title: Evaluation of potential distractors in the urology operating room.
abstract: OBJECTIVE
  Surgical outcomes depend on patient and disease-related factors, as well as the technical skill of the surgeon. Various distractions in the operating room (OR) environment have been shown to negatively impact a surgeon's performance. A survey was conducted with the objective to evaluate and characterize distractions during urologic surgery.
  
  
  METHODS
  An Internet-based survey was distributed to 2057 international urologists via email between April and October 2011; questions focused on a variety of disruptive factors postulated to have a negative impact on surgical performance.
  
  
  RESULTS
  Of the 523 (25%) respondents, 58% practiced in North America, 42% were from an academic institution, and 68% had completed a clinical fellowship. In an average year, 83% reported having operated at least once while sleep deprived, 84% when significantly ill, 55% with a musculoskeletal injury, and 65% under significant social stress. Up to 38% reported that on at least one occasion, such "internal distractions" had significantly affected surgical performance and 14% perceived that at least one surgical complication was caused mainly by an internal distraction. Less than 50% had ever cancelled surgery because of an internal distraction. Music was routinely played in the OR by 57% of respondents, >67% reported answering pages and discussing consults while operating, and 25% reported "commonly" working with scrub nurses/techs that were unfamiliar with the procedure and/or instruments. Only 44% had consistent individual(s) assisting, and 27% reported that the scrub nurse/tech would "commonly" scrub out during a critical portion of the procedure. Overall, 14.5% reported that at least one complication had occurred mainly because of such "external" or "interactive" distractions.
  
  
  CONCLUSIONS
  Urologists face various distractions in the OR that can negatively impact surgical performance, potentially compromising patient outcomes and safety. Further studies are needed to elucidate the true impact of such distractions and to develop strategies to mitigate their effects.
authors.affiliation: Division of Urology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jason Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Lantz
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Matthew
authors.initials: M
authors.lastname: Gettman
authors.forename: Robert
authors.initials: R
authors.lastname: Sweet
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
mesh_terms: D000328:Adult; D000368:Aged; D001288:Attention; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000523:psychology; D009146:Music; D009873:Operating Rooms / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D061214:Patient Safety; D012892:Sleep Deprivation / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects