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Distractions in the operating theatre

A 2019/2020 Summer Studentship research project

Distractions appear to be an important problem in operating theatres overseas but no information is available about their occurrence in New Zealand. Gathering information about the nature and frequency of potential distractions in operating theatres at Christchurch Hospital is a key step in identifying whether they represent an important local issue and may also furnish critical baseline information that can be used by quality improvement projects to prevent their occurrence in the future.

Student: Emilie Roberts
Supervisors: Dr Spencer Beasley, Dr Phil Hider
Sponsor: University of Otago, Christchurch

Introduction

Health care is increasingly using a human factors approach to understanding and thereby preventing events that may lead to patient harm1. Hallmarks of a human factors approach are the use of observation and systems thinking to explore how people work in busy workplaces as part of complex systems1. Operating theatres are active and stressful work places where surgical teams use sophisticated equipment to complete demanding tasks. Distractions in the operating theatre present unwelcome interruptions that can adversely affect patient safety. The results from previous research in the United Kingdom (UK) and the United States (US) suggests that distractions are common in operating theatres2,3. Similar research has not been conducted in New Zealand (NZ): although there are similarities in surgical practice in the UK, US and NZ, regional variations justify the investigation and characterization of the existence of these issues in the local setting.

Aim

The study aims to provide a baseline assessment of the frequency and nature of potential distractions in the operating theatres at Christchurch Hospital

Method

The investigation will employ two previously validated tools4. The first tool is a measure of the number of intra-operative theatre door openings and it serves as a proxy for movement and general theatre activity. The second tool involves a data record sheet with predefined categories and an ordinal rating scale that are used to assign interference ratings for any distractions. These tools are used to describe the number and degree of interference from any distractions in theatre4. The study will be conducted over 20 half-day operating sessions evenly spread across acute and elective operating theatres over a range of times/days. Data collection will be limited to the intra-operative period, that is, from incision time to closure. The observer(s) will be positioned in theatre so that all team members can be observed; observer position once established will usually be static. A brief explanation to the surgical team will be provided. Key results including the inter-rater reliability of the tools, the nature, frequency and impact of potential distractions will be tabulated and analysed using Spearman’s rho correlation, chi-square tests and Pearson correlation.

Student researcher’s component of the study

The student will receive full training in the two validated data collection methods. The first five operating sessions will involve the student collecting data with a supervisor. During the following fifteen sessions, the student will be responsible for data collection alone. In collaboration with the supervisors, the student will help collate and analyse results and prepare a project report suitable for dissemination in a peer reviewed journal.

References

  1. Hignett S., Jones E.L., Miller D., Wolf L., Modi C., Shahzad M.W., Buckle P., Banerjee J., Catchpole K.
  2. Human factors and ergonomics and quality improvement science: Integrating approaches for safety in healthcare. BMJ Quality and Safety. 2015. 24;4:250-254.
  3. Mentis H.M., Chellali A., Manser K., Cao C.G.L., Schwaitzberg S.D. A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. Surgical Endoscopy. 2016. 30;5:1713-1724.
  4. Willett M., Gillman O., Shin E., Sewart E., Muller D., Nauta M., Yoong W. The impact of distractions and interruptions during Cesarean Sections: a prospective study in a London teaching hospital. 2018. Archives of Gynecology and Obstetrics. 298;2:313-318.
  5. Healey AN, Sevdalis N, Vincent CA. Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics 2006;49(5-6):589-604.

Student Prerequisites

Senior Medical student

How to apply

Email spencer.beasley@cdhb.health.nz