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.