Human Factors Influencing the Decision to Use Videolaryngoscopes for Intubation in the Operating Room

Abstract

Objective: This study aimed to explore (1) the human factors influencing the decision to use videolaryngoscopes (VLs) instead of conventional Macintosh blades for intubation in operating room settings, and (2) the reasons anesthesia providers report for selecting VLs in clinical practice. Materials and Methods: A prospective observational study was conducted from September 2020 to June 2021 among anesthesia personnel at Siriraj Hospital. Eligible participants included anesthesiologists, anesthesia residents, and nurse anesthetists who used a VL for intubating adult patients under general anesthesia. Participants completed a structured questionnaire based on the Human Factors Investigation Tool (HFIT) model, which captured internal and external human factors, device selection rationale, and self-assessed performance. Data were analyzed using descriptive and inferential statistics. Results: A total of 176 VL intubation events were analyzed. Internal human factors such as stress (18.2%), discomfort (15.3%), and fatigue (10.2%), along with external factors like a pushy environment (15.3%) and after-hours work (7.9%), influenced VL use. The most cited reasons for choosing VLs included improved glottic visualization (39.8%), device familiarity (29.5%), fewer complications (14.8%), and better supervision (7.4%). These findings align with key domains of the HFIT model, including situational awareness, decision-making, and environmental conditions. Conclusion: This study demonstrates that the decision to use VLs is shaped not only by technical considerations but also by a range of human and contextual factors. The HFIT model provided a valuable framework for understanding how providers navigate complex clinical environments. These insights support targeted interventions in training and workplace design to enhance decision-making and airway safety.