title: The effect of distractions in the operating room during endourological procedures.
abstract: BACKGROUND
  Professionals working in the operating room (OR) are subject to various distractions that can be detrimental to their task performance and the quality of their work. This study aimed to quantify the frequency, nature, and effect on performance of (potentially) distracting events occurring during endourological procedures and additionally explored urologists' and residents' perspectives on experienced ill effects due to distracting factors.
  
  
  METHODS
  First, observational data were collected prospectively during endourological procedures in one OR of a teaching hospital. A seven-point ordinal scale was used to measure the level of observed interference with the main task of the surgical team. Second, semistructured interviews were conducted with eight urologists and seven urology residents in two hospitals to obtain their perspectives on the impact of distracting factors.
  
  
  RESULTS
  Seventy-eight procedures were observed. A median of 20 distracting events occurred per procedure, which corresponds to an overall rate of one distracting event every 1.8 min. Equipment problems and procedure-related and medically irrelevant communication were the most frequently observed causes of interruptions and identified as the most distracting factors in the interviews. Occurrence of distracting factors in difficult situations requiring high levels of concentration was perceived by all interviewees as disturbing and negatively impacting performance. The majority of interviewees (13/15) thought distracting factors impacted more strongly on residents' compared to urologists' performance due to their different levels of experience.
  
  
  CONCLUSIONS
  Distracting events occur frequently in the OR. Equipment problems and communication, the latter both procedure-related and medically irrelevant, have the largest impact on the sterile team and regularly interrupt procedures. Distracting stimuli can influence performance negatively and should therefore be minimized. Further research is required to determine the direct effect of distraction on patient safety.
authors: Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. mleinpersoon@hotmail.com
authors: Marjolein C
authors: MC
authors: Persoon
authors: Hans J H P
authors: HJ
authors: Broos
authors: J Alfred
authors: JA
authors: Witjes
authors: Ad J M
authors: AJ
authors: Hendrikx
authors: Albert J J M
authors: AJ
authors: Scherpbier
mesh_terms: D000328:Adult; D001288:Attention; D002983:Clinical Competence; D003558:Cystoscopy / Q000009:adverse effects / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods* / Q000523:psychology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods; D007396:Internship and Residency / Q000706:statistics & numerical data; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009873:Operating Rooms / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D013647:Task Performance and Analysis; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000193:education / Q000379:methods* / Q000523:psychology*