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Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow

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Distraction and interruption in anaesthetic practice.

G Campbell¹, K Arfanis, A F Smith

¹Department of Anaesthesia, Royal Lancaster Infirmary, Ashton Road, Lancaster, UK.

British Journal of Anaesthesia

|July 4, 2012

Summary

Distractions are frequent during anesthesia, impacting patient safety. Managing these events is a critical skill, with anaesthetists employing various strategies to mitigate risks and ensure optimal care.

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Area of Science:

Anesthesiology
Patient Safety
Human Factors in Medicine

Background:

Distractions pose a significant risk to patient safety in operating rooms.
Prior studies have examined specific anesthetic phases, not entire cases, and focused on hazards over existing error defenses.

Purpose of the Study:

To quantify and classify distracting events during entire anesthetic cases.
To explore anaesthetists' strategies for managing distractions in the operating theatre.

Main Methods:

Direct observation of 30 complete anesthetic procedures across various surgical settings.
Quantification and classification of distracting events during 31 hours of observation.
Semi-structured interviews with consultant anaesthetists regarding distraction management.

Main Results:

A total of 424 distracting events were recorded, with an average frequency of 0.23 per minute.
Distraction frequency varied by anesthetic phase, peaking during emergence (0.5/min).
22% of events had negative impacts, while 3.3% had positive effects; common management strategies included ignoring intrusions and proactive preparation.

Conclusions:

Distractions are endemic in anesthesia practice and managing them is a core professional skill, often part of tacit knowledge.
Anaesthetists' actions can also cause distractions, highlighting the reciprocal nature of safety in the operating theatre.