Newly Published
Perioperative Medicine  |   October 2017
Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events during Anesthesia Care
Author Notes
  • From the Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee (J.M.S., E.S.P., A.N.L., M.S.S., M.B.W.); Departments of Anesthesiology (J.M.S., A.N.L., M.S.S., M.B.W.) and Biostatistics (M.S.S.), Vanderbilt University School of Medicine, Nashville, Tennessee; Amazon, Seattle, Washington (D.A.); and Health Services Research Division and Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System–Nashville Campus, Nashville, Tennessee (M.B.W.).
  • This work was in part presented at the 2011 American Society of Anesthesiologists Annual Meeting in Chicago, Illinois, October 19, 2011; the 2016 Annual Meeting of the Anesthesia Patient Safety Foundation in Phoenix, Arizona, September 7, 2016; and the 2017 International Symposium on Human Factors and Ergonomics in Health Care in New Orleans, Louisiana, March 6, 2017.
    This work was in part presented at the 2011 American Society of Anesthesiologists Annual Meeting in Chicago, Illinois, October 19, 2011; the 2016 Annual Meeting of the Anesthesia Patient Safety Foundation in Phoenix, Arizona, September 7, 2016; and the 2017 International Symposium on Human Factors and Ergonomics in Health Care in New Orleans, Louisiana, March 6, 2017.×
  • Submitted for publication May 27, 2015. Accepted for publication July 25, 2017.
    Submitted for publication May 27, 2015. Accepted for publication July 25, 2017.×
  • Acknowledgments: The authors acknowledge the administrative and/or technical contributions of the following individuals: Neal Sanders, Ph.D. (Department of Health IT Data Analytics, Vanderbilt University Medical Center, Nashville, Tennessee), Steve Ampah, M.S. (Ph.D. student, Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama), Russ Beebe, B.A. (Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center), Andrew Kline, B.A. (Vanderbilt Comprehensive Care Clinic, Vanderbilt University Medical Center), Christine Goldsberry (Department of Anesthesiology, Vanderbilt University Medical Center), Kelly Peters, B.A. (Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center), and Callie Hanks, M.M.H.C. (Department of Performance Management and Improvement, Monroe Carell, Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee).
    Acknowledgments: The authors acknowledge the administrative and/or technical contributions of the following individuals: Neal Sanders, Ph.D. (Department of Health IT Data Analytics, Vanderbilt University Medical Center, Nashville, Tennessee), Steve Ampah, M.S. (Ph.D. student, Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama), Russ Beebe, B.A. (Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center), Andrew Kline, B.A. (Vanderbilt Comprehensive Care Clinic, Vanderbilt University Medical Center), Christine Goldsberry (Department of Anesthesiology, Vanderbilt University Medical Center), Kelly Peters, B.A. (Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center), and Callie Hanks, M.M.H.C. (Department of Performance Management and Improvement, Monroe Carell, Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee).×
  • Research Support: Supported by a grant from the Anesthesia Patient Safety Foundation (Indianapolis, Indiana; to Dr. Slagle) and by internal institutional resources. Some of Dr. Weinger’s time was supported by the Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System (Nashville, Tennessee).
    Research Support: Supported by a grant from the Anesthesia Patient Safety Foundation (Indianapolis, Indiana; to Dr. Slagle) and by internal institutional resources. Some of Dr. Weinger’s time was supported by the Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System (Nashville, Tennessee).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Slagle: Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building, Suite 732, Nashville, Tennessee 37212. jason.slagle@vanderbilt.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Education / CPD
Perioperative Medicine   |   October 2017
Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events during Anesthesia Care
Anesthesiology Newly Published on October 19, 2017. doi:10.1097/ALN.0000000000001915
Anesthesiology Newly Published on October 19, 2017. doi:10.1097/ALN.0000000000001915
Abstract

Background: When workload is low, anesthesia providers may perform non–patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events.

Methods: In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis. Participant workload and response to a vigilance (alarm) light were randomly measured. Postoperatively, participants were interviewed to elicit possible nonroutine events. Two anesthesiologists reviewed each event to evaluate their association with distractions.

Results: At least one self-initiated distraction was observed in 171 cases (54%), largely during maintenance. Distractions accounted for 2% of case time and lasted 2.3 s (median). The most common distraction was personal internet use. Distractions were more common in longer cases but were not affected by case type or American Society of Anesthesiologists physical status. Workload ratings were significantly lower during distraction-containing case periods and vigilance latencies were significantly longer in cases without any distractions. Three distractions were temporally associated with, but did not cause, events.

Conclusions: Both nurse anesthetists and residents performed potentially distracting tasks of a personal and/or educational nature in a majority of cases. Self-initiated distractions were rarely associated with events. This study suggests that anesthesia professionals using sound judgment can self-manage nonclinical activities. Future efforts should focus on eliminating more cognitively absorbing and less escapable distractions, as well as training in distraction management.