Background noise lowers the performance of anaesthesiology residents’ clinical reasoning

Enser, M. et al. European Journal of Anaesthesiology | Published online: 7 April 2017


Background: Noise, which is omnipresent in operating rooms and ICUs, may have a negative impact not only patients but also on the concentration of and communication between clinical staff.

Conclusion: Our study suggests that noise affects clinical reasoning of anaesthesiology residents especially junior residents when measured by SCT. This observation supports the hypothesis that noise should be prevented in operating rooms especially when junior residents are providing care.

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Impact of disruptions on anaesthetic workflow during anaesthesia induction and patient positioning: A prospective study

Al-Hakim, L. et al. European Journal of Anaesthesiology. August 2016.33 (8). pp. 581–587

L0028353 A gynaecological operation. Colour lithograph by Virginia Po
Image source: Virginia Powell – Wellcome Images // CC BY-NC-ND 4.0

Background: Work disruption in operating rooms hinders flow of patients and increases chances of error. Previous studies have largely considered the types of disruption occurring in operating rooms, but have not analysed systematically the objective impact of disruption.

Objective: The objective was to evaluate the impact of disruption on time efficiency in preoperative anaesthetic work in the operating room and to link disruption to failures in co-ordination of care.

Design: Prospective, cross-sectional and observational study.

Setting: Disruptions were evaluated in operating rooms of five hospitals across three countries: Australia (one community hospital, one teaching hospital); Thailand (two community hospitals); China (one teaching hospital).

Participants: The preoperative phase of anaesthesia induction/patient positioning of 64 surgical patients across specialities was prospectively evaluated (Australia = 33; Thailand = 12; China = 10). Further, interviews were carried out with 16 consultant anaesthetists and surgeons and 13 senior operating room nurses involved in the care of these patients.

Main Outcome Measures: Disruptions were identified by trained observers in real time during the preoperative phase; four types of care co-ordination problems were identified from the interviews with senior anaesthetists, surgeons and nurses, and linked to the disruptions. Descriptive analyses of time efficiency were performed.

Results: Complete data were available from 55 cases. Good inter-observer agreement was obtained across measurements (range 74 to 92%). An average of three disruptions per case during the preoperative phase, were observed (range 2 to 9). ‘Disruption types’: disruptive staff activities were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 4 min 45 s per case). ‘Care co-ordination problems’: co-ordination lapses within the operating room team, and between them and the preoperative team were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 5 min 0 s per case).

Conclusions: The study quantifies time inefficiencies affecting anaesthetic work during the preoperative phase. Work disruption wastes time and is preventable.

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The effect of a standardised source of divided attention in airway management: A randomised, crossover, interventional manikin study

Prottengeier, J. European Journal of Anaesthesiology: March 2016 – Volume 33 – Issue 3 – p 195–203

Background: Dual-tasking, the need to divide attention between concurrent tasks, causes a severe increase in workload in emergency situations and yet there is no standardised training simulation scenario for this key difficulty.

Objectives: We introduced and validated a quantifiable source of divided attention and investigated its effects on performance and workload in airway management.

Participant: One hundred and fifty volunteer medical students, paramedics and anaesthesiologists of all levels of training.

Interventions: Participants secured the airway of a manikin using a supraglottic airway, conventional endotracheal intubation and video-assisted endotracheal intubation with and without the Paced Auditory Serial Addition Test (PASAT), which served as a quantifiable source of divided attention.

Results: All 150 participants completed the tests. Volunteers perceived our test to be challenging (99%) and the experience of stress and distraction true to an emergency situation (80%), but still fair (98%) and entertaining (95%). The negative effects of divided attention were reproducible in participants of all levels of expertise. Time consumption and perceived workload increased and almost half the participants make procedural mistakes under divided attention. The supraglottic airway technique was least affected by divided attention.

Conclusion: The scenario was effective for simulation training involving divided attention in acute care medicine. The significant effects on performance and perceived workload demonstrate the validity of the model, which was also characterised by high acceptability, technical simplicity and a novel degree of standardisation.

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