Distractions during critical phases of anaesthesia for caesarean section: an observational study

Abstract

SummaryAviation's 'sterile cockpit' rule holds that distractions on the flight deck should be kept at a minimum during critical phases of flight. To assess current practice at comparable points during obstetric regional anaesthesia, we measured ambient noise and distracting events during 30 caesarean sections in three phases: during establishment of regional anaesthesia; during testing of regional blockade; and after delivery of the fetal head. Mean (SD) noise levels were 62.5 (3.9) dB during establishment of blockade, 63.9 (4.1) dB during testing and 66.8 (5.0) dB after delivery (p < 0.001). The median rates of sudden, loud (> 70 dB) noises, non-clinical conversations and numbers of staff present in the operating theatre increased during each of the three phases. Conversely, entrances into, and exits from, theatre per minute were highest during establishment of regional anaesthesia and decreased over the subsequent two time periods (p < 0.001).

Situation Awareness-Oriented Patient Monitoring with Visual Patient Technology: A Qualitative Review of the Primary Research

“…Frequent acoustic and visual alarms from patient monitoring lead to alarm fatigue. Correct alerts are no longer perceived because the practitioner becomes dulled [34][35][36][37][38][39][40]. Distractions, such as background music, alarm sounds, and other cognitive and emotional stimuli, are ubiquitous in operating rooms and intensive care units and cause attention consumption, which reduces the cognitive capacity of care providers for the complex task of patient monitoring [41].…”

“…In the operating room, the care providers face various distractions, including acoustic, visual, cognitive, and emotional stressors. Distractions are a safety-relevant factor because they may impair vigilance, situation awareness, and, most importantly, decision making [34][35][36][37][38]53]. Therefore, we wanted to test whether avatar-based monitoring could improve the perception of vital signs and situation awareness under distraction compared with regular monitoring.…”

Situation Awareness&ndash;Oriented Patient Monitoring with Visual Patient Technology: A Qualitative Review of the Primary Research

“…Correct alerts are no longer perceived because the practitioner becomes dulled. [34][35][36][37][38][39][40]. Distractions, such as background music, alarm sounds, and other cognitive and emotional stimuli, are ubiquitous in operating rooms and intensive care units and cause attention consumption, which reduces the cognitive capacity of care providers for the complex task of patient monitoring [41].…”

“…In the operating room, the care providers face various distractions, including acoustic, visual, cognitive, and emotional stressors. Distractions are a safety-relevant factor because they may impair vigilance, situation awareness, and, most importantly, decision making [34][35][36][37][38]53]. Therefore, we wanted to test whether avatar-based monitoring could improve the perception of vital signs and situation awareness under distraction compared with regular monitoring.…”

The gentle family-centered cesarean

“…Much of this noise is not conducive to a calm, soothing environment, and may distract clinicians from important tasks and safety procedures. 12) Our hospital is embracing a "culture of quiet" during cesarean deliveries, to enhance safety and also to enhance the gentle cesarean concept. It is likely that an appropriate level of perioperative music may facilitate a quieter atmosphere with regard to other sources of noise during these procedures.…”