People used to joke that in the 1970s and 1980s, only doctors and drug dealers had pagers. Drug dealers have moved on to more sophisticated technology, and doctors are probably the only profession using pagers. In our academic institution, residents still use pagers for consults and emergencies.
I’m reminded of this every time I’m in the operating room (OR), with the resident’s pager going off with the old-style shrieking, high-pitched ringer multiple times throughout the day. People in the OR don’t seem to mind at all, expect for me. Perhaps they’ve all been desensitized to all the technology-related noise and distractions that are so common today.
Besides pager noise pollution, there are a number of other distractions that can potentially lead to less than ideal surgical results. Here are 7 annoying distractions in the OR that can be detrimental to patient care:
1. Pagers
Most of the modern pagers have more pleasing ringtones, and even a vibrate option, but it seems that most doctors continue to use the most annoying ringtone to get their attention. It’s not just the bothersome ringtone—it also causes my assistant to get distracted and ends up having the circulating nurse call back the page and relay messages back to the person who initiated the page. Sometimes, the resident scrubs out to talk on the phone or gets called to the floor or ER to handle any emergency situations. Needless to say, this can be very distracting.
2. Chatter
Contrary to the old days when the OR was thought to be an operating theater, conversations start up between various non-surgical staff. Many are for reasons related to the surgical procedure, but often times, it’s just chi-chat. When I was in medical school, these conversions used to be in hushed tones, but now it’s at regular conversation levels. You can sometimes have two pairs of people having conversations.
3. Music
Every surgeon has preferences for whether or not they want music playing at all, and if they like music, will have very different tastes. My personal preference is to have no music at all. I take surgery seriously, as if I’m taking a test. Having music in the background may be soothing or relaxing to some people, but it can definitely have conscious or subconscious detrimental effects on test-taking or even surgery. Also, not every one will like the kind of music that’s chosen to be played. Studies have shown conflicting results on whether music in the OR can alter outcomes.
If we’re at the end of a case and closing and if someone requests, music, I insist on classical, jazz, or instrumental music only with no words.
3. Too many screens
This may only apply to some of the newer operating rooms. In my hospital with new operating rooms, there are literally 4 LCD monitors, usually hooked up to the camera that I’m using for the patent. Anesthesia has their own 2 to 3 monitors. The problem is that I can usually see 2 or three others in my direct line of sight or peripheral field of vision. Having the camera attached and not holding it steady will make the image shake or move around, making everyone in the room dizzy. Having two extra large LCD monitors make things much worse. Oftentimes, I go around to turn off one or two monitors, and switch the third monitor to the anesthesia machine, keeping only one for myself.
4. Screen savers
One really annoying thing that my hospital has done in the name of patient safety is to install screen savers that animate different messages, like wash your hands often, check the patient’s ID multiple times, get your flu shot, or don’t recap needles. The problem is that the animation is really distracting, in addition to being reminded of things that we’re already doing anyway. Now imagine seeing 4 monitors transitioning to a different screen every minute, like what you would see at a flat screen TV wall at Best Buy.
What I usually do is to turn off the screen savers at the beginning of each case. I do the same thing when seeing patients in the office, as it detracts from the doctor-patient experience.
5. Instrument noise
There can be dozens of medical equipment in a modern operating room. Some of these machines can beep, hum, buzz, screech or hiss at extremely loud noise levels. Alarm sounds can be even louder. These distractions can occur repeatedly throughout the case. Many studies have shown that sound levels in the OR can routinely exceed 100 dB, sometimes as high as 131 dB. 100 dB is as loud as a lawnmower or a motorcycle.
6. Too hot or cold temperature
The OR is intentionally kept somewhat cool, but oftentimes, it’s much too cold. Being dressed in scrubs in low 60 degree temperatures can be quite uncomfortable. Putting on surgical gowns makes things much more tolerable, but the circulating nurse and anesthesia staff are frequently shivering. The patient is always comfortable, with a warming blanket throughout the case. Rarely, it can get uncomfortably hot. In most cases the temperature can be adjusted, but not always.
7. No place to write
With more modern ORs, it’s expected that everything will be documented in the computer. However, the vast majority of paperwork that’s done in the OR is still done on paper. Since the one desk/table is being used by the circulating nurse, the only place for me to write my notes and discharge paperwork is on a trash bin, or small light source box. As you can imagine, these are not the most ideal surfaces to write on.
These 7 annoying distractions may be unique to my particular situation, but I’m sure that most surgeons will experience some, if not most of these same issues.
Some of these distractions may not be a big deal. But if added together, especially if they occur simultaneously at critical times during surgery, you can imagine it can potentially lead to less than optimal medical or surgical results. Here’s an article summarizing these potential dangers. Bare minimum, it can lead to miscommunication or misunderstandings amongst the staff.
In this age of high-technology and multitasking, we assume that we can handle multiple tasks at the same time. However, it’s been shown that we can focus on only one thing at a time. Various distractions can divert our attention away from our main area of focus. It doesn’t take a brain surgeon to know that these distractions do not provide the ideal situation for good patient care.
If you’ve undergone surgery recently, have you noticed any of the issues that I mentioned in this blog? Please enter your responses in the text box below.
I was totally surprised when I was wheeled into surgery and not “under” yet that they had on loud rock music. During a different surgery it was freezing cold in the OR room and I asked for blankets which they supplied right away. It seems nonsensical in this type of environment that these conditions exist. When myself or loved ones have surgery, I want to believe that my best interests for a successful outcome during surgery are met including unnecessary distractions..
As a patient I’ve also noticed that the OR is too cold. This is only a minor annoyance to the patient because he/she is quickly covered, but it’s detrimental to the doctors and staff – it’s difficult to work well, especially at delicate tasks, when you’re uncomfortably chilly.
Thanks Dr. Park – this article is a real eye opener.