Distractions in the Operating Room
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PATIENT SAFETY IN ANESTHESIA (SJ BRULL, SECTION EDITOR)
Distractions in the Operating Room Kevin T. Riutort 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The goal of this review is to investigate current research in the area of operating room (OR) distractions, in particular, from the perspective of the anesthesia provider. Additionally, the concept of the “sterile cockpit” is discussed as well as the science of attention span in humans. Recent Findings Etiology of distractions may be classified as patient care related, due to technology, noise, and alarms, from interpersonal dynamics or personally driven. Studies show that at least 5% of human factor errors in the OR are due to distractions. Lack of attention has been shown to contribute disproportionately to poor outcomes due to inadequate respiratory monitoring. Summary OR distractions continue to be problematic for the anesthesia providers and patients alike. Implementation of aviationstyle distraction mitigation strategies has been proposed though there is limited research to support their efficacy. Additional research in this field is necessary to determine the etiology of patient harm and to guide development of procedures and protocols to reduce OR distractions. Keywords Operating room . Distractions . Anesthesia workload . Patient safety
Part of patient care includes managing the working environment to control and when possible eliminate distractions that reduce appropriate attention to the patient within the anesthesia care environment. -American Society of Anesthesiologists’ Statement on Distractions, 2015 [1]
Introduction Distractions from anesthesia care in operating room (OR) and their effect on patient safety are of obvious concern. The ability to sustain attention is critical to the safety of the patient and, arguably, to other operating room staff. Though analysis of the American Society of Anesthesiologists’ Closed Claims This article is part of the Topical Collection on Patient Safety in Anesthesia * Kevin T. Riutort [email protected] 1
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, USA
database shows a seemingly small number of injury claims related to operating room distraction (13 out of 5822 injury claims), a review of anesthetic incidents indicate that at least 5% of human factor-related errors were due to distractions at one institution and that distracting events negatively impacted care during 20% of surgical cases [2–4]. In a 2018 closed claims analysis of human factor errors, lack of attention has been strongly attributed to errors in respiratory monitoring [5•]. Presented is a summary of current research on operating room distractions, a discussion of the cognitive neuroscience of attention span, a description of how the aviation industry approaches distraction in the cockpit, and recommendations for distraction mitigation, policy development, and training in anesthesia.
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