Surgical distractions could have disastrous consequences

By Sarah Guy

In a simulated study, the rate of major errors committed while novice surgeons were exposed to typical interruptions and distractions was almost 50%, indicating that such exposure could seriously risk patient safety.

The researchers say that operating room distractions and interruptions (ORDIs) are common and occur up to every 3 minutes in real-life scenarios.

To investigate the potential impact these ORDIs have on human error, Robin Feuerbacher (Oregon State University, Corvallis, USA) and colleagues put a group of 18 second-, third-, and research-year surgical residents through two simulated laparoscopic cholecystectomy procedures, one with ORDIs and one without.

Distractions included a ringing cell phone, an unexpected reaching movement made within the surgeons' field of vision, and noise from a dropped metal tray, and interruptions consisted of two questions; one that asked about how to treat a previous patient with breathing difficulties in the recovery room, and one asking why the surgeon chose this profession.

In all, eight (44%) of the 18 participants made a serious surgical error, defined as damage to the internal organs, ducts, and/or arteries, when completing the simulated surgery while exposed to ORDIs.

Conversely, when the same 18 participants performed the simulated surgery without ORDIs, just one (6%) committed a major error. This difference in error rate was significant, remark Feuerbacher et al in the Archives of Surgery.

Participants were also asked to perform a prospective memory task (announcing when the procedure was three-quarters complete), which 56% forgot to do while distracted, compared with just 22% while undistracted.

This "may have implications regarding patient safety in the event that a patient has a unique condition, which needs to be remembered at a certain point in the surgical procedure," writes the team.

The authors report an "interesting finding" after post-hoc analysis: that all surgical errors committed during ORDIs were done so after 13:00 hours - a significant finding that could possibly be explained by fatigue.

The team highlights that the ORDIs they induced were more frequent than is usual and were timed to occur at critical points, thus their results should not be "taken out of context."

However, "this research confirmed the high-level priority set by the Agency for Healthcare Research and Quality to reduce distractions and interruptions in an OR to improve patient safety," conclude Feuerbacher and co-investigators.

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