Impact of intraoperative distractions on patient safety: a prospective descriptive study using validated instruments.
BACKGROUND
There is emerging evidence indicating that distractions in the operating room (OR) are prevalent. Studies have shown a negative impact of distractions, but they have been conducted mostly with residents in simulated environments. We tested the hypothesis that intraoperative distractions are associated with deterioration in patient safety checks in the OR.


METHODS
We assessed 24 elective urologic procedures. Blinded trained assessors (two surgeons, one psychologist) used validated instruments to prospectively assess in vivo frequency and severity of distractions (related to communication, phones/pagers, equipment/provisions, OR environment, other hospital departments, or a member of the OR team) and completion of safety-related tasks (related to the patient, equipment, and communication). Descriptive and correlational analyses were conducted.


RESULTS
Mean case duration was 70 min (mean intraoperative time 31 min). A mean of 4.0 communication distractions (range 0-9) and 2.48 other distractions (range 0-5) were recorded per case (distraction rate of one per 10 min). Distractions from external visitors (addressed to the entire team or the surgeon) and distractions due to lack of coordination between hospital departments were most disruptive. Regarding safety checks, patient tasks were completed most often (85-100 %) followed by equipment tasks (75-100 %) and communication tasks (55-90 %). Correlational analyses showed that more frequent/severe communication distractions were linked to lower completion of patient checks intraoperatively (median rho -0.56, p < 0.05).


CONCLUSIONS
Distractions are prevalent in ORs and in this study were linked to deterioration in intraoperative patient safety checks. Surgeons should be mindful of their tolerance to distractions. Surgical leadership can help control distractions and reduce their potential impact on patient safety and performance.
Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, Wright Fleming Building (Room 507) Norfolk Place, London, W2 1PG, UK, n.sevdalis@imperial.ac.uk.
Nick
N
Sevdalis
Shabnam
S
Undre
James
J
McDermott
Jasdeep
J
Giddie
Lila
L
Diner
Gillian
G
Smith
D001288:Attention; D057189:Checklist; D002983:Clinical Competence; D003142:Communication; D017558:Elective Surgical Procedures / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D008131:London; D009873:Operating Rooms / Q000592:standards*; D061214:Patient Safety; D011446:Prospective Studies; D016037:Single-Blind Method; D013520:Urologic Surgical Procedures / Q000592:standards*