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Distractions in the OR How to Identify and Manage Them
Distractions in the OR
How to Identify and Manage Them
By ALISON McCOOK
The operating room is a surprisingly busy place.
Not long ago, a group of researchers at St. Michael’s Hospital and the University of Toronto reviewed surgical “black box” recordings, taken during 25 total laparoscopic hysterectomies (General Surgery News, July 2015, page 1; bit.ly/3FcRLcG). These recordings included various data points from around the OR, such as noises, team activity and physiologic details from the patient. During each procedure, the team experienced a median of 89 door openings, 158 machine alarms and 10 incoming calls to the OR. More than 60% of the cases included a conversation that was unrelated to it (Cureus 2021;13[7]:e16218).
The number of distractions during the procedures surprised study author Pansy Schulthess, RN, the manager of quality, patient safety and education, Perioperative Services at St. Michael’s, who spoke about the study at the Association of periOperative Registered Nurses (AORN) 2021 virtual Global Surgical Conference & Expo (session 1010).
“Prior to reviewing the black box data and videos, I didn’t have a good understanding of how often distractions were occurring and what their implications might be,” Ms. Schulthess told attendees. The equivalent, she said, would be if during her presentation—which lasted roughly half the time of a typical hysterectomy—there were approximately 45 door openings and 80 alarms. “It would be very hard for me to convey information to you in an effective way with the constant distractions.”
Many studies have shown that distractions are a way of life in the OR and can affect surgical performance (Surg Endosc 2016;30[5]:1713-1724). By studying the nature and timing of OR distractions captured by the black box recordings, clinicians can develop ideas for how to mitigate them and minimize their impact, Ms. Schulthess said. “The black box videos and data have helped me in my own practice highlight and pay more attention to the times in a procedure when it might be easier to communicate and when it would be distracting.”
During her session, Ms. Schulthess played several videos that reenacted actual black box recordings, showing how common distractions can disrupt procedures in numerous ways. They ranged from loud music, to a surgical staff member needing to scrub out because of a phone call, to circulating people watching a video on a phone and not noticing a new scrub person was waiting for their gown to be tied, thus delaying the transition.
Each facility should analyze its own distractions, but based on the recordings captured at St. Michael’s, Ms. Schulthess and
her colleagues presented the following advice to reduce OR distractions: • Ensure proper communication. ORs need to always make sure people can communicate with one another, despite distractions. As an example, if music is played too loudly, turn it down during key moments. Enforce strict rules about phones in the OR. “Sometimes, we’re not aware of how distracting being on your cell phone is.” nversa • Respect critical periods. Distractions can be particularly 18). disruptive during critical periods in a procedure, which ur- differ according to your specialty, Ms. Schulthess noted. er For anesthesia, that critical time may be intubation e and extubation; for surgeons, it may be creating an anastomosis. If distractions arise during a critical period, you can politely inform your colleagues that you can’t shift your focus at the moment. “We need to recognize each other’s critical phases.” • Stay focused on the procedure. Surgical staff are always multitasking, and it’s important to anticipate inevitable distractions. For instance, some surgical staff may have to teach while performing a procedure. “It’s important to always pay attention to the procedure, even if you’re trying to communicate something important to someone else.” Lisa Spruce, DNP, RN, agreed that distractions are an issue in the perioperative setting, which is “one of the most complex work environments in health care.” Dr. Spruce reiterated the idea that ORs need to minimize distractions that don’t serve a clinical function and respect critical periods during surgery, and suggested the creation of a “no-interruption zone” during which nonessential talk and work are prohibited. However, facilities can’t take a top-down approach to designing interventions to reduce distractions and noise, cautioned Dr. Spruce, the director of evidence-based perioperative practice at AORN. “Making changes to minimize noise and distractions should be done by a multidisciplinary team approach to create a safer environment for patients and perioperative team members.” This work should apply not just to traditional ORs, she noted, but anywhere invasive procedures are performed, such as ambulatory surgery centers. “Operative and invasive procedures are high-risk activities that require vigilance, concentration and situational awareness,” Dr. Spruce said. “Distractions and noise can cause disruptions in communication and teamwork, which may contribute to errors that can compromise patient safety.” ■
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