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Observational Study
. 2019 May 15;9(5):e026410.
doi: 10.1136/bmjopen-2018-026410.

Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study

Camilla Göras #  1   2   3 , Karolina Olin #  4   5 , Maria Unbeck  6   7 , Karin Pukk-Härenstam  4   8 , Anna Ehrenberg  9 , Mesfin Kassaye Tessma  4 , Ulrica Nilsson  10 , Mirjam Ekstedt  4   11
Affiliations
Observational Study

Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study

Camilla Göras et al. BMJ Open. .

Abstract

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.

Keywords: complexity; interruptions; multitasking; operating room; patient safety.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Distribution of the proportion of the observed time* participants spent performing tasks in a particular category. *Total observation time per profession was 66 hours each for ORNs and RNAs, whereas surgeons were observed for 37 hours. ORNs, operating room nurses; RNAs, registered nurse anaesthetists.
See this image and copyright information in PMC

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