title: Factors compromising safety in surgery: stressful events in the operating room.
abstract: BACKGROUND
  Stressful events occur in the operating room (OR) with potentially severe consequences for patient safety. We recorded the incidence of these events in the OR, assessed the levels of stress that they caused, and investigated their detectability.
  
  
  METHODS
  Stressful incidents in the OR were recorded and rated in real time by an observer in 55 general and orthopedic procedures. Operating surgeons also rated incident stressfulness and their stress (validated State Trait Anxiety Inventory).
  
  
  RESULTS
  The total count of stressors/case ranged from 1 to 23.5 (mean, 5.87). Technical, patient, and equipment problems occurred frequently and were most stressful. Frequent but least severe stressors were distractions/interruptions, whereas least frequent/most severe stressors were teamwork problems. These events were associated with an increase in surgeons' self-reported stress. The observer was able to capture surgeons' stress accurately.
  
  
  CONCLUSIONS
  Systematically occurring stressors in the OR affect surgeons and can be assessed accurately. Further research should investigate the impact of stress on surgical performance.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor QEQM, St Mary's Hospital, South Wharf Rd., London W2 1NY, UK. sonal.arora06@imperial.ac.uk
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.forename: Louise
authors.initials: L
authors.lastname: Hull
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: Tanya
authors.initials: T
authors.lastname: Tierney
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.forename: Maria
authors.initials: M
authors.lastname: Woloshynowych
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
mesh_terms: D002983:Clinical Competence; D017558:Elective Surgical Procedures / Q000523:psychology / Q000592:standards*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D019370:Observation; D015588:Observer Variation; D016017:Odds Ratio; D009873:Operating Rooms; D019637:Orthopedic Procedures / Q000523:psychology / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011787:Quality of Health Care; D015203:Reproducibility of Results; D018570:Risk Assessment; D017751:Safety Management; D013315:Stress, Psychological; D006113:United Kingdom; D016526:Workload / Q000523:psychology; D017132:Workplace / Q000523:psychology