techniques evaluate the global
performance associated with a measure (for
example, simulated patient outcome); however,
they do not inform directly about SA. More
recently, eye tracking devices have been used to
evaluate SA during simulated critical incidents,
hypothesising that the distribution of visual
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