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An exploratory study of distractions during the induction phase of pediatric procedural sedation with propofol
Juan P Boriosi1, Jens C Eickhoff2, Christina Bryndzia1
1Department of Pediatrics, University of Wisconsin, Madison, USA.
Insights
Distractions frequently disrupt pediatric procedural sedation, with extraneous events being most common. While these events impact workflow, particularly for nurses, they did not affect patient outcomes or induction length.
Area of Science:
- Medical Anesthesiology
- Pediatric Sedation
- Patient Safety
Background:
- Distractions are a significant cause of workflow disruption in healthcare settings.
- Anesthetic teams in operating rooms experience frequent distractions impacting patient care.
- Procedural sedation outside the operating room presents unique challenges regarding workflow interruptions.
Purpose of the Study:
- To evaluate the frequency, source, target, and impact of distractions during pediatric procedural sedation induction.
- To identify common types of distractions and their effects on the sedation team.
- To analyze the influence of distractions on workflow and patient outcomes.
Main Methods:
- Video recordings of 45 pediatric procedural sedation inductions for oncology procedures were analyzed.
- Distractions were defined as events potentially disturbing the sedation team's primary tasks.
- Distraction types (communication, coordination, extraneous events, equipment, layout, usability) and their impact were cataloged using a Likert scale.
Main Results:
- 567 distractions occurred, averaging 12.6 per induction, with extraneous events (55%) being most frequent.
- Distractions led to multitasking (46%) and task disruption (17%), with nurses most frequently affected (62%).
- Coordination and usability issues had the greatest negative impact; no association was found between distractions and adverse events or induction length.
Conclusions:
- Distractions are common during pediatric procedural sedation, primarily stemming from extraneous events.
- Coordination and usability issues significantly impact sedation team workflow, with nurses being the most affected.
- Despite workflow impacts, distractions during sedation induction were not associated with adverse patient outcomes.
Introduction:
Distractions are a leading cause of disturbance to workflow during medical care. Distractions affecting the anesthetic team in the operating room are frequent and have a negative impact on patient care one-fifth of the time. The objective of this study was to evaluate the frequency, source, target, and impact of distractions during the induction phase of pediatric procedural sedation outside the operating room.
Methods:
Distractions were analyzed during propofol induction for oncology procedures from 45 video recordings. Distraction was defined as any event that disturbs or has potential to disturb the sedation team from performing their primary tasks. The type of distraction was cataloged into communication, coordination, extraneous events, equipment, layout, and usability. A five-point Likert scale was used to quantify the impact on the sedation team or its members.
Results:
All patients had a diagnosis of acute lymphocytic leukemia and had a mean age of 8.4 years. Five hundred and sixty-seven distractions occurred and averaged 12.6 events (±5.6) per induction (mean induction time 3 min 12 s). Extraneous events were most common, accounting for 55% (312/567) of all distractions. Most distractions had an impact on the sedation team's workflow, resulting in multitasking (46%, n = 262), and in either brief or complete disruption from a primary task (17%). Sedation nurses were impacted most often, 62% of the time. Coordination and usability issues resulted in the greatest negative impact, mean ± SD, 3.7 ± 1.0 and 3.5 ± 0.9, respectively. There was no significant association between distractions and adverse events or induction length.
Discussion:
Distractions are common during procedural sedation, with extraneous events being most frequent. Coordination issues within the team and usability problems had the greatest negative impact on sedation team workflow. Nurses were the most frequent target.
Conclusion:
Distractions impacted sedation team workflow but had no association with patient outcomes.
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