Factors compromising safety in surgery: stressful events in the operating room

Sonal Arora, Louise Hull, Nick Sevdalis, Tanya Tierney, Debra Nestel, Maria Woloshynowych, Ara Darzi, Roger Kneebone

Research output: Contribution to journalArticlepeer-review

146 Citations (Scopus)

Abstract

BACKGROUND: Stressful events occur in the operating room (OR) with potentially severe consequences for patient safety. We recorded the incidence of these events in the OR, assessed the levels of stress that they caused, and investigated their detectability.

METHODS: Stressful incidents in the OR were recorded and rated in real time by an observer in 55 general and orthopedic procedures. Operating surgeons also rated incident stressfulness and their stress (validated State Trait Anxiety Inventory).

RESULTS: The total count of stressors/case ranged from 1 to 23.5 (mean, 5.87). Technical, patient, and equipment problems occurred frequently and were most stressful. Frequent but least severe stressors were distractions/interruptions, whereas least frequent/most severe stressors were teamwork problems. These events were associated with an increase in surgeons' self-reported stress. The observer was able to capture surgeons' stress accurately.

CONCLUSIONS: Systematically occurring stressors in the OR affect surgeons and can be assessed accurately. Further research should investigate the impact of stress on surgical performance.

Original languageEnglish
Pages (from-to)60-65
Number of pages6
JournalAmerican Journal of Surgery
Volume199
Issue number1
Early online date17 Dec 2009
DOIs
Publication statusPublished - Jan 2010

Keywords

  • Clinical Competence
  • Elective Surgical Procedures
  • Female
  • Great Britain
  • Hospitals, Teaching
  • Humans
  • Male
  • Observation
  • Observer Variation
  • Odds Ratio
  • Operating Rooms
  • Orthopedic Procedures
  • Practice Patterns, Physicians'
  • Prospective Studies
  • Quality of Health Care
  • Reproducibility of Results
  • Risk Assessment
  • Safety Management
  • Stress, Psychological
  • Workload
  • Workplace

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