Over the past several decades the majority of high risk industries have investigated the effects of distraction and / or fatigue on performance. This has been most prevalent in aviation. Fatigue, burnout, and environmental stressors are underrated, under-investigated causes of human distraction in the Operating Room.
I was lucky to have had Ann Wheelock agree to talk to me today on their June 2015 paper published in the Annals of Surgery. While there have been many papers thus far that look at distractions in the OR and their negative consequences, this group micro-dissected this problem by directly observing the OR cases and then measuring staff stress levels. As most of us suspect, they witnessed about 7 distractions per case which came to approximately one every 10 minutes. Surprisingly, the most prevalent distractor was by external staff entering the OR (81% of which were un- necessary), followed by case-irrelevant conversation within the OR team (often times initiated by other surgeons). Case irrelevant conversation during “non-stressful” periods was very common and associated with poor team performance. Not too terribly surprising was that equipment related distractions created the most intense stress. While these occurred at a lower frequency (1 every 90 minutes) this created much more stress on nursing staff than previously recognized. Overall acoustic distractions (phone calls or pages) were associated with a high stress level on the surgeons and higher workload on the anesthesia team. In the end, the study highlights that even seemingly small distractions, such as misplaced cautery pedals, can create more stress than previously recognized. Dr. Wheelock confided that these studies implicate opportunities for improvements and they are working in that direction in their facility. I look forwards to further communication with their group on those efforts.
KENNETH A. LIPSHY, MD, FACS
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