Anesthesia in the News
  • How Music, Phones and Chatter Can Distract the OR Anesthesia Provider

    In a 2017 survey of 519 operating room (OR) staff members, including 142 anesthesia providers, over 77% of participants reported that OR noise negatively impacted staff communication, 74% stated that noise was detrimental to tasks requiring concentration, and over half believed that noise impaired effective teamwork.

    But acoustic levels are only one of the myriad of distractions confronting anesthesia professionals in the operating theatre that can degrade clinical focus, thus putting patients in jeopardy. While many such distractions are unavoidable, many are initiated by the anesthesia professionals themselves. Knowing more about the nature and source of OR distractions can lead to strategies to mitigate them and their threats to patient safety.

    Anesthesia-specific

    A first of its kind narrative review of OR distractions as they specifically relate to anesthesia providers appeared in the February 2021 issue of the Journal of Clinical Anesthesia.  In it, anesthesia providers at University of Virginia Health System and Mount Sinai West-St. Luke’s Hospital in New York, conducted an in-depth literature review of several hundred peer-reviewed journal articles as well as numerous case studies and scholarly editorials.

    The authors then categorized the articles by distraction type: noise in the operating room; music; case-irrelevant conversation and “small talk;” environmental distractions (including workspace, equipment, and staff entrance and exit); phone and pager noise; intraoperative reading and non-record-keeping workstation activity; and personal electronic device use.

    Facing the music

    Among the authors’ findings in the literature search, one of the main contributors to OR noise is music. In a survey of 144 anesthesiologists, over 72% reported music playing in the OR regularly. Of that group, 51% reported that music was distracting when an anesthetic problem was encountered, 26% reported that music reduced their vigilance, and 24% found that music impaired their communication with other OR staff.

    One case the authors located even reported that loud music in the OR had prevented recognition of an audible high-pressure ventilator alarm due to a kinked endotracheal tube until the music stopped between songs.

    On the other hand, while they assert that more controlled clinical trials are warranted, the authors present published survey data suggesting that, in some instances, music in the OR may provide some benefits. These include instances in which music, if played at a reasonable volume, can help keep anesthesia providers alert during periods of low activity or potentially cause OR staff to talk less.

    Chat risk

    Among the most disruptive noises in the OR, the authors state, is what they termed “case-irrelevant conversation,” which is communication not directly relevant to the patient in the operating room, as it has the potential to directly divert attention from the current patient. They cite one study which found that, on average, 3.5 case-irrelevant conversations took place per operation. Of these conversations, 25% were related to patients other than the one in the operating room.

    In summary, while the authors acknowledge that communication is an essential aspect of good teamwork, “it is critical to identify safer times for both case-relevant and case-irrelevant conversations.”

    Don’t text and anesthetize

    Perhaps the most recent and troubling OR distraction the authors report is the burgeoning use of personal electronic devices (PED) by anesthesia providers in theatre.

    While the prevalence of smartphones, tablets, and portable laptops in the OR can improve patient-related communication and even improve patient safety by providing quick access to, say, an emergency checklist during an anesthesia crisis, the authors present data that PED use is a common cause of distracting events.

    A 2015 survey of 955 anesthesiologists, resident anesthesiologists, and CRNAs found that 93.7% of participants reported using smartphones during anesthetized patient care, including making phone calls (65.4%) and messaging (46.4%).  So, in addition to PED use being quite common, the authors express concern that “anesthesia providers may underappreciate the ability of PED use to cause self-initiated distractions” in the OR.

    Further, they caution that anesthesia providers should “consider the possible serious, medico-legal consequences of PED use.”

    “As discussed at a 2016 Anesthesia Patient Safety Foundation conference, PED use data are discoverable, and a defense-favorable verdict is less likely when PED use data is presented as evidence for lack of the anesthesiologist’s vigilance.”

    Read the full review “Distraction in the operating room: A narrative review of environmental and self-initiated distractions and their effect on anesthesia providers.” J Clin Anesth. 2021 Feb;68:110110 at https://pubmed.ncbi.nlm.nih.gov/33075633/