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Impact of disruptions on anaesthetic workflow during anaesthesia induction and patient positioning: A prospective
Latif Al-Hakim1, Sonal Arora, Nick Sevdalis
1From the National Institute for Innovation Management, Zhejiang University, Zhejiang, China (LA-H); School of Information Technology and Mathematical Sciences, University of South Australia, Adelaide, South Australia, Australia (LA-H); Department of Surgery and Cancer and Imperial Patient Safety Translational Research Centre, Imperial College London (SA); and Centre for Implementation Science, King's College London, London, UK (NS).
Background:
Work disruption in operating rooms hinders flow of patients and increases chances of error. Previous studies have largely considered the types of disruption occurring in operating rooms, but have not analysed systematically the objective impact of disruption.
Objective:
The objective was to evaluate the impact of disruption on time efficiency in preoperative anaesthetic work in the operating room and to link disruption to failures in co-ordination of care.
Design:
Prospective, cross-sectional and observational study.
Setting:
Disruptions were evaluated in operating rooms of five hospitals across three countries: Australia (one community hospital, one teaching hospital); Thailand (two community hospitals); China (one teaching hospital).
Participants:
The preoperative phase of anaesthesia induction/patient positioning of 64 surgical patients across specialities was prospectively evaluated (Australia = 33; Thailand = 12; China = 10). Further, interviews were carried out with 16 consultant anaesthetists and surgeons and 13 senior operating room nurses involved in the care of these patients.
Main Outcome Measures:
Disruptions were identified by trained observers in real time during the preoperative phase; four types of care co-ordination problems were identified from the interviews with senior anaesthetists, surgeons and nurses, and linked to the disruptions. Descriptive analyses of time efficiency were performed.
Results:
Complete data were available from 55 cases. Good inter-observer agreement was obtained across measurements (range 74 to 92%). An average of three disruptions per case during the preoperative phase, were observed (range 2 to 9). 'Disruption types': disruptive staff activities were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 4 min 45 s per case). 'Care co-ordination problems': co-ordination lapses within the operating room team, and between them and the preoperative team were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 5 min 0 s per case).
Conclusion:
The study quantifies time inefficiencies affecting anaesthetic work during the preoperative phase. Work disruption wastes time and is preventable.
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