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Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study
Örebro University, School of Health Sciences. Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden; Centre for Clinical Research, Falun, Dalarna, Sweden.ORCID iD: 0000-0002-0883-4072
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Development Centre, Turku University Hospital, Turku, Finland.
Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden.
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e026410Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

SETTING: An OR department at a county hospital in Sweden.

PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

TRIAL REGISTRATION NUMBER: 2016/264.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019. Vol. 9, no 5, article id e026410
Keywords [en]
Complexity, interruptions, multitasking, operating room, patient safety
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-74314DOI: 10.1136/bmjopen-2018-026410ISI: 000471192800188PubMedID: 31097486Scopus ID: 2-s2.0-85065927356OAI: oai:DiVA.org:oru-74314DiVA, id: diva2:1316719
Note

Funding Agencies:

Center for Clinical Research Dalarna  

Finnish state funding for university-level health research 

Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-07-22Bibliographically approved

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Göras, Camilla

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