Noise, distractors and communication during surgeries : impact on patient outcome and intra-operative team processes

Performing long abdominal surgeries requires concentration for the surgeons at the individual level, and adequate teamwork behaviors at the team level. However, the work environment in the operating room (OR) is complex, with potential sources of noise and distraction; at the same time, taskwork and teamwork require attention. The papers included in my dissertation focus on determinants and consequences of teamwork, noise, and distractions in the OR. The first paper presents a survey study that investigated teamwork as perceived by OR teams. We compared assessment of teamwork in general and after specific surgeries. We showed that the assessment of teamwork is different when teams assess teamwork on a general basis than when after specific surgeries. In particular, whereas senior surgeons assessed teamwork better than nurses in general, nurses were more satisfied with teamwork than senior surgeons after specific surgeries. In the second paper we investigated the effects of observed distractions and communication on surgical site infections, one of the most frequent complications after abdominal surgery. More case-relevant communication was associated with a decreased likelihood of surgical site infections (specifically organ/space infections), whereas increased case-irrelevant communication during the closing phase was associated with an increased risk of surgical site infection (specifically incisional infections). We found no direct effect of observed distractions on surgical site infections. The third paper focused on the impact of team familiarity on surgical complications. The results indicated that complications where more frequent when a senior and a junior surgeon where less familiar with one another (first month of their collaboration) that when they were familiar (sixth month of their collaboration). More noise and a decreased concentration of senior surgeons where also found when less familiar teams operated. In the fourth paper, we related measured noise levels during different phases of surgeries to reported concentration of OR teams. Junior surgeons were distracted by higher noise levels during the main and also most critical surgical phase. Anaesthetists were most distracted by noise during the closing phase, which is a high load phase for the anaesthetists because of patient emergence. We found no effect of noise levels on concentration of senior surgeons and scrub nurses. The fifth paper aimed to investigate the effects of noise peaks on communication within the surgical team, focusing on five-minute intervals. Whereas case-relevant communication decreased in intervals with more frequent noise peaks, case-irrelevant communication tended to decrease under high noise peaks conditions. Interestingly, there was no effect of noise peaks on case-relevant communication during the phase of the surgery led by senior surgeons. Thus, the results indicated that communication of junior surgeons, during the less critical phase of the surgery, was most impaired by noise.