Examining Critical Task Performance in Blue and Green Ambient Lighting Environments in Modern Interventional Suites:...

An optimal visual environment in operating rooms (ORs) is critical for ensuring safe effective patient care. This study's primary objective assessed-in a simulated environment-OR staff task performance under spectrally shifted (blue and green) ambient lighting conditions, commonly used in minimally invasive surgical procedures, by comparing success rates, error rates and completion times to that under white light. Secondary objectives included identifying drug label features most relied on for accurate decision-making under these lighting conditions.

This randomized-single-center-crossover trial involved 300 OR staff and volunteers at the Royal Brisbane and Women's Hospital. Participants were screened for color vision deficiencies using the Ishihara and Farnsworth D-15 Tests (FT), then randomized to 1 of 2 lighting sequences (blue-green or green-blue). Each participant completed the FT and Drug Label Matching Test (DLMT) under each lighting condition, with performances compared to white light. A questionnaire assessed which drug label characteristics participants used for identification under each lighting condition.

Of the 266 eligible participants, all successfully completed the FT under white light (100% success; 95% confidence interval [CI], 99.01%-100%), but none succeeded under blue/green light (0% success; 95% CI, 0.00%-0.99%). Median FT completion times were 50 (interquartile range [IQR], 39-63) seconds (white), 64 (IQR, 49-84) seconds (blue), and 64 (IQR, 44-93) seconds (green). Median DLMT completion times were 76 (IQR, 65-89) seconds (white), 103 (IQR, 88-126) seconds (blue), and 96 (IQR, 78-120) seconds (green), with significantly faster performance under white light compared to blue or green ( P < .001 for both). DLMT failure rates were significantly higher ( P = .033) under blue/green light compared to white, with the odds of an error occurring under blue/green light estimated to be 3.67 times higher (95% CI, 1.05-12.87). Under blue and green light, reliance on color for drug identification dropped sharply (from 96.6% to ~41%-42.5%), while use of drug names differed slightly (76.3% to ~80%-83%), grouping (8.3% to ~50%-56.8%) and memory (0.4% to ~42%-45%) both increased substantially.

This study demonstrated that ambient blue and green lighting significantly impairs the ability of OR staff to distinguish color hues, compromising color-dependent decision-making. The Farnsworth D-15 Test confirmed that color hues become virtually indistinguishable under spectrally shifted lighting. Drug Label Matching Test performance declined to a lesser extent due to the presence of multiple identifiers on drug labels with increased reliance on noncolor cues. These findings underscore potential challenges in accurately assessing tissue perfusion and identifying medications, thereby elevating risks of medication errors. To address these concerns, strategies such as improved environmental lighting control, use of machine-readable drug labeling, or integration of augmented reality tools should be considered. Further research is warranted to explore clinical implications of spectrally shifted lighting and to evaluate solutions in real-world perioperative settings.