Distraction and Interruption in Anaesthetic Practice
Distraction and Interruption in Anaesthetic Practice
Background Distractions are a potential threat to patient safety. Previous research has focused on parts of the anaesthetic process but not on entire cases, and has focused on hazards rather than existing defences against error
Methods We observed anaesthetists at work in the operating theatre and quantified and classified the distracting events occurring. We also conducted semi-structured interviews with consultant anaesthetists to explore existing strategies for managing distractions.
Results We observed 30 entire anaesthetics in a variety of surgical settings, with a total observation time of 31 h 2 min. We noted 424 distracting events. The average frequency of distracting events, per minute, was 0.23 overall, with 0.29 during induction, 0.33 during transfer into theatre, 0.15 during maintenance, and 0.5 during emergence. Ninety-two (22%) events were judged to have a negative effect, and 14 (3.3%) positive. Existing strategies for managing distractions included ignoring inappropriate intrusions or conversation; asking staff with non-urgent matters to return later at a quieter time; preparation and checking of drugs and equipment ahead of time; acting as an example to other staff in timing their own potentially distracting actions; and being aware of one's own emotional and cognitive state.
Conclusions Distractions are common in anaesthetic practice and managing them is a key professional skill which appears to be part of the tacit knowledge of anaesthesia. Anaesthetists should also bear in mind that the potential for distraction is mutual and reciprocal and their actions can also threaten safety by interrupting other theatre staff.
Distractions and interruptions are common in many healthcare settings. It is well recognized in other disciplines, such as aviation, that distraction increases the risk of error and within anaesthesia, distraction has been implicated in the development of critical incidents. In recent years, studies have been conducted to analyse how the theatre environment affects surgical performance. Later studies have examined the anaesthetist and the anaesthetic team, but these have focused on the induction of anaesthesia or split the process down to look at each phase separately, missing critical phases such as transfer between anaesthetic room and theatre. In contrast, we aimed to determine the frequency and nature of distracting events to the anaesthetist throughout the entire anaesthetic process and to analyse the possible consequences these might have on the patient. Further, Reason's systemic model of accident causation not only describes hazardous acts and omissions but also postulates the presence of countervailing factors which act to mitigate or neutralize the hazards. This system property is termed resilience, and our secondary aim was to explore this by documenting the existing strategies already used by practising anaesthetists in dealing with distractions and interruptions. We proposed to do this by conducting and qualitatively analysing in-depth interviews with experienced anaesthetists.
Abstract and Introduction
Abstract
Background Distractions are a potential threat to patient safety. Previous research has focused on parts of the anaesthetic process but not on entire cases, and has focused on hazards rather than existing defences against error
Methods We observed anaesthetists at work in the operating theatre and quantified and classified the distracting events occurring. We also conducted semi-structured interviews with consultant anaesthetists to explore existing strategies for managing distractions.
Results We observed 30 entire anaesthetics in a variety of surgical settings, with a total observation time of 31 h 2 min. We noted 424 distracting events. The average frequency of distracting events, per minute, was 0.23 overall, with 0.29 during induction, 0.33 during transfer into theatre, 0.15 during maintenance, and 0.5 during emergence. Ninety-two (22%) events were judged to have a negative effect, and 14 (3.3%) positive. Existing strategies for managing distractions included ignoring inappropriate intrusions or conversation; asking staff with non-urgent matters to return later at a quieter time; preparation and checking of drugs and equipment ahead of time; acting as an example to other staff in timing their own potentially distracting actions; and being aware of one's own emotional and cognitive state.
Conclusions Distractions are common in anaesthetic practice and managing them is a key professional skill which appears to be part of the tacit knowledge of anaesthesia. Anaesthetists should also bear in mind that the potential for distraction is mutual and reciprocal and their actions can also threaten safety by interrupting other theatre staff.
Introduction
Distractions and interruptions are common in many healthcare settings. It is well recognized in other disciplines, such as aviation, that distraction increases the risk of error and within anaesthesia, distraction has been implicated in the development of critical incidents. In recent years, studies have been conducted to analyse how the theatre environment affects surgical performance. Later studies have examined the anaesthetist and the anaesthetic team, but these have focused on the induction of anaesthesia or split the process down to look at each phase separately, missing critical phases such as transfer between anaesthetic room and theatre. In contrast, we aimed to determine the frequency and nature of distracting events to the anaesthetist throughout the entire anaesthetic process and to analyse the possible consequences these might have on the patient. Further, Reason's systemic model of accident causation not only describes hazardous acts and omissions but also postulates the presence of countervailing factors which act to mitigate or neutralize the hazards. This system property is termed resilience, and our secondary aim was to explore this by documenting the existing strategies already used by practising anaesthetists in dealing with distractions and interruptions. We proposed to do this by conducting and qualitatively analysing in-depth interviews with experienced anaesthetists.