Distractions and interruptions in the OR: evidence for practice: perioperative clinicians must seek effective strategies that will reduce interruptions and distractions and thus make clinical care safer in the OR

AORN Journal, Sept, 2007 by Suzanne C. Beyea

Perioperative clinicians are acutely aware that distractions and interruptions can and do occur on a regular basis. Limited evidence exists, however, to help clinicians understand the nature and frequency of interruptions and distractions. Furthermore, less is known about effective strategies to reduce interruptions and distractions and thus make clinical care safer.

Recently published research reports examine the nature and types of interruptions and distractions in the OR. These reports provide numerous insights about how to most effectively approach research questions related to interruptions and distractions. They also offer a starting point for categorizing the effects of interruptions and distractions on surgical team members' performance. This column provides a summary of these recent reports and describes their relevance to clinical practice.

INTRAOPERATIVE INTERFERENCE

Healey, Sevdalis, and Vincent (1) examined distractions and interruptions in the OR during surgery. Their observations occurred in a teaching hospital in Great Britain during 50 general surgical procedures, both laparoscopic and open. The researchers defined distractions as "a break in attention, evidenced by observed behaviour, such as orienting away from a task or verbal responding." (1(p590)) An interruption was defined as a "break in task activity, evidenced by observed cessation of a task." (1(p590))

The researchers used a 9-point rating scale to record the effect of the interruption or distraction on surgical team members. A rating of "1" indicated that the observed effects on the team were only potentially distracting, whereas "9" indicated that the observed effect interrupted the flow of the procedure. Each interruption and distraction was recorded and then rated for its effect on the team. Examples of distractions and interruptions included the telephone ringing, a beeper going off, communications with external staff members, communication difficulties, and equipment-related issues. (1)

After observing 50 surgeries, these researchers found that distractions and interruptions occurred during every procedure, with a mean of 13.56 events during each surgery and a mean rate of 0.29 events per minute of surgery. The number of events per procedure ranged from a low of one event to a high of 39. Beepers going off, movement behind the video monitors, and nonprocedure-related conversation accounted for the highest frequency of interruptions. Surgeons, nurses, and anesthesia care providers all experienced distractions, but surgeons were the most frequently distracted. The researchers reported that many distractions were related to equipment, work environment, and procedural events.

The researchers concluded that the high volume of distractions and interruptions may have a negative influence on teamwork in the OR as well as on surgical outcomes. They also recommended that future research be conducted to examine the nature and types of distractions and interruptions and the effects on surgical teams and outcomes. (1)

QUANTIFYING DISTRACTION

Healey, Primus, and Koutantji (2) recently published their findings of observations from 30 urologic day-case procedures in a London, England, hospital. These researchers defined a distraction as an "observed behaviour such as orienting away from a primary task" (2(p136)) and they defined an interruption as a "distraction resulting in a primary break in primary task activity." (2(p136)) In this study, researchers used an 8-point scale to rate the effects of distractions with "1" only having a potential for distraction and "8" actually interrupting the surgical team's work. (2)

These researchers found an average of 20.47 events during each surgical procedure, with a range from one to 89 and a mean frequency of 0.45 events per minute. They also reported that the OR doors opened at the rate of 1.08 times per minute. Major sources of interruption and distraction included conversation, work environment problems, telephone calls, and equipment problems, and these interruptions had the greatest effect on the work of surgical team members.

The researchers in this study concluded that significant numbers of distractions and interruptions occurred in the OR and resulted in work interference. They recommend that future research efforts focus on the relationship between distractions or interruptions and patient safety. They also recommended an evaluation of team performance issues in surgery. (2)

DISTRACTING COMMUNICATIONS

Sevdalis, Healey, and Vincent (3) studied distracting communications in the OR. The research study occurred at a large teaching hospital in Great Britain and focused on 48 general surgery procedures and case-irrelevant communications. The data used for this study were collected during the researchers' observations recorded in the Healey, Sevaldis, and Vincent study. (1) The source and the recipient for each case-irrelevant communication were recorded as was a brief note of the content of the communication. Each event also was rated for its effects on the surgical team using the 9-point scale previously described. (1,3)