Implementation of Eye-Tracking Technology to Monitor Clinician Fatigue in Routine Clinical Care: A Feasibility Study

Abstract Background  Physician fatigue increases the likelihood of medical errors. Eye-tracking technology offers an unobtrusive and objective way to measure fatigue but has only been implemented in controlled settings. Objective  Our objective was to determine the feasibility of capturing physiological indicators of fatigue using eye-tracking technology in a real-world clinical setting. Methods  A mixed-methods feasibility study was performed in a convenience sample of clinicians practicing in an urban, academic emergency department from November 11 to December 15, 2021. Outcomes included fatigue assessed at the beginning and end of each shift via eye-tracking (with low scores indicating greater fatigue) and self-report. Results  Among 15 participants, self-reported fatigue and task load increased from the beginning to the end of their shift (fatigue visual analog scale [FVAS] 3.7–4.6, p  = 0.04; physician task load [PTL] 97.7–154.3, p  = 0.01). It was feasible to collect eye-tracking data at a fixed computer workstation with twice daily calibration and 61% capture of reliable data when the clinician was working at the study computer. Eye-tracking metrics did not change significantly from the beginning to the end of the shift. Eye metric fatigue score was associated with the change in PTL score (r 0.59, p  = 0.02) but not FVAS. This association persisted after adjusting for age, gender, and role, with every 10-point increase in PTL, there was a 0.02-point increase in fatigue score ( p  = 0.04). Conclusion  It is unclear whether the inability to detect fatigue via eye-tracking in routine clinical care was due to confounding factors, the technology, study design, sample size, or an absence of physiological fatigue. Further research and advances in functionality are needed to determine the eye-tracking technology's role in measuring clinician fatigue in routine care.