of the closures. Data was collected for several categories of disrup-
tions and interruptions that occurred during wound closure — com-
munication, coordination (change of staff), and other human or
technological interruptions. Average and peak decibel levels were
also recorded to better understand the noise level occurring during
wound closure. Routine patient- and case-related communication is
essential and was not considered a distraction or interruption, and
therefore not collected as part of this project.
Distractions often combine with other distractions to create an
attention-destroying cacophony. In compiling observational data, the
focus was not on individual interruptions, but rather the combina-
tions of them. The research was eye-opening because the interrup-
tions staff experienced were heavily related to communication and
the OR environment. Many unplanned or unexpected distractions
affected attention to the task at hand and increased injury risk.
• Coordination interruptions. OR team members often take deep
breaths when a procedure is completed and think, "We did it. We're
done. On to the next case." Wound closure is often viewed as less
critical and relatively easy to do, and it's often delegated to novice
or inexperienced staff. Attention moves toward activities required to
end the case and away from the person closing the wound.
The entire team shifts to a future-oriented mindset. Relief staff often
replace those who have been present throughout the procedure. The
patient might be emerging from anesthesia. Nurses are focused on
reconciling counts and specimens, finishing their documentation and
getting ready to transfer the patient to PACU. Amid these disruptions,
team members are working to close the wound. That's when mistakes
can happen. Broken concentration, not negligence, is the cause.
• Cognitive fatigue. Human beings can focus on only so many
things at one time. We have natural limitations in terms of the
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