Sunday, April 26, 2015

Distractions increase surgeons’ potential for mistakes

By Lee Bowman

Just how much attention your surgeon pays to tasks in the operating room can be affected by a number of distractions, recent research suggests.

First off, operating rooms are not libraries. Equipment can be noisy, colleagues chatty and many surgeons work with music in the background. Not everyone may mute, or even not answer, their personal communications devices.

Researchers at the University of Kentucky Medical Center set up a test using 15 surgeons with one to 30 years of experience. Their ability to understand and repeat words was checked under four conditions: quiet; noise filtered through a surgical mask; and operating-room background noise both with and without music. Subjects were tested both while they were engaged in a surgical task and when they were not.

The results, published in the May issue of the Journal of the American College of Surgeons, showed that comprehension of speech went down in the presence of background noise when the words were unpredictable, but that music was a significant barrier to speech comprehension only when the surgeon was engaged in a task.

Music in the operating room has long been a source of disagreement among surgeons, anesthesiologists and caregivers. Many argue that sounds distract from the task, but others insist music can be soothing and help the surgical team focus.

Another study, published last year by researchers at Oregon State University and the Oregon Health and Sciences University, showed that young surgeons in their second, third or research year of residency made mistakes nearly half the time when they were distracted during a simulated gall-bladder removal.

Eight of 18 surgical residents made serious errors when distracted by noises like a cellphone ringing, an instrument tray being dropped, being asked questions about another patient or a political discussion among caregivers at the edge of the OR.

Mistakes were particularly likely when the test was run in the afternoon. Major errors during the minimally invasive surgery included damage to organs, ducts and arteries, some of which could lead to a patient’s death in a real surgery.

But only one of the surgeons made a mistake on the simulator when there were no distractions.

Research done on a group of medical students at Penn State College of Medicine in Hershey, Pa., last year added the element of sleep deprivation to simulated surgery.

In a study published last year in The American Journal of Surgery, the scientists reported that students trained on a virtual-reality simulator were able to perform a previously learned task or learn a new one as well when they were sleep-deprived as when they were well-rested.

When the students were presented with a new unexpected task — counting flashes on a screen — both the tired and the well-rested handled the extra task, but the sleep-deprived had to exert more brain effort to achieve the same level of performance.

Other studies suggest that a surgeon’s lack of sleep can have severe consequences. One 2009 report in The Journal of the American Medical Association showed a significant increase in the risk of complications for patients who had elective daytime surgery performed by a surgeon who had slept less than six hours during a previous night on call.

Concern about fatigue in the OR prompted one group of Harvard Medical School sleep specialists and ethicists to suggest in a 2010 editorial that sleep-deprived physicians be required to disclose their condition to patients and get their consent before going ahead with an elective procedure. Their New England Journal of Medicine article proposed that the disclosure mandate apply to both surgeons and anesthesiologists.

— Contact Scripps health and science writer Lee Bowman at [email protected]



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