Journal of Clinical Anesthesia 40 (2017) 39
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Journal of Clinical Anesthesia
Editorial
Inattentional blindness - Do we really see what we see?
Vigilance is essential to safe anesthesia care. The ability for the anesthesiologist to note clinical change, analyze the events and take effective and timely action is critical to our practice. In this study, Dr. Ho and colleagues turn our attention to an understudied phenomenoninattentional blindness [1]. This is defined as the failure to note events or actions that are in plain view, especially when that event is unexpected [2]. In this study, practicing academic anesthesiologists and medical students were asked to report on any abnormal vital signs or activities in a video of a simulated patient. Surprisingly, the anesthesiologists miss the patient moving. The authors suggest this might be an example of inattentional blindness. Psychologists have identified the phenomenon of inattentional blindness as a failure of attention and perception [3,4]. An excellent example of this is the failure of most observers to notice a gorilla moving through a group of ball throwing students [5]. Other examples exist in medical practice including four real life scenarios where health care providers failed to see obvious clues to patient deterioration leading to patient injury [6]. Inattention blindness has also been implicated in failure to note important items in a patient handoff [7]. Perception of the environment is the first level of situational awareness, a term originating from aviation but used in industries where dynamic decision-making is essential such as anesthesiology [8,9]. Through visual, auditory and tactile prompts, the anesthesiologist must be able to continuously perceive changes to the environment. Clearly, if the item is not perceived due to inattentional blindness, then the correct action cannot take place and the situation will deteriorate. Much has been written about the human factors that interfere with anesthesiologists' ability to monitor patients effectively in complex environments. Performance factors such as fatigue, cognitive load, distractions, temperature and a host of others are known deterrents of situational awareness [10,11]. One interesting outcome of this study is that the medical students, who lack experience or expertise in monitoring, were so perceptive in finding the problems in the video. This was unexpected because expertise is also a factor in perception- the novice requires more experience to handle the high volume of information. Novices are hampered by limited attention, fatigue and limited working memory [8]. Over time they develop the mental models and heuristics needed to decrease the mental load. Knowing that we have such a weakness as inattentional blindness, what can be done to focus our attention at critical times? Performance
http://dx.doi.org/10.1016/j.jclinane.2017.03.041 0952-8180/© 2017 Elsevier Inc. All rights reserved.
factors can be optimized and we can use alarms and decision support software but these have their own issues. Automation may make many decisions for the operator but that might interfere with perception and action. If inattentional blindness occurs in the clinical setting, it is obviously a risk to vigilance and patient safety. The authors have drawn our attention to a gorilla in our midst. How to recognize this weakness and put actions in place to increase our vigilance is essential to our responsibility as ‘those who watch”. References [1] Ho AM, Leung JY, Chan MT, Contardi LH, Lo TS, Lee AK, Mizubuti GB. Inattentional blindness in anesthesiology, a simulation study. J Clin Anesth 2017 (in print). [2] Simons DJ. Attentional capture and inattentional blindness. Trends Cogn Sci 2000;4: 147–55. [3] Srinivasan N. Interdependence of attention and consciousness. Prog Brain Res 2008; 168:65–75. [4] Simons DJ, Rensink RA. Change blindness: past, present, and future. Trends Cogn Sci 2005;9:16–20. [5] Simons D aCC. Selective attention test. 2010. [6] Jones A, Johnstone MJ. Inattentional blindness and failures to rescue the deteriorating patient in critical care, emergency and perioperative settings: four case scenarios. Australian critical care: Official Journal of the Confederation of Australian Critical Care Nurses 2016. [7] Gosbee J. Handoffs and communication: the underappreciated roles of situational awareness and inattentional blindness. Clin Obstet Gynecol 2010;53: 545–58. [8] Schulz CM, Endsley MR, Kochs EF, Gelb AW, Wagner KJ. Situation awareness in anesthesia: concept and research. Anesthesiology 2013;118:729–42. [9] Wickens CD. Situation awareness: review of Mica Endsley's 1995 articles on situation awareness theory and measurement. Hum Factors 2008;50:397–403. [10] Weinger MB, Ancoli-Israel S. Sleep deprivation and clinical performance. JAMA 2002;287:955–7. [11] LeBlanc VR, Manser T, Weinger MB, Musson D, Kutzin J, Howard SK. The study of factors affecting human and systems performance in healthcare using simulation. Simulation in healthcare: Journal of the Society for Simulation in Healthcare 2011; 6(Suppl):S24–9.
Jane Easdown Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 The Vanderbilt Clinic, 37232-5614 Nashville, TN, United States E-mail address:
[email protected]. 23 March 2017
