A Taxonomy of Distraction Mitigation Strategies for Operating Rooms

摘要

Operating rooms (ORs) are complex dynamic settings that require individual OR team members to conduct focused and cognitively demanding tasks. The team focus may be disrupted by distractions such as alarms, phone calls, or in-person communications irrelevant to work. Some of these distractions can result in a break in task performance which are known as interruptions (Healey, Primus, & Koutantji, 2007). Distractions are inherent in the ORs and are generally considered as harmful (Mentis, Chellali, Manser, Cao, & Schwaitzberg, 2016). Studies have shown that distractions are associated with disrupted surgical flow (Wiegmann, Elbardissi, Dearani, Daly, & Sundt Ⅲ, 2007), decreased cognitive task performance (Hsu, Man. Gizicki, Feldman, & Fried, 2008), increased time taken to complete surgical tasks, impaired dexterity, and increased surgical error rates (Ahmed, Ahmad, Stewart, Francis, & Bhatti, 2015). Individuals can experience prospective memory failures after an interruption, i.e., forgetting to resume the interrupted task or resuming the task at an incorrect step (Reason & Hobbs, 2003). Negative effects of distractions have been the central concern of these studies; however, literature is increasingly agreeing on the potential benefits of distractions (e.g., communication) such as decreasing stress, boredom, and mental fatigue (Weigl, Antoniadis, Chiapponi, Bruns, & Sevdalis, 2015) and improving surgical task performance (Kyrillos & Caissie, 2017). It is important to foster positive distractions, while mitigating the negative ones. Research is limited when explaining the conditions in which OR distractions are beneficial or harmful and the consequences of removing or reducing these distractions. Despite this lack of evidence, several techniques, mostly adapted from other high risk industries such as aviation, have been suggested for mitigating OR distractions (see Feil, 2014 for a comprehansive review).