Mitigating operating room distractions: A systematic review assessing intervention effectiveness

Abstract

ABSTRACT: Background: Distractions in the operating room (OR) are common and can threaten patient safety. A variety of strategies have been proposed to mitigate OR distractions. The objective of this review was to identify the strategies that have been implemented and evaluated in surgical settings and determine their effectiveness. Methods: A systematic search was conducted in five databases (Medline, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, Web of Science) on 28 January 2020 and was updated on 5 November 2020. Original studies investigating the effects of OR distraction mitigation strategies on distraction rate, or technical (e.g., error rates) or non-technical performance measures (e.g., communication) were included. Excluded studies took place in non-surgical or clinical settings, were non-English, or did not empirically assess a distraction mitigation strategy. Risk of bias was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tools. Results: Ten studies were included in our final analysis, with three rated low, five rated medium and two rated high in risk of bias. Eight studies were conducted in real-OR settings and two were conducted in simulation, with auditory distractions targeted the most (n=5). A variety of strategies (e.g., training, signs, headset systems) were implemented, and all studies but one reported reduced distraction rates and/or improved outcomes (e.g., technical/non-technical performance measures, patient outcomes). Training was used as the most frequently implemented intervention (n=7/10) and was typically used as a supplemental strategy (n=6/7), such as training for teamwork or noise prevention. Only two studies provided explicit definitions of distraction, and outcome measures of intervention effectiveness varied widely, limiting our ability to aggregate findings. Conclusion: Although few studies have evaluated the strategies that mitigate OR distractions, those that have, generally report them as effective. Standardized definitions and validated tools for evaluating OR distractions are needed to enable the aggregation of results in the literature and for the development of rigorous future research on reducing distractions in the OR that threaten patient safety. PROSPERO registration: CRD42020185035

Keywords

• surgery
• interruptions
• patient safety
• human factors
• countermeasures