title: Identification and interference of intraoperative distractions and interruptions in operating rooms.
abstract: BACKGROUND
  Intraoperative interruptions potentially interfere with surgical flow, contribute to patient safety risks, and increase stress. This study aimed to observe interruption events in operating rooms (ORs) and to measure surgical team's intraoperative interference from interruptions during surgery.
  
  
  METHODS
  Sixty-five surgical cases were observed at two surgical clinics in Germany (mainly abdominal and orthopedic surgery). An established observational tool was successfully adapted to German ORs. Various disruptions to surgical work were captured with a predefined coding scheme. In addition, the severity of each observed interruption was rated on behaviorally anchored scale to define the level of OR team involvement. Pilot test supported tools' reliability.
  
  
  RESULTS
  Mean intraoperative duration was 1 h, 23 min (standard deviation = 50:55 min). Overall N = 803 intraoperative interruptions and disruption events were observed. Most frequent were people entering or exiting the OR and telephone or beeper calls. On average, OR teams were distracted or interrupted 9.82 times per hour (standard deviation = 3.97). Equipment failures and OR-environment-related disruptions were rated as the highest interference of OR team functioning. The involved OR professions were differently affected by interruption events. Distribution of intraoperative interruptions within the procedure varied significantly; during early stages of the case, significantly more interruptions were observed.
  
  
  CONCLUSIONS
  The study demonstrates the high level of interference in ORs. Furthermore, it provides a useful measure for intraoperative workflow disruptions and their interference of OR team functioning. OR environments need to be well designed to reduce unnecessary interruptions and distractions, so that surgical teams can manage their surgical tasks efficiently and safely.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany; Department of Obstetrics and Gynecology, University Hospital Munich, Großhadern, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Antoniadis
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Passauer-Baierl
authors.affiliation: Clinic of Anesthesiology, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Baschnegger
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany. Electronic address: matthias.weigl@med.lmu.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Weigl
mesh_terms: D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007432:Intraoperative Period; D009873:Operating Rooms / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000523:psychology* / Q000592:standards; D013647:Task Performance and Analysis; D057188:Workflow
keywords: Distractions; Interruptions; Observation; Operating room; Surgery teamwork; Surgical teams