4 research outputs found
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Realistic Distractions and Interruptions Impair Simulated Surgical Performance by Novice Surgeons
Hypothesis: Although the risks for operating room distractions and interruptions (ORDIs) are acknowledged, most research on this topic is unrealistic, inconclusive, or methodologically unsound. We hypothesized that realistic ORDIs induce errors in a simulated surgical procedure performed by novice surgeons.
Design, Setting, and Participants: Eighteen second-year, third-year and research-year surgical residents completed a within-subjects experiment on a laparoscopic virtual reality simulator. Based on 9 months of operating room observations, 4 distractions and 2 interruptions were designed and timed to occur during critical stages in simulated laparoscopic cholecystectomy. The control factor was the absence or presence of ORDIs, with order randomly counterbalanced across the subjects.
Main Outcome Measures: The primary outcome measure was surgical errors measured by the simulator as damage to arteries, bile duct, or other organs. The second outcome measure was whether the participants remembered a prospective memory task assigned prior to the procedure and important to operative conduct.
Results: Major surgical errors were committed in 8 of 18 simulated procedures (44%) with ORDIs versus only 1 of 18 (6%) without ORDIs (P = 0.02). Interrupting questions caused the most errors. Sidebar conversations were the next most likely distraction to lead to errors. Ten of 18 participants (56%) forgot the prospective memory task with ORDIs, while 4 of 18 (22%) forgot the task without ORDIs (P = 0.04). All 8 surgical errors with ORDIs occurred after 1 PM (P = 0.001).
Conclusions: Typical ORDIs have the potential to cause operative errors in surgical trainees. This performance deficit was prevalent in the afternoon
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Effects of realistic distractions and interruptions on simulated surgical task performance
Distractions and interruptions are common occurrences in an operating room (OR), but little is known about their effects on surgical task performance. Based on human factors research, it was hypothesized that realistic distractions and interruptions in an OR would adversely impact surgical task performance. Because of the concern of patient safety in an OR, research on distractions and disruptions needed to be conducted in a laboratory. Consequently, this research applied an advanced virtual reality simulator for a laparoscopic surgical procedure.
The experimental design consisted of a two factor within-subjects test. The primary factor was the absence or presence of distractions and interruptions with the order being randomly counterbalanced. Four distractions and two interruptions were timed to occur during critical stages of the simulated surgical procedure. The secondary factor was the experience level of the surgeons. Eighteen surgical residents volunteered to participate in this study which yielded two experience levels of 2nd year and 3rd year residents.
The results supported the hypothesis since major surgical errors were committed in 44% of the simulated surgical procedures when distracted and interrupted versus only 6% when not distracted or interrupted. This difference was significant with a p-value = 0.020. No effect was shown for surgical errors with respect to the different experience levels, possibly because of the limited separation in experience. For another type of error, 56% of the participants forgot to perform a prospective memory task when distracted and interrupted, while just 22% forgot in the non-distracted conditions. This difference was significant with a p value = 0.035. Although no significant effects were indicated for total task times due to distractions and interruptions, there was a significant time difference for a subtask that coincided with an interruption and distraction. Finally, no effect was shown with pre-specified measures of performer fatigue and personal distractibility traits. However, a significant dependency was observed with respect to time of day outcomes which may have been related to fatigue.
Findings from this research are applicable in the training of surgeons to become more resistant to the effects of distractions and interruptions, thereby improving patient safety