Examining Interruptions in the Operating Room.

Abstract

Background: Since the Institute of Medicine's To Err is Human report (2000) brought nationwide attention to the negative impact of interruptions in healthcare, several patient safety organizations have acknowledged that interruptions may be a contributing factor in medical error. Although distractions and interruptions in the operating room (OR) are prevalent, studies have shown only quantitative data. Studies examining individual cognitive reactions to interruptions are lacking, which hinders the development of effective interventions to reduce interruptions. Aim: Three specific aims were (1) to gather data on potential distractions and interruptions in the OR by observation, and to identify the most frequent interruptions occurring in typical general surgery cases; (2) to develop and test simulation scenarios that could be used to gain insight into circulating nurses’ decision-making on how to respond to interruptions; and (3) to explore the cognitive process of the circulating nurses’ response to potentially interrupting situations. Methods: A mixed-methods study was conducted including observations, high-fidelity simulations, and debriefing interviews. Fifteen general surgeries were observed to record the frequency and source of distractions and interruptions that occurred during the critical tasks in the surgeries. A convenience sample of 30 OR nurses was employed to examine the performance of participants as distracting events occurred during critical tasks. Debriefing interviews were conducted with each participant while viewing portions of their video-taped simulation performance. The interview data were analyzed using qualitative methods to explore cognitive processes. Results: Data indicated that distractions and interruptions for the nurses occurred during each identified critical task. When nurse management of distractions in the scenarios was compared based on years of experience in the OR, experienced nurses more frequently violated policy in terms of allowing interrupting events to continue during time-out procedures (p < .003). Results from debriefing interviews indicated participants used two cognitive strategies to manage distractions and interruptions: prioritizing and staying focused on the primary task. Conclusions: This study provides evidence of the need to minimize unnecessary distractions and interruptions during critical tasks in the OR. It also supports the use of high-fidelity simulation as a tool to examine circulating nurses’ decision-making in management of distractions.