What’s up y’all this is Jon Lowrance and this is episode 89 – Distraction in the OR with Heather Turcotte, DO. Y’all, I am so stoked to bring you this conversation… I caught up with Dr Turcotte earlier this summer as she was finishing her residency in anesthesia and I’m pumped to finally get this out to you in early September of 2022. This topic was the focus of her residency project and senior grand rounds presentation and it definitely created a stir in our group as CRNAs, physicians, residents & SRNAs grappled with how to appropriately use cell phones and other technology in their practices.
Since it’s late summer, early fall… I gotta give a shout out to all the residents & SRNAs out there who graduated this summer. It’s always fun to see yall wrap up clinicals & residency projects and transition into your new jobs or fellowships.
I love getting texts & photos from SRNAs of their board results with the word PASS printed in the middle of the page… It’s such an incredible moment that makes all of the hard work worth it. So thanks to all of you who have reached out by email, text & social media recently with your passing boards photos, positive reviews & ratings of the podcasts and questions. This podcast puts me in touch with so many amazing people… I’ve recently heard from experienced providers to newly minted CRNAs on the day they pass boards, to brand new CA1’s to ICU nurses who found the podcast and are on the path to becoming anesthesia providers. Wherever you are in your own journey, my hope is that Anesthesia Guidebook will be a go-to guide for you as you seek to get your learn on and master your craft.
Heather Turcotte, DO joins me in this is fascinating conversation that weaves through the considerations around using cell phones in the OR, checking email/internet, music that’s playing, conversations, door swings and other forms of distraction in the operating room.
Dr Turcotte was born and raised in the great state of Maine. She earned a doctorate in physical therapy and practiced as a physical therapist for 4 years before going back to medical school in 2014 at the University of New England. Dr Turcotte finished her residency in anesthesiology at Maine Medical Center in 2022 and entered into private practice. Outside of medicine, she enjoys spending time with her husband and 3 kids, who are 9, 6, and 1 years old at the time of this recording, going to the beach, and drinking lots of coffee!
In this conversation, Dr Turcotte brings this discussion to life with a case study where an anesthesia provider settled out of court in a dispute on negligence in a case where the patient experienced hypotension and a PEA arrest, survived the case but died a few days later. The anesthesia provider had used their cell phone and anesthesia station computer to check email and online news stories. Interestingly, an expert anesthesia witness testified that the actions of the anesthesia provider in managing the patient were flawless. But just because the provider had used their cell phone & surfed the internet on the work computer, the legal team advised they settle to avoid a jury verdict on the case.
Cell phone use, open internet access including email, music playing the OR and so many other forms of distraction are common elements in operating rooms across the United States. Some institutions create policies that limit cell phone use in the OR. Others have policies that are more vague while others have no formal policies around cell phone use in the OR. There’s legitimate considerations for each of these… On one hand, how does a hospital enforce a policy that is very strict? Does creating a policy set that institution up for compliance issues or litigation? On the other hand, how can hospitals help engineer safe and reliable environments for providers to work in? As technology continues to become more and more central t0 the work we do, the issues of attention span, distraction, user experience of technology and systems engineering to create & maintain safe environments will remain important factors for each provider, group and institution to consider.
References
- Staughton, J. (8 July 2022). Can humans actually multitask. Science ABC. Retrieved from https://www.scienceabc.com/humans/can-humans-actually-multitask.html
- Luthra, S. (13 July 2015). Do cell phones belong in the operating room. The Washington Post. Retrieved from https://www.washingtonpost.com/national/health-science/do-cellphones-belong-in-the-operating-room/2015/07/13/f524e908-1e9e-11e5-aeb9-a411a84c9d55_story.html
- van Pelt, M., & Weinger, M. B. (2017). Distractions in the anesthesia work environment: Impact on patient safety? Report of a meeting sponsored by the anesthesia patient safety foundation. Anesthesia & Analgesia, 125(1), 347-350. Retrieved from https://www.apsf.org/article/distractions-in-the-anesthesia-work-environment-impact-on-patient-safety-report-of-a-meeting-sponsored-by-the-anesthesia-patient-safety-foundation/
- Bédard, M., Pelletier-Roy, R., Angers-Goulet, M., Leblanc, P. A., & Pelet, S. (2015). Traffic in the operating room during joint replacement is a multidisciplinary problem. Canadian Journal of Surgery, 58(4), 232.
- Jung, J. J., Elfassy, J., & Grantcharov, T. (2020). Factors associated with surgeon’s perception of distraction in the operating room. Surgical Endoscopy, 34(7), 3169-3175.
- Katz, J. D. (2014). Noise in the operating room. Anesthesiology, 121(4), 894-898.
- Neves, S., & Soto, R. G. (2019). Distraction in the OR: bells and whistles on silent mode. International anesthesiology clinics, 57(3), 62-67.
- Mcleod, R. W. J., Myint-Wilks, L., Davies, S. E., & Elhassan, H. A. (2021). The impact of noise in the operating theatre: a review of the evidence. The Annals of The Royal College of Surgeons of England, 103(2), 83-87.
- Mears, S. C., Blanding, R., & Belkoff, S. M. (2015). Door opening affects operating room pressure during joint arthroplasty. Orthopedics, 38(11), e991-e994.
- Rothman, B. S., Bledsoe, S., & Rice, M. J. (2022). Turn Your Attention to Distractions. Anesthesia & Analgesia, 134(2), 266-268.
- Slagle J., et. al. Prevalence of potential distracting noncore activities and their effects of vigilance, workload and nonroutine events during anesthesia care. Anesthesioology. 128(1):44-54. doi: 10.1097/ALN.0000000000001915.
- Klumpner, T. T., Biggs, D. A., Chan, L. Y., & Rothman, B. S. (2018). Your Attention Please: Personal Electronic Device Use in the OR. ASA Monitor, 82(6), 18-20.
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