Slagle Jason M, Porterfield Eric S, Lorinc Amanda N, Afshartous David, Shotwell Matthew S, Weinger Matthew B
From the Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee (J.M.S., E.S.P., A.N.L., M.S.S., M.B.W.); Departments of Anesthesiology (J.M.S., A.N.L., M.S.S., M.B.W.) and Biostatistics (M.S.S.), Vanderbilt University School of Medicine, Nashville, Tennessee; Amazon, Seattle, Washington (D.A.); and Health Services Research Division and Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System-Nashville Campus, Nashville, Tennessee (M.B.W.).
Anesthesiology. 2018 Jan;128(1):44-54. doi: 10.1097/ALN.0000000000001915.
When workload is low, anesthesia providers may perform non-patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events.
In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis. Participant workload and response to a vigilance (alarm) light were randomly measured. Postoperatively, participants were interviewed to elicit possible nonroutine events. Two anesthesiologists reviewed each event to evaluate their association with distractions.
At least one self-initiated distraction was observed in 171 cases (54%), largely during maintenance. Distractions accounted for 2% of case time and lasted 2.3 s (median). The most common distraction was personal internet use. Distractions were more common in longer cases but were not affected by case type or American Society of Anesthesiologists physical status. Workload ratings were significantly lower during distraction-containing case periods and vigilance latencies were significantly longer in cases without any distractions. Three distractions were temporally associated with, but did not cause, events.
Both nurse anesthetists and residents performed potentially distracting tasks of a personal and/or educational nature in a majority of cases. Self-initiated distractions were rarely associated with events. This study suggests that anesthesia professionals using sound judgment can self-manage nonclinical activities. Future efforts should focus on eliminating more cognitively absorbing and less escapable distractions, as well as training in distraction management.
当工作量较低时，麻醉医护人员可能会进行临床、教育或个人性质的非患者护理活动。关于干扰对实际护理的发生率或影响的数据有限。我们研究了自我发起的非临床干扰的发生率及其对麻醉工作量、警觉性和非日常事件发生情况的影响。
在一家学术医疗中心的319例符合条件的病例中，使用基于网络的电子病历，一名经过培训的观察者记录视频并进行行为任务分析。随机测量参与者的工作量和对警觉（警报）灯的反应。术后，对参与者进行访谈以引出可能的非日常事件。两名麻醉医生对每个事件进行审查，以评估其与干扰的关联。
在171例病例（54%）中观察到至少一次自我发起的干扰，主要发生在维持期。干扰占病例时间的2%，持续时间为2.3秒（中位数）。最常见的干扰是个人使用互联网。干扰在较长的病例中更常见，但不受病例类型或美国麻醉医师协会身体状况的影响。在包含干扰的病例期间，工作量评分显著较低，而在没有任何干扰的病例中，警觉潜伏期显著更长。三次干扰在时间上与事件相关，但未导致事件发生。
在大多数病例中，麻醉护士和住院医生都进行了具有个人和/或教育性质的潜在干扰性任务。自我发起的干扰很少与事件相关。这项研究表明，运用合理判断的麻醉专业人员可以自我管理非临床活动。未来的努力应集中在消除更具认知吸引力且难以避免的干扰，以及进行干扰管理培训。
