By Thomas Davis, CRNA, MAE, Lt. Col, (ret)

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Little Alex is finally a big boy.   Now that he is age 5, mom and dad eagerly sign him up for T-ball visualizing their future big-league hall-of-famer hitting a home run in the final game of the World’s series.  Wearing his new T-shirt and oversized hat, Alex crouches standing ready to catch the ball in center field waiting for something to happen and then it does.  A butterfly flits by drifting with the breeze and lands nearby. Five-year-old Alex abandons his position in center field and starts chasing the butterfly just as the slugger at the plate rolls one through the infield directly to the spot where Alex once stood.  The distraction of one player effected the outcome for the entire team.

When children grow and mature into adults, life’s distractions increase as does the consequences of diverting attention away from the task at hand.  The National Highway Traffic Safety Administration reports that in 2015 a total of 3,477 drivers lost their lives and another 391,000 were injured due to a lapse of attention while driving.

Distraction in the healthcare workplace is common and can cause mistakes that have devastating effects on our patients.  Because interruption of attention has been linked to the injury or death of many people who entrusted their safety to the healthcare community, the Anesthesia Patient Safety Foundation assembled a panel of national patient safety experts to evaluate the harmful effects of diverting attention away from the patient in the operating room.   An article by Maria van Pelt and Matthew Weinger published in the October, 2017 APSF newsletter reviewed the findings of the panel.

Personal Electronic Devices are the elephant in the room when the topic of distracted operating room workers is addressed.  Although the use of PEDs remains a threat to the focus of attention on the patient, there are many other less obvious causes for concern.  Here are 5 common causes for distraction in the operating room taken from the APSF:

Patient-related activity poses a risk by shifting focus from the technical aspects of ensuring safety for the patient at hand (ventilation, hemodynamics) and is diverted to considering the needs of other patients or new activities related to the current case.  Attention is diverted when:

• PACU or pre-op calls with questions about your previous or next patient.
• You set up for the next patient during the current case.
• Ultrasound is used to place a block after induction.
• Another physician comes into the room to consult with your surgeon during the case.

Technology-related problems divert concentration from the patient to a computer that stores data and maintains records.  Technology compromises patient safety when:

• Either the anesthesia or the operating room computer malfunctions and requires re-booting or calling the help desk.
• The required data entry is excessive and time consuming.
• Time is spent searching data bases for lab or consultation reports.

Noise and alarms make conversation difficult or interrupts the train of thought of workers in the operating room.  Noise and alarms divert attention from the patient when:

• Alarm activation occurs due to inappropriate alarm limits or faulty equipment (loose wires on ECG or pulse ox).
• The sound level of music is excessive.
• OR workers and vendors participate in unnecessary chatter unrelated to the case.

Interpersonal dynamics cause drama and stress thereby disrupting collaboration between members of the operating room team.  Interpersonal factors steal the effectiveness of team members when:

• Threatening attitudes stifle communication and creative thought.
• Hierarchal power structure inhibits the sharing of information.
• Team member complain and engage others to talk about personal issues.
• Disruptive behavior such as swearing, throwing instruments or disparaging others on the team is tolerated.

Self-induced distractions include unnecessary activity that the individual willingly brings into the operating room.   We distract ourselves when we:

• Use personal electronic devices while caring for a patient.
• Read books or solve puzzles to fill the time on a long case.
• Participate in unnecessary chatter about our personal or social interests.

One-hundred- fifty years ago vigilance in the operating room was the hallmark for safety. In the high technology operating room of today, vigilance is just as important as it was when ether was dripped onto cotton gauze.   Regardless of your position on the healthcare team, be an advocate for your patient and keep your finger on the pulse when distractions emerge.  It is up to you to commit to patient safety by reducing distractions and maintaining total focus on the patient.  Keep your head in the game and your eye on the ball when the butterfly flutters by.

Thomas Davis is a noted author, speaker, leadership coach and clinical anesthetist.