Interruptions in Surgery: A Comprehensive Review

Abstract

Background: Recent literature showed that analysis of interruptions can contribute to evaluating the care process in the operating room and thus understanding potential errors which may occur during surgical procedures. The aim of this comprehensive review was to summarize current knowledge on the description and impact of interruptions in surgery. Material and methods: A literature search was conducted according to a set of criteria in the databases MEDLINE, BASE, Cochrane's Library and PsycINFO. Results: 41 articles were included. 2 main methodological approaches were found, observational in the OR, or controlled in an experimental simulated environment. Interruptions in the OR were manifold and several classifications were used. The severity of interruptions differed according to the category of the interruptions. Interruptions were influenced by team familiarity and the expertise of the surgical team; high team familiarity and a high level of expertise decreased the frequency of interruptions. However, our literature search lacked controlled studies carried out in the OR. Interruptions seemed to increase the workload and stress of the surgical team and impair non-technical skills, but no clear evidence of this was advanced. Conclusions: Interruptions are probably risk factors for errors in the operating room. However, there is as yet no clear evidence of the association of interruption frequency with errors in the operating room. There is a need to define and target interruptions which should be reduced, by putting safeguards in place, thereby allowing those which could be beneficial and neglecting those with no potential consequences.

Impact of Surgical Table Orientation on Flow Disruptions and Movement Patterns during Pediatric Outpatient Surgeries

“…The definition of each type of FD can be found in Table 1. All FDs were further classified for severity of FD based on a taxonomy developed by Parker et al [21]. Flow disruptions were classified into one of six categories: 1-no impact/minor disruptionno response; 2-momentary disruption (acknowledgement of disruption, no pause in task); 3-momentary distraction (short pause < 10 s); 4-primary task interrupted (task cessation > 10 s); 5-primary task disruption (secondary task engaged); 6-repeat task.…”

Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis

“…The actual effects of FDs on the surgery itself, on providers and patient care are manifold. 11 Previous investigations found that FDs lead to higher stress levels, fatigue 12 and expand Systematic review procedure time, for example, in cardiac surgery, about 7% of operating time was associated with FD events. 13 Other studies reported larger delays up to 20%.…”

“…16 As current research suggests that different types of FDs may have specific effects-some are harmful, others beneficial and some essential for a seamless surgical workflowdetailed classification and systematic aggregation is essential. 11 Despite the growing interest and literature on surgical FDs, there is, to the best of our knowledge, no systematic review that synthesises the current research base and considers the diversity of potential effects. In contrast to previous reviews, 6 11 our review further sought to encompass the broad spectrum of potential consequences as well as to systematically appraise the methodological quality of the study base.…”

Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room

“…Any additional stress factors potentially increases this risk for patient's safety and outcomes [3,4]. One of these challenges are flow disruption events (FDs) which have been found to be ubiquitous in the OR [5,6]. FD incidents have been described as 'deviations of the natural progression of the operative procedure' [7,8].…”