PsyErgo Beitrag bei der Euroanaesthesia 2019 in Wien

Dr. Tobias Grundgeiger nahm auf Einladung von Prof. Dr. Matt Weinger, Vanderbuild University, USA, an der Diskussionsrunde mit dem Titel „From cell phones to noisy rooms – Can distractions in the OR harm your patient?“ teil. Weitere Teilnehmer waren Dr. Malcolm Broom, Consultant Anaesthetist, Glasgow Royal Infirmary, Scotlandm, Prof. Dr. Matt Weinger und Dr. Jason Slagle, Vanderbuild University, USA.

Bericht über die Diskussionsrunde aus dem ESA Newsletter:

Session 14S2: From cell phones to noisy rooms – can distractions in the OR harm your patients

In this four-part session, the panel will address the myriad of interruptions and distractions in the operating room (OR). “This is an international issue. There have always been events that interrupt the anaesthesia professional from their current anaesthesia care activities,” explains session chair and co-presenter Dr Matthew Weinger, Secretary and Board Director of the Anesthesia Patient Safety Foundation (APSF), and Professor of Anesthesiology, Biomedical Informatics, and Medical Education at the Vanderbilt University School of Medicine, Nashville, TN, USA. “A good example is a request from the surgeon to reposition the patient (move the OR table) when the anaesthesia professional is treating hypotension. However, the issue has become more salient with the ubiquitous access to electronic information management and communication technologies in the OR.”

A distraction can be defined as “something that makes it difficult to think or pay attention”. Distractions can be self-initiated or induced by external “agents” (humans, processes, or technology). An interruption is a distraction that directly disrupts ongoing processes or activities for an individual and/or group. “The degree of direct control of the nature and timing of the distracting event/activity (that is, the ability to terminate it) affects how disruptive it will be to primary task performance,” explains Dr Weinger. “Generally, external distractions are more likely to be disruptive.”

After a brief introduction (by Dr Weinger), Dr Tobias Grundgeiger (Julius-Maximilians-Universität Würzburg, Germany) will draw on his extensive experience as an experimental psychologist who studies interruptions in nursing, medicine, and other fields to provide the context for the panel. He will provide data on the incidence of clinical interruptions and their consequences. He will provide a theoretical framework that will allow the audience to understand the mental consequences of interruptions – how they can affect our thought processes and actions. Specifically, he will describe how interruptions can cause forgetting of the precedent task, increase cognitive workload, and loss of situational awareness.

Next Dr Jason Slagle (also of Vanderbilt University School of Medicine) will focus on self-induced distractions (such as the use of the internet and electronic devices) during anaesthesia care. He will summarise the results of a large US prospective observational study at an academic medical centre, which was recently published in Anesthesiology.  This study showed that self-induced distractions were largely limited to the maintenance phase of anaesthesia but were relatively common, especially in longer and/or less complex cases. Further, self-induced distractions were associated with lower provider workload and did not significantly affect the anaesthesia provider’s vigilance (measured with a randomly illuminated alarm light). Dr Slagle says: “Finally, while a there were a few occurrences where self-induced distractions were related to non-routine events, self-induced distractions did not appear to cause the occurrence of any non-routine events that occurred during the cases that were studied. I will discuss the implications of these findings.”

Dr Broom will highlight external distractions occurring during critical phases of anaesthesia. Focussing on induction and emergence, he will introduce aviation’s ‘sterile cockpit’ concept, to illustrate the potential impact of distractions during moments of critical activity. Dr Broom says: “I will describe my own studies on auditory and physical distractions in both general and obstetric theatres. One notable finding was that sound levels and extraneous conversations during critical phases, and especially during emergence, can be higher than may be appreciated. I will describe why distractions are a problem, with a brief literature review and with particular mentions towards difficult airway management and potential medicolegal issues.”

Finally, Dr Weinger will present the recommendations developed at the APSF’s Consensus Conference on “Distractions in the Anesthesia Work Environment: Impact on Patient Safety?” and published in the July 2017 issue of Anesthesia and Analgesia. The conference yielded 11 high-level recommendations. Dr Weinger will focus on those most likely to be implementable by individual anaesthesia professionals within their hospital or group. These include, for example, deliberate efforts to eliminate unnecessary clinical distractions and moderate unavoidable distractions (e.g., with a sterile cockpit protocol), reduce environmental noise (e.g., through music and conversation management), develop and implement a pragmatic approach to minimising self-induced distractions of a personal nature, and development of European and local policies and guidelines on distraction management.