PART 2: The prevalence and effects of changeovers and other potential distractions during post-operative counts in general surgery
Event Type
Oral Presentations
TimeWednesday, June 8th3:30pm - 4:00pm EDT
DescriptionBackground: Surgical count process aims to reduce the retained foreign body incidents. This task requires focused attention from nurses to ensure no equipment is left in patient body. However, changeovers and other potential distractions such as operating room (OR) traffic can interfere with the required attention and may lead to counting errors. The goal of this study is to examine the prevalence and the effects of changeovers and other potential distractions during post-operative counts.
Methods: Qualitative data is currently being collected through an ongoing focus group and interview study with surgical team members. Quantitative data was collected via the OR Black Box® (ORBB®), an audio-video recording platform, from a teaching hospital in Canada between January 2019 and March 2020 (SMH REB#16-243). The ORBB® recordings were reviewed and coded by two trained individuals using standardized protocols: changeovers, OR traffic, and communication (e.g., pagers, incoming and outgoing phone calls) were captured. The dataset also detailed external instruments (e.g., X-ray) brought to the OR. Qualitative data highlighted surgical team member perceptions about these potential distractions, and the quantitative data revealed their prevalence during post-operative counts and repeated count processes.
Results: Two OR nurses (out of four participants) who participated in our ongoing qualitative study mentioned that changeovers and distractions during counts could lead to increased operation time, repeated counts, and using of the X-ray in case of count discrepancy. 41 general surgery cases were analyzed from the ORBB data (mean, M, surgery duration: 1h 37m, standard deviation, SD= 42m). The average post-operative count duration was 4m 33s (SD=4m 23s). 39 out of 41 cases (95%) had at least one distraction during post-operative counts, mainly involving OR traffic (M=0.63 times per case, SD=0.39), which was also the most common distraction type observed in general for the entire surgery (mean, M=0.29 per case, SD=0.12). Four cases had scrub nurse/tech (n=2) or anesthesiologist (n=2) changeovers during post-operative counts. Counting was repeated in one of these case after a scrub nurse/tech changeover. The recount took 14m and 37s. No X-rays were used.
Conclusion: Surgical counts are safety critical tasks that require focused attention. Changeovers and other distractions occur frequently and may have negative effects on post-operative counts, such as having to repeat the counting and lengthening the operation time. To cultivate surgical safety, appropriate staff scheduling and raising awareness among OR team members about distractions may help reduce such detrimental effects.