Electronic Distraction, the Perioperative Experience

Roy ConstantineRoy H. Constantine  PA-C, MPH, PhD, FCCM, DFAAPA
Former CSPS Liaison & Chair

Article originally printed in Sutureline: Nov/Dec 2014 p. 10

On October 8, 2013, the Council on Surgical and Perioperative Safety (CSPS) adopted the following Safe Surgery Resource.

“The CSPS endorses all measures to reduce the risk of noise and distraction in the perioperative period.”

The following excerpts from Dr. Papadakos’s article, “As Doctors Use More Devices, Potential for Distraction Grows” will set the tone.

“You walk around the hospital, and what you see is not funny, said Dr. Peter J. Papadakos, an anesthesiologist and director of critical care at the University of Rochester Medical Center in upstate New York, who added that he had seen nurses, doctors and other staff members glued to their phones, computers and iPads.


 You justify carrying devices around the hospital to do medical records, but you can surf the Internet or do Facebook, and sometimes, for whatever reason, Facebook is more tempting….but like many cures, this solution has come with an unintended side effect: doctors and nurses can be focused on the screen and not the patient, even during moments of critical care. And they are not always doing work; examples include a neurosurgeon making personal calls during an operation, a nurse checking airfares during surgery and a poll showing that half of technicians running bypass machines had admitted texting during a procedure (Papadakos).”

If you go to the CSPS site, www.cspsteam.org, look at resource (#21) and you will find several articles and position statements that support this Safe Surgical Resource.

The literature points to the fact that ambient background noise can affect auditory processing. What that means is spoken words can be misinterpreted as a direct result to noise (ACS).

In the operating room, electronic or cellular devices may directly relate to a compromise in care. The use of these devices needs to be carefully planned. Alternate considerations should be made for urgent or emergent calls to be received and managed. Ideally, communication devices can be forwarded to voice mail or messages can be received by a co-worker, the main OR desk, your office, etc. (ACS).

The availability of Internet access, the ability to freely review magazines, books, blogs, games, take pictures and videos pose both a safety and personal threat. “Concerns continue to increase regarding professional boundaries and patient privacy rights protected by the Health Insurance Portability and Accountability Act of 1996 (HIPPA) (AANA).

Ideally, a multidisciplinary approach is needed to reduce distractions and noise overall (AORN). During critical phases of a surgical procedure an inter-operative time out is suggested. This holds true in many other critical care and procedural settings. There should be a no-interruptive period where non-essential conversations are discontinued and all other activities are prohibited. The literature refers to this as the “sterile cockpit, the zone of silence or the red zone.”  Elements regarding Noise and Distraction, Cellular Devices in the Operating Room and Infection Control should be incorporated into the multidisciplinary team approach.

Members of the CSPS have produced and copyrighted a poster entitled “The Electronic Distraction – Perioperative Experience.”  Simple awareness is all that may needed in order to prevent a sentinel event. Copies of the poster can be obtained from the CSPS c/o of the American College of Surgeons – Phone 312-202-5700 – Email: [email protected].

Research continues to focus on Best Practices, Safety Tools, and Cognitive Aids in the clinical setting. The Surgical Physician Assistant is a key stakeholder in the development and implementation of organizational safety initiatives. There is no excuse – WE ALL NEED TO BE INVOLVED!!!


  1. As Doctors Use More Devices, Potential for Distraction Grows. The New York Times. Retrieved from http://www.nytimes.com/2011/12/15/health/as-doctors-use-more-devices-potential-for-distraction-grows.html?ref=mattrichtel&_r=1&
  2. Noise in the Perioperative Setting. AORN. Retrieved from http://www.aorn.org/Clinical_Practice/Position_Statements/PosStat_Noise.aspx
  3. Mobile Use Device. AANA. Retrieved from http://www.aana.com/resources2/professionalpractice/Documents/PPM%20PS%202.18%20Mobile%20Device%20Use.pdf
  4. [ST-59]. Statement on use of cell phones in the operating room. American College of Surgeons. Retrieved from http://www.facs.org/fellows_info/statements/st-59.html