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The Impact of Operating Room Distractions on Stress, Workload, and Teamwork

Wheelock, Ana MSc*; Suliman, Amna MBBS; Wharton, Rupert BM; Babu, E. D. FRCS; Hull, Louise PhD*; Vincent, Charles PhD; Sevdalis, Nick PhD*; Arora, Sonal PhD*

doi: 10.1097/SLA.0000000000001051
Original Articles

Objective: To investigate whether distractions in the operating room (OR) are associated with higher mental workload and stress, and poorer teamwork among OR personnel.

Background: Engaging in multiple tasks can affect performance. There is little research on the effect of distractions on surgical team members' behavior and cognitive processes.

Methods: Ninety general surgery cases were observed in real time. Cases were assessed by a surgeon and a behavioral scientist using 4 validated tools: OR Distractions Assessment Form, the Observational Teamwork Assessment for Surgery tool, NASA-Task Load Index, and short form of the State Trait Anxiety Inventory. Analysis of variance was performed to evaluate significant differences between teamwork, workload, and stress level among team members. Correlations (Pearson r) were computed to evaluate associations between variables.

Results: The most prevalent distractions were those initiated by external staff, followed by case-irrelevant conversations. Case-irrelevant conversations were associated with poorer team performance. Irrelevant conversations initiated by surgeons were associated with lower teamwork in surgeons (across team skills: r = −0.44 to −0.58, P < 0.05 to 0.01) and anesthesiologists (r = −0.38 and r = −0.40, for coordination and leadership; P < 0.05). Equipment-related distractions correlated with higher stress (r = 0.48, P < 0.05) and lower teamwork (across team skills: r = −0.42 to −0.50, P < 0.05) in nurses. Acoustic distractions correlated with higher stress in surgeons (r = 0.32, P < 0.05) and higher workload in anesthesiologists (r = 0.30, P < 0.05).

Conclusions: Although some distractions may be inevitable in the OR, they can also be detrimental to the team. A deeper understanding of the effect of distractions on teams and their outcomes can lead to targeted quality improvement.

Distractions can affect performance in high-pressure environments. This study investigated whether distractions in the operating room (OR) are associated with impaired teamwork, higher mental workload, and stress among surgical personnel. Findings suggest that although some distractions may be inevitable in the OR, they can harm surgical teams.

*Department of Surgery and Cancer, Imperial College London, London, UK

Department of Surgery, Hillingdon Hospital, London, UK; and

Department of Experimental Psychology, University of Oxford, Oxford, UK.

Reprints: Ana Wheelock, MSc, Department of Surgery and Cancer, Imperial College London, 5th Floor, Wright Fleming Building, Norfolk Place, London W2 1PG, UK. E-mail: a.wheelock@imperial.ac.uk.

Disclosure: This research was funded by the National Institute for Health Research (NIHR), UK. The authors declare there are no conflicts of interest.

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