• Ana Wheelock, Amna Suliman, Rupert Wharton, E D Babu, Louise Hull, Charles Vincent, Nick Sevdalis, and Sonal Arora.
• *Department of Surgery and Cancer, Imperial College London, London, UK †Department of Surgery, Hillingdon Hospital, London, UK; and ‡Department of Experimental Psychology, University of Oxford, Oxford, UK.
• Ann. Surg. 2015 Jun 1; 261 (6): 1079-84.

ObjectiveTo investigate whether distractions in the operating room (OR) are associated with higher mental workload and stress, and poorer teamwork among OR personnel.BackgroundEngaging in multiple tasks can affect performance. There is little research on the effect of distractions on surgical team members' behavior and cognitive processes.MethodsNinety general surgery cases were observed in real time. Cases were assessed by a surgeon and a behavioral scientist using 4 validated tools: OR Distractions Assessment Form, the Observational Teamwork Assessment for Surgery tool, NASA-Task Load Index, and short form of the State Trait Anxiety Inventory. Analysis of variance was performed to evaluate significant differences between teamwork, workload, and stress level among team members. Correlations (Pearson r) were computed to evaluate associations between variables.ResultsThe most prevalent distractions were those initiated by external staff, followed by case-irrelevant conversations. Case-irrelevant conversations were associated with poorer team performance. Irrelevant conversations initiated by surgeons were associated with lower teamwork in surgeons (across team skills: r = -0.44 to -0.58, P < 0.05 to 0.01) and anesthesiologists (r = -0.38 and r = -0.40, for coordination and leadership; P < 0.05). Equipment-related distractions correlated with higher stress (r = 0.48, P < 0.05) and lower teamwork (across team skills: r = -0.42 to -0.50, P < 0.05) in nurses. Acoustic distractions correlated with higher stress in surgeons (r = 0.32, P < 0.05) and higher workload in anesthesiologists (r = 0.30, P < 0.05).ConclusionsAlthough some distractions may be inevitable in the OR, they can also be detrimental to the team. A deeper understanding of the effect of distractions on teams and their outcomes can lead to targeted quality improvement.

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