Distractions and the anaesthetist: a qualitative study of context and direction of distraction

Distractions are cited as contributory to healthcare-associated errors in a large proportion of incidents including those involving anaesthetists. The anaesthetist is relatively understudied, despite the closer coupling between action and outcome than in surgery.

After formal regulatory approval, we undertook an observational study using a validated rating scale for the observed effect of distractions. We also recorded the parties involved, the relative urgency of the distraction and the likely benefit or harm to the initiator and recipient.

Thirty-two separate surgical operations were observed. Median case duration was 103 min (range 22-227 min). 3557 potentially distracting events were observed, of which 1173 (33%) were deemed to score ≥ 2 on the distraction scale (i.e. caused distraction). Of these 3557 events, 1227 involved the anaesthetist either as an initiator of a potential/actual distraction, or the recipient of an actual distraction. The commonest initiators of distraction were the circulating nurse (832/3557) and the anaesthetist (816/3557). Sixty distracting events were observed while the anaesthetist was preparing or administering drugs (~2 per case). Of the 60 drug-related distracting events, 26 were initiated by the anaesthetist, and 3 of 7 airway events.

Distracting events involving the anaesthetist are common, but approximately two-thirds of these events have no externally visible effect. Another anaesthetist was the most common recipient of a distracting event initiated by the anaesthetist. Anaesthetists need to address themselves as causes of distractions and the potential impact on patient safety.