Frequency and Causes of

Distractions in the Operating Room:

Systematic ReviewÖzlem SOYER ER1

Meryem YAVUZ van GIERSBERGEN2

1Afyonkarahisar Health Sciences University, Health Sciences Faculty, Surgical Nursing

Department, Afyonkarahisar, Turkey.

2 Ege University, Nursing Faculty Surgical Nursing Department, Bornova, İzmir, Turkey.

Presentation Plan

ConclusionsResultsMaterials and

MethodsObjectiveIntroduction

• The operating room is an environment where healthcare team

members perform high-risk, complex tasks that require situational

awareness, concentration, knowledge transfer and

communication between team members.

• Distractions performed in the operating room by any member of

the perioperative team can affect patient care.

Introduction

(JCI, 2017;

AORN, 2014)

• Distractions in the operating room;

• Equipment,

• Pager/telephone,

• Radio,

• Communication unrelated to the case,

• Personnel entering and leaving the operating room,

• Noise

• Ring tones and alarms of personal electronic devices

Introduction - 2

(Reznick et al.., 2016; Persoon et al., 2011; Mackenzie and Foran, 2020; JCI, 2017; Primus et al., 2007; Beyea, 2007; Sevdalis et al., 2007; Ribeiro et

al., 2018; AORN, 2014)

In this presentation, studies examined

the frequence and causes of

distractions in operating rooms was

reviewed.

Objective

• It was conducted as a retrospective screening of the studies

published before February 2021,

• Scopus, Embase, Pubmed/MEDLINE, Cochrane Library and

Scholar databases used keywords “distractions”, “operating room”

and “nursing”.

Materials and Methods

• As a result of the search, 1225 studies were reached.

• Repetitive studies, meta-analyzes, qualitative

studies, reviews, systematic reviews, patents, case

studies, animal experiments, theses, papers, book and book

chapters, guides, reports, and studies published outside of

English were excluded.

• 16 studies were included in the study.

Materials and Methods - 2

• The articles in the study were evaluated standard data

summarization form.

• The data summarization form was included, the first author of the

studies, the year, the number of samples and their

characteristics, information about frequency and causes of

distractions in the operating room were given.

Materials and Methods - 3

Materials and Methods - 4

Germany6%

United States50%

Netherlands13%

United Kingdom

31%

Distribution of Studies by Country

Materials and Methods - 5

Types of Studies

Observational; 14

Randomized Controlled; 1

Mixed method (quantitative

and qualitative); 1

; 0

Results

• For 58 general surgery cases requiring general anesthesia, 64

healthcare workers were observed for 148 hours and 4594 events

were recorded, with an average distraction ratio of 32.8 ± 16.3.

2021

During anesthesia induction Door movements were the most

common events, 869 (63%).

During the surgery, verbal communication unrelated to

cases

During the surgery, smartphone use

Results-2

2021

Results-3

• Twelve cases of cervical endocrine surgery were observed

2016

The most common distraction type was entering and leaving

the room

The second problem was the equipment problem

Results-4

• Distractions were observed at a rate of 98%.

• The average number of intraoperative distractions was found to be 10.94 ±

7.11 per case.

The most common distractions were those initiated by external personnel entering the operating room (81%)

Followed by unrelated interviews with the case within the operating

room team

2015

Results-5

• 725 intraoperative interruptions were detected.

2015

Most frequently, people entering/leaving the operating room

(30.6%)

Phone/audio alert interruptions (23.6%) occurred.

Results-6

• During endourological cases (n = 78) an average of 20 distracting

events occurred per case.

2011

Equipment problems and non-incident-related communication interruptions are the most common causes and are the most

distracting factors in conversations

Results-7

• The total average of distractions due to surgery ranged from 5 to

192 and reached an average number of 60.8 ± 38.2.

The biggest factors associated with interruptions and distraction were identified as entering and leaving the operating room (2577 times) equipment alarms (2334 times).

2011

Results-8

• During urological cases,

2006

Equipment problems, frequent door openings, and non-incident-related conversations

were found to be an important source of intraoperative distraction.

Results-9

• Although necessary, communication events unrelated to this case are the

most distracting.

2007

Results-10

• 50 surgical cases was observed.

• The total number of distractions recorded per case ranged from

one to 39.

The most common occurrence was found to be alarms in the operating

room

the movement behind the video monitors guiding the surgical action

and conversations between staff

unrelated to the case at hand.

2006

Results-11

• Nurses providing care in surgical units have experienced many

interruptions.

• Over a three hour period, the number of interruptions ranged from

seven to 31, with an average of 19.

2003

Results-12

• It has been reported that the nurses on duty in the operating room

had unrelated communication between 32 and 74 cases per hour.

• The most common reason for unrelated communication from the

incident in the operating room is to ensure the safety of the

equipment.

2004

Results-13

• In this randomized controlled study examining the effect of noise

on clinical decision making,

• The mean score for correct responses to clinical questions during

the distracted phase was 80 % (SD ±14 %).

2016

Results-14

• 304 incident reports were disclosed, which were

cited as factors that occurred in the operating

room and contributed to distractions and/or

interruptions.

2014

Results-15

• This study evaluated noise levels in hernia repairs found that

patients who developed surgical site infection had significantly

higher noise levels during the wound closure period, suggesting a

potential distraction and loss of adherence to aseptic processes.

2015

Conclusions

Distractions are frequently observed in

the operating rooms, and the most

frequently reported distraction in

studies is when someone enters and

leaves the room.

Conclusions-2

The most frequently observed distractions in the studies performed are;

1

3

4

7

Communication events unrelated to the case

Equipment Problem

Noise/Alarms

Someone entering and leaving the room/Door movements

Conclusions-3

• A mean (SD) event rate of 32.8 (16.3) per hour. (van

Harten et al., 2020)

• The mean rate of distractions was 6.69 (SD = 4.73)

per hour. (Wheelock, 2015)

• OR teams were on average disrupted 9.78 times

per hour (Weigl et al., 2015)

• OR nurses interfered with unrelated communication

from 32 to 74 cases per hour (Sevdalis et al., 2007).

Conclusions-4

• Distractions at a rate of 0.45 events/minute (Healey et

al., 2007)

• The average total number of events per minute

was 0.62 (Pereira et al.2011)

• Distractions at a rate of 0.29 per minute (Healey et

al., 2006).

References

1. Reznick, D., Mino, J., Monteiro, R., & Siperstein, A. (2016). Perioperative inefficiencies and distractions in an endocrine surgical service.

Perioperative Care and Operating Room Management, 4, 7-11.

2. Feil, M. (2014). Distractions in the Operating Room. Pennsylvania Patient Safety Advisory, 11(2):45-52.

3. Persoon, M. C., Broos, H. J., Witjes, J. A., Hendrikx, A. J., & Scherpbier, A. J. (2011). The effect of distractions in the operating room during

endourological procedures. Surgical endoscopy, 25(2), 437-443.

4. Pluyter JR, Buzink SN, Rutkowski AF, Jakimowicz JJ (2010) Do absorption and realistic distraction influence performance of component task

surgical procedure? Surg Endosc 24(4):902–907.

5. Association of periOperative Registered Nurses-AORN. (2014). AORN position statement on managing distractions and noise during perioperative

patient care. AORN J, 99(1), 22-26.

6. Wheelock, A., Suliman, A., Wharton, R., Babu, E. D., Hull, L., Vincent, C., ... & Arora, S. (2015). The impact of operating room distractions on

stress, workload, and teamwork. Annals of surgery, 261(6), 1079-1084.

7. Weigl, M., Antoniadis, S., Chiapponi, C., Bruns, C., & Sevdalis, N. (2015). The impact of intra-operative interruptions on surgeons’ perceived

workload: an observational study in elective general and orthopedic surgery. Surgical endoscopy, 29(1), 145-153.

8. Primus, C. P., Healey, A. N., & Undre, S. (2007). Distraction in the urology operating theatre. BJU international, 99(3), 493-494.

9. Healey, A. N., Primus, C. P., & Koutantji, M. (2007). Quantifying distraction and interruption in urological surgery. BMJ Quality & Safety, 16(2), 135-

139.

10. Pereira, B. M. T., Pereira, A. M. T., Correia, C. D. S., Marttos Jr, A. C., Fiorelli, R. K. A., & Fraga, G. P. (2011). Interruptions and distractions in the

trauma operating room: understanding the threat of human error. Revista do Colégio Brasileiro de Cirurgiões, 38(5), 292-298.

11. Beyea, S. C. (2007). Distractions, interruptions, and patient safety. AORN journal, 86(1), 109-112.

12. Moss J, Xiao Y. Improving operating room coordination: communication pattern assessment. J Nurs Adm. 2004;34(2):93-100.

13. Ebright PR, Patterson ES, Chalko BA, Render ML. Understanding the complexity of registered nurse work in acute care settings. J Nurs Adm.

2003;33(12): 630-638.

References

17. Joint Commission International (JCI). (2017). Minimizing noise and distractions in the OR and procedural units 35:1-2.

18. Dholakia S, et al. The association of noise and surgical-site infection in day-case hernia repairs. Surgery. 2015;157(6):1153-6.

19. Mentis HM, et al. A systematic review of the effect of distraction on surgeon performance: Directions for operating room policy and surgical training.

Surgical Endoscopy. 2016;30(5):1713-24.

20. Ribeiro, H. C. T. C., Rodrigues, T. M., Teles, S. A. F., Pereira, R. C., Silva, L. D. L. T., & Mata, L. R. F. D. (2018). Distractions and interruptions in a

surgical room: perception of nursing staff. Escola Anna Nery, 22(4).

21. van Harten, A., Gooszen, H. G., Koksma, J. J., Niessen, T. J. H., & Abma, T. A. (2020). An observational study of distractions in the operating

theatre. Anaesthesia.

22. Mackenzie, S., & Foran, P. (2020). The impact of distractions and interruptions in the operating room on patient safety and the operating room

team: An integrative review. Journal of Perioperative Nursing, 33(3), e-34.

14. Murji, A., Luketic, L., Sobel, M. L., Kulasegaram, K. M., Leyland, N., & Posner, G. (2016). Evaluating the effect of distractions in the operating

room on clinical decision-making and patient safety. Surgical endoscopy, 30(10), 4499-4504.

15. Healey, A. N., Sevdalis, N., & Vincent, C. A. (2006). Measuring intra-operative interference from distraction and interruption observedin the

operating theatre. Ergonomics, 49(5-6), 589-604.

16. Sevdalis, N., Healey, A. N., & Vincent, C. A. (2007). Distracting communications in the operating theatre. Journal of evaluation in clinical

practice, 13(3), 390-394.