Impact of Intraoperative Distractions on Patient Safety: A Prospective Descriptive Study Using Validated Instruments

Sevdalis, Nick; Undre, Shabnam; McDermott, James; Giddie, Jasdeep; Diner, Lila; Smith, Gillian

doi:10.1007/s00268-013-2315-z

Cited by 72 publications

(87 citation statements)

References 35 publications

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“…NOTECHS scores correlated inversely with ‘glitch rate’, whereas OTAS scores inversely correlated with the impact of distractions6 10. NOTSS and the Cannon‐Bowers scale correlated well with each other40 46, 48.…”

Section: Resultsmentioning

confidence: 91%

“…In addition to surgeons' technical proficiency, non‐technical skills have been implicated in clinical outcomes after surgery and operating theatre efficiency. These non‐technical skills include, in addition to teamwork, attitudes towards safety, situational awareness, decision‐making, communication and theatre environment1, 2, 3, 4, 5, 6, 7, 8, 9, 10. This review was designed to focus on teamwork.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of methods for quantifying teamwork in the operating theatre

Marshall

Sykes

et al. 2018

BJS Open

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BackgroundTeamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self‐assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking.MethodsMEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter‐rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter‐rater agreement and reliability. Quantitative meta‐analysis was deemed unsuitable.ResultsForty‐eight articles were selected for final inclusion; self‐assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self‐assessment of teamwork by profession varied with the profession of the assessor. The most robust self‐assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non‐Technical Skills (NOTECHS) system, which demonstrated both test–retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96).ConclusionSelf‐assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.

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Section: Resultsmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Systematic review of methods for quantifying teamwork in the operating theatre

Marshall

Sykes

et al. 2018

BJS Open

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“…In one observational study, up to 39 events (distractions or interruptions, such as doors opening, phones/bleeps going off, irrelevant communication, etc.) were observed in a single case [4].…”

Section: Introductionmentioning

confidence: 76%

“…Observational studies [4,5] have tried to determine the effect of distraction on surgical outcomes. In an analysis of events reported via Pennsylvania Patient Report System in the period between January 2011 and May 2013 [6], 304 procedure problems were found in which distraction had played a contributing part.…”

Section: Discussionmentioning

confidence: 99%

QUIET PLEASE! Effect of distraction on simulated posterior segment surgical performance

McGowan¹,

Jawaheer²,

Young

et al. 2018

Graefes Arch Clin Exp Ophthalmol

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Purpose To determine the effect of distraction on posterior segment surgical performance using a virtual reality simulator in expert and novice ophthalmic surgeons. Methods Twenty subjects were given 6 min to read an unpublished research paper and then were randomized into two groups. Group 1 subjects were allowed 3 min to complete a standardized vitreoretinal simulated task undistracted. Group 2 subjects were asked six questions on the research paper whilst completing the same task. Each subject then performed the alternate scenario. Finally, all participants were asked six questions on the research paper whilst not operating. Results There was no evidence of a difference in the odometer values (p = 0.127), cognitive task score (p = 0.390) or overall surgical task scores (p = 0.113) between the two groups. The time taken by the distracted group was significantly greater (95% CI −26.03 to −1.67, t-test p = 0.028). Conclusion Distraction significantly increases the time taken to perform a simulated vitreoretinal surgical task for all grades of surgeon. More studies are required to understand the impact on different types of distraction on surgical performance.

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“…Emerging evidence of the prevalence of opportunity for error in the OR related to these factors has sparked research into decreasing chances for preventable harm, increasing patient safety, and improving surgical outcomes. [3][4][5][6][7] Halverson et al 3 classified communication breakdowns in the OR by type, subject, and effect. They identified 66 communication failures over a 150-hour period and observed that most communication errors were related to surgical equipment.…”

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confidence: 99%

Improving Operative Flow During Pediatric Airway Evaluation

Prager

Ruiz

Mooney

et al. 2015

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEMicrolaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure.OBJECTIVES To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. DESIGN, SETTING, AND PARTICIPANTSA QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention.INTERVENTIONS Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. MAIN OUTCOMES AND MEASURESOperating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention.RESULTS Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education regarding break timing, improvements in communication, and improvements in ordering and preparation of equipment. After the QI intervention, the surgical technologist exiting rate decreased from 20% (n = 8) to 8% (n = 5), and the circulator exiting rate decreased from 38% (n = 15) to 27% (n = 17). In addition, the rate of surgeon exiting decreased significantly (from 25% [n = 10 of 40] to 9% [n = 6 of 66]) (P = .03). The surgical technologist and circulating nurse remaining in the room were significantly associated with decreased operating time (1.84-minute decrease for surgical technologist [P = .04] and 1.95-minute decrease for circulating nurse [P = .001]).CONCLUSIONS AND RELEVANCE Gains were made in personnel exiting behavior and case timing after implementation of the QI interventions, potentially leading to decreased risk. This process is easily reproduced and is widely accepted by stakeholders.

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Impact of Intraoperative Distractions on Patient Safety: A Prospective Descriptive Study Using Validated Instruments

Cited by 72 publications

References 35 publications

Systematic review of methods for quantifying teamwork in the operating theatre

Systematic review of methods for quantifying teamwork in the operating theatre

QUIET PLEASE! Effect of distraction on simulated posterior segment surgical performance

Improving Operative Flow During Pediatric Airway Evaluation

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