4 Signs of Surgeons' Inattention in the OR

Cheryl Clark, for HealthLeaders Media , September 30, 2010

4. Stopping. The surgeon stops the operative procedure.

"As the (surgical) fellow was transecting the liver parenchyma, the surgeon, recognizing unusual anatomy, said 'What the hell is that? Let's just stop and see how we're doing here.' The surgeon then placed his hand in the field to prevent the fellow from operating and looked up at the ceiling for a few seconds with his eyes closed."

"When the researcher asked what he was thinking, he (half) joked, 'I am looking at the textbook on the ceiling.'"

A fifth behavior, called inattentive automatic state" was also observed when the surgeon failed to make a transition as required. Interestingly, many of the surgeons interviewed vehemently denied that they ever entered an automatic mode while operating.  But some apparently do.

"While the surgeon assisted the fellow in this more mundane and routine part of the procedure, the surgeon and trainee engaged in extraneous conversation. Returning to the porta hepatis, the surgeon placed the right angle around the bile duct, forgetting, for the moment, the aberrant artery that had been delicately dissected out 30 minutes before," the researchers recounted.

"Unknowingly the artery was tied off with the bile duct....the surgeon explained tat it was normally such a routine part of the procedure, and admitted to being distracted by conversation."

When surgeons allow themselves to drift, "they fail to engage in the essential monitoring activities that allow them to detect the cues that will initiate a slowing down event," the researchers wrote.

Co-authors are affiliated with the University of British Columbia in Vancouver, the Schulich School of Medicine and Dentistry at the University of Western Onario and Mount Sinai Hospital in Toronto.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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