Abstract
Background
There is emerging evidence indicating that distractions in the operating room (OR) are prevalent. Studies have shown a negative impact of distractions, but they have been conducted mostly with residents in simulated environments. We tested the hypothesis that intraoperative distractions are associated with deterioration in patient safety checks in the OR.
Methods
We assessed 24 elective urologic procedures. Blinded trained assessors (two surgeons, one psychologist) used validated instruments to prospectively assess in vivo frequency and severity of distractions (related to communication, phones/pagers, equipment/provisions, OR environment, other hospital departments, or a member of the OR team) and completion of safety-related tasks (related to the patient, equipment, and communication). Descriptive and correlational analyses were conducted.
Results
Mean case duration was 70 min (mean intraoperative time 31 min). A mean of 4.0 communication distractions (range 0–9) and 2.48 other distractions (range 0–5) were recorded per case (distraction rate of one per 10 min). Distractions from external visitors (addressed to the entire team or the surgeon) and distractions due to lack of coordination between hospital departments were most disruptive. Regarding safety checks, patient tasks were completed most often (85–100 %) followed by equipment tasks (75–100 %) and communication tasks (55–90 %). Correlational analyses showed that more frequent/severe communication distractions were linked to lower completion of patient checks intraoperatively (median rho –0.56, p < 0.05).
Conclusions
Distractions are prevalent in ORs and in this study were linked to deterioration in intraoperative patient safety checks. Surgeons should be mindful of their tolerance to distractions. Surgical leadership can help control distractions and reduce their potential impact on patient safety and performance.
Similar content being viewed by others
References
Weigl M, Müller A, Vincent C et al (2012) The association of workflow interruptions and hospital doctors’ workload: a prospective observational study. BMJ Qual Saf 21:399–407
Weigl M, Müller A, Zupanc A et al (2009) Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians. BMC Health Serv Res 29:110
Rivera-Rodriguez AJ, Karsh BT (2010) Interruptions and distractions in healthcare: review and reappraisal. Qual Saf Health Care 19:304–312
Grundgeiger T, Sanderson P (2009) Interruptions in healthcare: theoretical views. Int J Med Inform 78:293–307
Sevdalis N, Forrest D, Undre S et al (2008) Annoyances, disruptions, and interruptions in surgery: the disruptions in surgery index (DiSI). World J Surg 32:1643–1650. doi:10.1007/s00268-008-9624-7
Healey AN, Sevdalis N, Vincent C (2006) Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics 49:589–604
Sevdalis N, Healey AN, Vincent CA (2007) Distracting communications in the operating theatre. J Eval Clin Pract 13:390–394
Primus CP, Healey AN, Undre S (2007) Distraction in the urology operating theatre. BJU Int 99:493–494
Healey AN, Primus CP, Koutantji M (2007) Quantifying distraction and interruption in urological surgery. Qual Saf Health Care 16:135–139
Zheng B, Martinec DV, Cassera MA et al (2008) A quantitative study of disruption in the operating room during laparoscopic antireflux surgery. Surg Endosc 22:2171–2177
Wiegmann DA, El Bardissi AW, Dearani JA et al (2007) Disruptions in surgical workflow and their relationship to surgical errors: an exploratory investigation. Surgery 142:658–665
Goodell KH, Cao CG, Schwaitzberg SD (2006) Effects of cognitive distraction on performance on laparoscopic tasks. J Laparoendosc Adv Surg Tech A 16:94–98
Hsu KE, Man FY, Gizicki RA et al (2008) Experienced surgeons can do more than one thing at a time: effect of distractions on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc 22:196–201
Feuerbacher RL, Funk KH, Spight DH et al (2012) Realistic distractions and interruptions that impair simulated surgical performance by novice surgeons. Arch Surg 147:1026–1030
Miscovic D, Rosenthal R, Zingg U et al (2008) Randomized controlled trial investigating the effect of music on the virtual reality laparoscopic learning performance of novice surgeons. Surg Endosc 22:2416–2420
Monsell S (2003) Task switching. Trends Cogn Sci 7:134–140
Undre S, Healey AN, Darzi A et al (2006) Observational assessment of surgical teamwork: a feasibility study. World J Surg 30:1774–1783. doi:10.1007/s00268-005-0488-9
Russ S, Arora S, Wharton R et al (2013) Measuring safety and efficiency in the operating room: development and validation of a metric for evaluating task execution in the operating room. J Am Coll Surg 216:472–481
Abell N, Springer DW, Kamata S (2009) Developing and validating rapid assessment instruments. Oxford University Press, Oxford
Arora S, Sevdalis N, Aggarwal R et al (2010) Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc 24:2588–2593
Arora S, Sevdalis N, Nestel D et al (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147:318–330
CORESS (2013) A confidential reporting system for surgery. Available at: http://www.coress.org.uk
Hull L, Arora S, Kassab E et al (2011) Observational teamwork assessment for surgery: content validation and tool refinement. J Am Coll Surg 212:234–243
Wilson MR, Poolton JM, Malhotra N et al (2011) Development and validation of a surgical workload measure: the surgery task load index (SURG-TLX). World J Surg 35:1961–1969. doi:10.1007/s00268-011-1141-4
Acknowledgments
The National Institute for Health Research funded this research via the Imperial Center for Patient Safety and Service Quality (www.cpssq.org).
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
See Table 5.
Rights and permissions
About this article
Cite this article
Sevdalis, N., Undre, S., McDermott, J. et al. Impact of Intraoperative Distractions on Patient Safety: A Prospective Descriptive Study Using Validated Instruments. World J Surg 38, 751–758 (2014). https://doi.org/10.1007/s00268-013-2315-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-2315-z