An observational study of distractions in the operating theatre

Abstract

Summary Several studies have reported on the negative impact of interruptions and distractions on anaesthetic, surgical and team performance in the operating theatre. This study aimed to gain a deeper understanding of these events and why they remain part of everyday clinical practice. We used a mixed methods observational study design. We scored each distractor and interruption according to an established scheme during induction of anaesthesia and the surgical procedure for 58 general surgical cases requiring general anaesthesia. We made field notes of observations, small conversations and meetings. We observed 64 members of staff for 148 hours and recorded 4594 events, giving a mean (SD) event rate of 32.8 (16.3) h‐1. The most frequent events observed during induction of anaesthesia were door movements, which accounted for 869 (63%) events, giving a mean (SD) event rate of 28.1 (14.5) h‐1. These, however, had little impact. The most common events observed during surgery were case‐irrelevant verbal communication and smartphone usage, which accounted for 1020 (32%) events, giving a mean (SD) event rate of 9.0 (4.2) h‐1. These occurred mostly in periods of low work‐load in a sub‐team. Participants ranged from experiencing these events as severe disruption through to a welcome distraction that served to keep healthcare professionals active during low work‐load, as well as reinforcing the social connections between colleagues. Mostly, team members showed no awareness of the need for silence among other sub‐teams and did not vocalise the need for silence to others. Case‐irrelevant verbal communication and smartphone usage may serve a physical and psychological need. The extent to which healthcare professionals may feel disrupted depends on the situation and context. When a team member was disrupted, a resilient team response often lacked. Reducing disruptive social activity might be a powerful strategy to develop a habit of cross‐monitoring and mutual help across surgical and anaesthetic sub‐teams. Further research is needed on how to bridge cultural borders and develop resilient interprofessional behaviours.

The frequency and effects of distractions in operating theatres

“…Many of the findings from this study are consistent with previous research. Distracting events, including door openings, are common in OTs and are frequent in both acute and routine procedures for adult and paediatric cases 5,9,13–18 . Case‐irrelevant communication has been previously observed to be the most common category of potential distraction 15,17–19 and equipment issues have formerly been identified as a common distraction type likely to stop an operation 14 .…”

“…Distracting events, including door openings, are common in OTs and are frequent in both acute and routine procedures for adult and paediatric cases. 5,9,[13][14][15][16][17][18] Case-irrelevant communication has been previously observed to be the most common category of potential distraction 15,[17][18][19] and equipment issues have formerly been identified as a common distraction type likely to stop an operation. 14 In contrast to the findings from previous research, distractions were not more frequent among elective procedures 20 and procedure-related distractions did not have as much impact on the surgical team.…”

Workplace distractions in the digital era – are smartphones a threat to safety or an essential tool?

“…And it is without doubt that they have much to offer as a professional tool: applications and browsers provide ready access to information often unobtainable on workplace computers with restricted internet access; encrypted messaging provides a secure means to communicate with colleagues [22]; social media is valuable for continuing professional development [23]; and mobile platforms provide an efficient method for acquiring research and audit data [24]. However, as demonstrated in a vignette from van Harten et al.’s data in which staff members gather together to laugh at a video on a colleague’s smartphone [5], the versatility of these devices makes them potentially as disruptive as they are useful. Furthermore, smartphone use carries with it a degree of professional risk.…”

“…In balancing the advantages of smartphones against their potential disadvantages, it is clear that there are times [5]. This suggests that the use of smartphones for pure leisure, for example, gaming, may not only distract the individual but also lead to tension among the team and, we believe, would be perceived with particular distain in the investigation of any incident [25];…”

Investigating the attentional focus to workplace-related soundscapes in a complex audio-visual-motor task using EEG

“…Interestingly, the focus of attention to sounds and their interpretation changes throughout a surgery. For example, conversations are sometimes perceived as disturbing as the staff member must concentrate on the task, while other times they are attended and even encouraged (van Harten et al, 2021). In the former case auditory attention is narrowed to task-relevant sounds (e.g., instructions) and tries to suppress irrelevant sounds.…”