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Annoyances, Disruptions, and Interruptions in Surgery: The Disruptions in Surgery Index (DiSI)

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Abstract

Background

Recent studies have investigated disruptions to surgical process via observation. We developed the Disruptions in Surgery Index (DiSI) to assess operating room professionals’ self-perceptions of disruptions that affect surgical processes.

Materials

The DiSI assesses individual issues, operating room environment, communication, coordination/situational awareness, patient-related disruptions, team cohesion, and organizational issues. Sixteen surgeons, 26 nurses, and 20 anesthetists/operating departmental practitioners participated. Participants judged for themselves and for their colleagues how often each disruption occurs, its contribution to error, and obstruction of surgical goals.

Results

We combined the team cohesion and organizational disruptions to improve reliability. All participants judged that individual issues, operating room environment, and communication issues affect others more often and more severely than one’s self. Surgeons reported significantly fewer disruptions than nurses or anesthetists.

Conclusion

Although operating room professionals acknowledged disruptions and their impact, they attributed disruptions related to individual performance and attitudes more to their colleagues than to themselves. The cross-professional discrepancy in perceived disruptions (surgeons perceiving fewer than the other two groups) suggests that attempts to improve the surgical environment should always start with thorough assessment of the views of all its users. DiSI is useful in that it differentiates between the frequency and the severity of disruptions. Further research should explore correlations of DiSI-assessed perceptions and other observable measures.

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Acknowledgment

The authors thank Ms. Sonal Arora for her useful feedback on previous drafts of the present paper.

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Authors and Affiliations

  1. Clinical Safety Research Unit, Department of Bio-Surgery & Surgical Technology, Imperial College, 10th floor, QEQM, St. Mary’s Hospital, South Wharf Road, London, W2 1NY, UK

    Nick Sevdalis, Damien Forrest, Shabnam Undre, Ara Darzi & Charles Vincent

  2. National Patient Safety Agency, London, UK

    Nick Sevdalis

Authors
  1. Nick Sevdalis
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  2. Damien Forrest
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  3. Shabnam Undre
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  4. Ara Darzi
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  5. Charles Vincent
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Corresponding author

Correspondence to Nick Sevdalis.

Appendix: Full Analysis of Variance (ANOVA)

Appendix: Full Analysis of Variance (ANOVA)

The following factors (independent variables) were included in the ANOVA:

  • Group (surgical versus anesthetic versus nursing); measured between-subjects

  • Disruption type (individual issues versus operating room environment versus communication versus coordination/situational awareness versus patient-related disruptions versus team/organizational issues); measured within-subjects

  • Target (self versus others); measured within-subjects

Because both between- and within-subjects factors were included in the analysis, this was a mixed-model ANOVA.

(i) Disruption frequency

  • Main effect of target (F(1, 38) = 12.41, p < 0.01): the frequency of all disruptions was estimated higher for others than for the self.

  • Interaction between target and disruption type (F(5, 190) = 4.43, p < 0.01): the breaking down of the interaction into “self” versus “other” differences across the six disruption types revealed that the participants judged that others are more frequently affected than themselves by individual disruptions (t(50) = 4.14, p < 0.001), by disruptions in the operating room environment (t(50) = 4.07, p < 0.001), and by communication issues (t(53) = 3.21, p < 0.01). The remaining disruptions (i.e., coordination/situational awareness, patient-related disruptions, and team/organizational disruptions) were judged to affect everyone in the operating room equally often.

  • Main effect of group (F(2, 38) = 4.4, p < 0.05): surgeons estimated lower frequencies for all disruptions (M surgeons  = 25%; SE = 5%) than nurses (M nurses  = 42%; SE = 4%; p < 0.01) or anesthetists/operating departmental practitioners (M anaesthetists/ODPs  = 37%; SE = 4%; p < 0.05).

(ii) Disruption contribution to error

  • Main effect of target (F(1, 36) = 6.20, p < 0.05): the disruptions were judged to be contributing to others’ errors more than to errors of one’s own.

  • Main effect of disruption type (F(5, 180) = 16.68, p < 0.001): patient-related disruptions were judged as more serious contributors to error than all other disruptions (all pair-wise ps < 0.01) and communication issues were judged as less serious contributors than all disruptions except team/organizational disruptions (all pair-wise ps < 0.05).

  • Interaction between Target and Disruption type (F(5, 180) = 4.79, p < 0.001): the breaking down of the interaction into “self” versus “others” differences across the six disruption types revealed that the participants judged others as more vulnerable than themselves to error resulting from individual disruptions (t(51) = 3.99, p < 0.001), from disruptions in the operating room environment (t(53) = 3.36, p < 0.01), and from communication issues (t(58) = 2.46, p < 0.05). The three remaining disruptions were judged as contributing equally to errors for everyone in the operating room.

(iii) Goal obstruction by disruption

  • Main effect of disruption type (F(5, 180) = 13.04, p < 0.001): patient-related disruptions were judged as more serious contributors to error than all other disruptions (all pair-wise ps < 0.01), and team/organizational disruptions were judged as less serious contributors than all disruptions except communication issues (all pair-wise ps < 0.05).

  • Interaction between target and disruption type (F(5, 180) = 5.77, p < 0.001): the breaking down of the interaction into “self” versus “others” differences across the six disruption types revealed that the participants judged that the goals of the procedure are more affected for others than they are for themselves by individual issues (t(53) = 3.51, p < 0.01), by disruptions in the operating room environment (t(54) = 2.21, p < 0.05), and by communication problems (t(59) = 2.49, p < 0.05). No such differences were obtained for the remaining three disruptions.

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Sevdalis, N., Forrest, D., Undre, S. et al. Annoyances, Disruptions, and Interruptions in Surgery: The Disruptions in Surgery Index (DiSI). World J Surg 32, 1643–1650 (2008). https://doi.org/10.1007/s00268-008-9624-7

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