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August 28, 2014

Distractions During Surgery is Common

Patients often consider surgery to be performed in a setting where there are no distractions so that the surgeon can focus on the task at hand. Unfortunately, this impression is far from the truth where distractions abound and sometimes can approach on the chaotic.

Although anecdotal stories can be told, perhaps it is better to mention a few studies where third parties observed the goings on in the operating room.

A study done in 2013 observed 3,557 distractions over 32 separate surgical cases (averaging 111 distractions per case). 33% of the distractions were considered significant. The most common cause of the distraction was the circulator nurse or the anesthesiologist.

study in 2006 found a distraction occurred during surgery on average every 3.4 minutes.

Another study in 2007 found a significant number of case-irrelevant distractions which was felt to interfere with highly sensitive work. In this particular study, they noted that the surgeon himself accounted for 1/3 of the distractions.

What are some of these distractions that occur DURING surgery?

- Being informed of missing orders on next case or preceding case
- Time-Outs
- Preceding or next surgical patient wanting to ask a question
- Consult on an inpatient
- Equipment related questions for preceding, current, or following case
- Gossiping
- Missing equipment
- Door opening and closing (constantly)
- Change in OR staff personnel
etc, etc, etc

Most surgeons learn to block out such distractions in order to focus and operate safely. However, there are moments when distractions may reach a critical level of aggravation that the surgeon may need to speak up.

Also, a certain level of common sense must be present... Does the surgeon really need to be bothered in order to ask whether a tylenol can be given to a patient complaining of a headache... or can it wait until after the surgery is over.


References:
Distractions and the anaesthetist: a qualitative study of context and direction of distraction. Br J Anaesth. 2013 Sep;111(3):477-82. doi: 10.1093/bja/aet108. Epub 2013 Apr 16.

Distracting communications in the operating theatre. J Eval Clin Pract. 2007 Jun;13(3):390-4.

Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics. 2006 Apr 15-May 15;49(5-6):589-604.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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