Are operating room distractions, interruptions, and disruptions associated with performance and patient safety? A systematic review and meta-analysis.

BACKGROUND The operating room (OR) is a complex environment in which distractions, interruptions, and disruptions (DIDs) are frequent. Our aim was to synthesise research on the relationships between DIDs and (a) operative duration, (b) team performance, (c) individual performance, and (d) patient safety outcomes; in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. METHODS Electronic databases (MEDLINE, Embase, CINAHL, PsycINFO) and reference lists were systematically searched. Included studies were required to report quantitative outcomes of the association between DIDs and team performance, individual performance, and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality, and extracted data. A random effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. RESULTS Twenty-seven studies were identified. The majority were prospective observational studies (n=15), of moderate quality (n=15). DIDs were often defined, measured, and interpreted differently in studies. DIDs were significantly associated with: extended operative duration (n=8), impaired team performance (n=6), self-reported errors by colleagues (n=1), surgical errors (n=1), increased risk and incidence of surgical site infection (n=4), and fewer patient safety checks (n=1). A random effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% CI 15.7-29.9). CONCLUSION DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.