Disruptive intraoperative behavior is prevalent and harms multiple parties in the operating room. Institutions require comprehensive measures to prevent the behavior and to mitigate consequences.

Background: Delirium is common after cardiac surgery and is associated with adverse outcomes. Perioperative benzodiazepine use is associated with delirium and is common during cardiac surgery, which may increase the risk of postoperative delirium. We undertook a pilot study to inform the feasibility of a large randomised cluster crossover trial examining whether an institutional policy of restricted benzodiazepine administration during cardiac surgery (compared with liberal administration) would reduce delirium. Methods: We conducted a two-centre, pilot, randomised cluster crossover trial with four 4 week crossover periods. Each centre was randomised to a policy of restricted or liberal use, and then alternated between the two policies during the remaining three periods. Our feasibility outcomes were adherence to each policy (goal !80%) and outcome assessment (one delirium assessment per day in the ICU in !90% of participants). We also evaluated the incidence of intraoperative awareness in one site using serial Brice questionnaires. Results: Of 800 patients undergoing cardiac surgery during the trial period, 127/800 (15.9%) had delirium. Of these, 355/ 389 (91.3%) received benzodiazepines during the liberal benzodiazepine periods and 363/411 (88.3%) did not receive benzodiazepines during the restricted benzodiazepine periods. Amongst the 800 patients, 740 (92.5%) had !1 postoperative delirium assessment per day in the ICU. Of 521 patients screened for intraoperative awareness, one patient (0.2%), managed during the restricted benzodiazepine period (but who received benzodiazepine), experienced intraoperative awareness.

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Background Disruptive intraoperative behaviour has detrimental effects on clinicians, institutions, and patients. Abusive behaviour is an egregious form of disruptive behaviour that has a particular risk of detrimental consequences. The prevalence of abusive behaviour in the operating room (OR) is uncertain. We therefore examined the prevalence and frequency of exposure to abusive behaviour in a cohort of Canadian and US OR clinicians. Methods This was a sub-study of an international survey examining disruptive behaviour in the OR. It included a cohort of clinicians from Canada and the United States who were recruited from six perioperative associations and two institutions. Clinicians were asked about their intraoperative exposure to three abusive behaviours: physical assault, verbal threats, and intimidating invasion of their personal space. From the responses, we derived the proportion of clinicians who experienced or witnessed abuse (i.e., prevalence) and the number of abusive events experienced by all respondents (i.e., frequency). Results Of the 7,465 clinicians who responded to the original international survey, 2,875 were part of this abuse Alexander Villafranca and Kirby Magid have contributed equally to the work.