title: Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety.
abstract: Answering telephone calls and pagers is common distraction in the operating room. We sought to evaluate the impact of distractions on patient care by (1) assessing the accuracy and safety of responses to clinical questions posed to a surgeon while operating and (2) determining whether pager distractions affect simulation-based surgical performance.
  
  
  
  We conducted a randomized crossover study of obstetrics and gynecology residents. After studying a patient sign-out list, subjects performed a virtual salpingectomy. They were randomized to a distraction phase followed by quiet phase or vice versa. In the distraction phase, a pager beeped and subjects were asked questions based on the sign-out list. Accuracy of responses and the number of unsafe responses were recorded. In the quiet phase, trainees performed the task uninterrupted. Measures of surgical performance were successful task completion, time to task completion and operative blood loss.
  
  
  
  The mean score for correct responses to clinical questions during the distracted phase was 80 % (SD ±14 %). Nineteen residents (63 %) made at least 1 unsafe clinical decision while operating on the simulator (range 0-3). Subjects were more likely to successfully complete the surgical task in the allotted time under the quiet compared to distraction condition (OR 11.3, p = 0.03). There was no difference between the conditions in paired analysis for mean time (seconds) to task completion [426 (SD 133) vs. 440 (SD 186), p = 0.61] and mean operative blood loss (mL) [73.14 (SD 106) vs. 112.70 (SD 358), p = 0.47].
  
  
  
  Distractions in the operating room may have a profound impact on patient safety on the wards. While multitasking in a simulated setting, the majority of residents made at least one unsafe clinical decision. Pager distractions also hindered surgical residents' ability to complete a simulated laparoscopic task in the allotted time without affecting other variables of surgical performance.
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 700 University Ave - 3rd Floor, Toronto, ON, M5G 1Z5, Canada. amurji@mtsinai.on.ca.
authors.forename: Ally
authors.identifier: 0000-0002-4216-4172
authors.initials: A
authors.lastname: Murji
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 700 University Ave - 3rd Floor, Toronto, ON, M5G 1Z5, Canada.|Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
authors.forename: Lea
authors.initials: L
authors.lastname: Luketic
authors.affiliation: Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, 700 University Ave - 3rd Floor, Toronto, ON, M5G 1Z5, Canada.
authors.forename: Mara L
authors.initials: ML
authors.lastname: Sobel
authors.affiliation: The Wilson Center, University of Toronto, Toronto, ON, Canada.
authors.forename: Kulamakan Mahan
authors.initials: KM
authors.lastname: Kulasegaram
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Leyland
authors.affiliation: Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Glenn
authors.initials: G
authors.lastname: Posner
mesh_terms: D001288:Attention; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D018592:Cross-Over Studies; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008297:Male; D009873:Operating Rooms; D061214:Patient Safety; D058994:Salpingectomy
keywords: Gynecology; Patient safety; Postgraduate surgical education