Monday, July 30, 2012

Distractions in the OR

More research that we didn’t need (with needlessly inflammatory headlines)

Last week was not a good one for the advancement of surgical research. I’ve already blogged about two studies that attempted to mystify the teaching of laparoscopic surgery.

On Thursday, MedPage Today devoted over 700 words to reporting on a study from Archives of Surgery called “Realistic distractions and interruptions that impair simulated surgical performance by novice surgeons.” It was an interesting experiment which looked at the effects of common types of operating room distractions, like cell phone ringing, questions about floor patients and a dropped metal tray, on the performance of simulated laparoscopic surgery. The subjects were all second and third year residents.

The performance of the 18 residents was tested with and without the interruptions. When distractions were present, 8 major errors in the simulated surgery occurred vs. only 1 major error in the non-distracted series, p = 0.02.

An unexpected finding was that all of the major errors occurred in the afternoon, which was also statistically significant. Fatigue, a very subjective characteristic, did not seem to play a role, although one could speculate that residents might be more tired in the afternoon.

The authors mentioned several limitations of the study including that it wasn’t carried out in a real operating room and only novice surgeons were tested.

The research was cleverly done and obviously could not have taken place in a real OR with a patient. It accomplished the number one goal of any study, which is to get published.

However, I take issue with the way it was reported. Here’s the MedPage headline: “Distractions in OR Make Errors More Likely.” That is grossly misleading since it fails to mention that the errors were made by junior residents, who were the only subjects of the experiment. This is important because even in my day, JUNIOR RESIDENTS NEVER OPERATED WITHOUT SUPERVISION!

Not until the sixth paragraph does the MedPage report point out the important disclaimers that “the authors said the results should not be interpreted as representative of operating-room (OR) experience in general” and that “these results should not be used to infer that almost half of all surgical procedures with distractions and interruptions are expected to have major surgical errors."

The paper was also covered by Medwire news with the headline “Surgical distractions could have disastrous consequences.” The story did not explain that second and third year residents do not operate by themselves.

Personally, I do not play music in the OR. During a difficult case, I am so focused on what I am doing that I don’t know who has come in or gone out of the room, nor do I hear extraneous conversations.

Distractions can be a problem. But this paper and the way it was reported by medical news agencies do nothing but heighten the anxiety of an already skittish public when it comes to fear of medical errors. I don’t see how proving that novice surgeons can be easily distracted adds anything toward the enlightenment of mankind.


Unknown said...

I agree. Research is a must for improving medicine, but being able to explain what your findings mean is very important!

Skeptical Scalpel said...

This might be an example of "publish or perish."

Anonymous said...

Distractions in a Surgical Setting should be at the discretion of the circulating nurse, who is able to determine if it a STAT ???????

Anonymous said...

In my own independent research I found that operative times increased by 31% and complications by 12% when an attractive sales or instrument rep was in the operating room. Resident satisfaction rates improved by 92%, however.

Skeptical Scalpel said...

Thanks for the comments. Agree nurses should be able to screen calls. Some won't do it saying, "It's not my job."

I agree about the reps.

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