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4 Signs of Surgeons' Inattention in the OR

Cheryl Clark, for HealthLeaders Media, September 30, 2010

We all know that the more often a doctor performs a procedure, the better the chances of a good surgical outcome. The more experienced providers who specialize in one or two procedures, all the time, at specialty hospitals, usually perform very very well.

But like any repetitive routine, doing the same operation over and over can become old and boring. Doctors and nurses on the team play the same music, tell the same jokes and gossip and perform the same steps in the same order.

And sometimes, a dangerous trance, or "drifting" can set in.  Reporting in the October issue of Academic Medicine Canadian researchers dissected just that process, which they call "automaticity." 

Engaged in conversation about the kids or the car in for repairs, doctors can make critical surgical errors that are hard to correct. Such mishaps, even among the most experienced high-volume practitioners, are more likely to take place at those times, according to lead author Carol-anne Moulton, MD, assistant professor of the Department of Surgery at the University of Toronto.

"Errors...occur because routinization leads to automatic behaviors that are not accompanied by close attention," Moulton and co-authors wrote. "Often the only evidence of drifting in these situations is when errors occur."

The article, entitled "Slowing Down to Stay Out of Trouble in the Operating Room: Remaining Attentive in Automaticity," doesn't refer to a temporal slowing down, but rather a refocusing of attention to grapple with the emerging problem.

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