The effect of distractions in the operating room during endourological procedures

Abstract

BackgroundProfessionals working in the operating room (OR) are subject to various distractions that can be detrimental to their task performance and the quality of their work. This study aimed to quantify the frequency, nature, and effect on performance of (potentially) distracting events occurring during endourological procedures and additionally explored urologists’ and residents’ perspectives on experienced ill effects due to distracting factors.MethodsFirst, observational data were collected prospectively during endourological procedures in one OR of a teaching hospital. A seven-point ordinal scale was used to measure the level of observed interference with the main task of the surgical team. Second, semistructured interviews were conducted with eight urologists and seven urology residents in two hospitals to obtain their perspectives on the impact of distracting factors.ResultsSeventy-eight procedures were observed. A median of 20 distracting events occurred per procedure, which corresponds to an overall rate of one distracting event every 1.8 min. Equipment problems and procedure-related and medically irrelevant communication were the most frequently observed causes of interruptions and identified as the most distracting factors in the interviews. Occurrence of distracting factors in difficult situations requiring high levels of concentration was perceived by all interviewees as disturbing and negatively impacting performance. The majority of interviewees (13/15) thought distracting factors impacted more strongly on residents’ compared to urologists’ performance due to their different levels of experience.ConclusionDistracting events occur frequently in the OR. Equipment problems and communication, the latter both procedure-related and medically irrelevant, have the largest impact on the sterile team and regularly interrupt procedures. Distracting stimuli can influence performance negatively and should therefore be minimized. Further research is required to determine the direct effect of distraction on patient safety.

Surgical Flow Disturbances in Dedicated Minimally Invasive Surgery Suites: An Observational Study to Assess Its Supposed Superiority Over Conventional Suites

“…This could be realized by the incorporating this as a mandatory item in a preoperative checklist [5,31]. Previous research has demonstrated that surgical flow disturbances are directly related to surgical performance [25,32,33]. The number of surgical flow disturbances per procedure that we objectified was in line with similar studies.…”

“…Studies describing surgical processes were generally based on live observation in the OR; video observation has only been used infrequently [6,8,22,23]. Nevertheless, video registration is deemed superior since it is not limited by the capacity of an observer, cause-and-effect relationships are better analyzable, and the Hawthorne effect (i.e., the awareness of being observed alters the way a person behaves) is minimized [6,7,24,25].…”

Not All Interruptions are Created Equal: Positive Interruptions in Healthcare

“…Periera et al (2011) "Distraction was defined as the behavior observed when there was diversion of attention during the execution of a primary task and/or a verbal response to a secondary task related or not related to the activity performed." Persoon et al (2011) "An interruption was defined as when a distraction leads to a break in main task activity." "A distracting stimulus was defined as any event that can cause diversion from the task at hand, and a distraction was any observed behavior indicating orientation away from the main task."…”

The Epidemic of Distraction

“…Distracting events are common in the operating room, ranging from problems with equipment and unexpected procedure-related events to irrelevant conversations and interruptions. Residents and medical students are noted to be most negatively affected by distractions, whereas experienced surgeons were much more adept at multitasking and able to maintain a high level of proficiency despite distractions or interruptions [22,23]. Similarly, exposure to music or conversation as well as irritation with coworkers produces a decrease in surgical task performance by medical interns [24].…”