New study focuses on distractions, interruptions during surgical counting

The number of distractions in day-to-day life is only increasing with technology and inundations from all forms of multimedia. Operating rooms (ORs) are no exception, but they also are areas where any type of interruption can lead to an inaccuracy that compromises patient safety.

A new observational study published in the September 2021 issue of the Joint Commission Journal on Quality and Patient Safety—“Prevalence and characteristics of interruptions and distractions during surgical counts”—focuses on the issue of interruptions and distractions during surgical counting.* And though the study authors did not observe inaccurate counts nor draw a direct correlation between interruptions and inaccuracies, surgical professionals generally understand that interruptions are not good in the OR setting.

The authors—Katherine A. Bubric, MSc; Susan L. Biesbroek, MSc; Jason C. Laberge, MSc; Jessica A. Martel, MSc; and Stacey D. Litvinchuk, MSN—point out that surgical counting is “a complex and safety-critical task that requires sustained attention by multiple members of the surgical team in order to prevent the occurrence of an unintentionally retained foreign object.”*

Examples of interruptions or distractions to surgical counting include the following:*

  • People entering and exiting the room
  • Phone calls and pagers
  • Music
  • Personal conversations
  • Equipment failures
  • Procedure events

The authors found that studies have shown that distractions and interruptions can lead to fewer safety checks, less teamwork and communication, and greater stress and perceived workload.

To investigate the issue, the study authors observed 28 operations—15 were major operations, six were laparoscopic procedures, and two were arthroscopic. They analyzed the initial counts, additions and removals to and from the surgical field, and closure counts. The authors arrived at the following findings:*

  • Interruptions occurred in 10 percent of initial counts, 15.4 percent of additions, 23.5 percent of removals, and 33.3 percent of closure counts.
  • The source of 80.4 percent of interruptions was a surgeon, typically when asking a nurse for an item.
  • Distractions were noted in 46.7 percent of initial counts, 38.5 percent of additions, 41.2 percent of removals, and 40.9 percent of closure counts, with common sources of distraction being music, conversations, people entering and exiting the room, and the phone ringing.

Jeopardizing patient safety

As a result of their findings, the authors concluded that interruptions and distractions are common during surgical counts and could potentially affect patient safety by “jeopardizing the accuracy of the count.”

“It is important to acknowledge that despite best efforts, it will not be possible to prevent the occurrence of all interruptions and distractions during surgical counts,” the authors wrote. “Some of these events cannot be controlled by the surgical team. Consequently, nurses must develop strategies to mitigate the impacts of interruptions and distractions and maintain surgical count accuracy.”*

The authors offered several suggestions to reduce distractions or interruptions and to improve the surgical count process, such as the following:*

  • Use of standardized processes and tools to restart a count after an interruption.
  • Teamwork between nurses if an interruption occurs.
  • Technology, such as radio-frequency identification systems
  • Buy-in from surgeons to set the culture of the OR as one that values the importance of reducing distractions and interruptions
  • Incorporating practices such as timeouts

The article can be found online here.


The thoughts and opinions expressed in this column are solely those of Dr. Jacobs and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.

*Bubric KA, Biesbroek SL, Laberge JC, Martel JA, Litvinchuk SD. Prevalence and characteristics of interruptions and distractions during surgical counts. Jt Comm J Qual Patient Saf. May 22, 2021. Available at: Accessed October 4, 2021.

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