Identification and interference of intraoperative distractions and interruptions in operating rooms

Sophia Antoniadis; Stefanie Passauer-Baierl; Heiko Baschnegger; Matthias Weigl

doi:10.1016/j.jss.2013.12.002

Identification and interference of intraoperative distractions and interruptions in operating rooms

J Surg Res. 2014 May 1;188(1):21-9. doi: 10.1016/j.jss.2013.12.002. Epub 2013 Dec 12.

Authors

Sophia Antoniadis¹, Stefanie Passauer-Baierl², Heiko Baschnegger³, Matthias Weigl⁴

Affiliations

¹ 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.
² Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
³ Clinic of Anesthesiology, University Hospital, Ludwig-Maximilians-University, Munich, Germany.
⁴ Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig-Maximilians-University, Munich, Germany. Electronic address: matthias.weigl@med.lmu.de.

PMID: 24405613
DOI: 10.1016/j.jss.2013.12.002

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.

Materials and 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.

Keywords: Distractions; Interruptions; Observation; Operating room; Surgery teamwork; Surgical teams.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Health Personnel / psychology*
Humans
Intraoperative Period
Operating Rooms / statistics & numerical data*
Surgical Procedures, Operative / psychology*
Surgical Procedures, Operative / standards
Task Performance and Analysis*
Workflow*