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uncovered the potential risk of interruptions. We observed wound closure as a standalone process for 35 surgical procedures at BIDMC, and we separated interruptions into three categories: • communication • coordination (staff relief/break), and • other interruptions (human or technological). During the 35 observed wound closures, we noted 333 total interruptions — an average of 9.5 interruptions per case. An overwhelming majority of interruptions (255) were caused by communication. It was apparent the interruptions during clo- sure affected staff attention to task and increased risk potential. Staff viewed wound closure as less critical in the observed cases. As a time of transi- tion for staff relief, nurses and techs thought about future cases. Plus, it was a time of compet- ing regulatory and policy demands. These findings highlight a great opportunity for surgical facility leaders. Remind your staff that closure is a high-risk time for sharps injuries, so that they're cognizant of what's at stake and more tuned in to the task at hand. A recent study by human factors experts Albert Bouquet, PhD, and Tara Cohen, PhD, also affected my thinking on wound closure and sharps safety. The authors determined that interruptions aggre- gate over the course of surgeries, creating an ever- expanding "threat window." Surgical team members need to be aware of the threat window concept. Several disruptions can take place during proce- 1 6 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 2 0 dures, and they add up to increase risk of injury. The interruptions can be everything from people entering to check on case progress, telephone calls, workers relieving each other for breaks — the list goes on. Staff need to be aware of the effects of dis- ruptions, and they need to stay mindful. The researchers looked for disruptions during 24 cardiac procedures and recorded their frequency, and the time needed to resolve them. They detected a total of 693 interruptions during 139 hours of total observation time. It took hospital staff a total of about 10 hours to resolve interruptions, averaging about 62 seconds for each one. What interested me most was that during wound closure, the threat window risk is at its highest. The procedure is almost finished, and staff might breathe a sigh of relief and start thinking about what's next, taking attention away from the present — and their safety. The human element A significant benefit of this research project was taking a novel approach to understanding sharps injuries. Surgical professionals often get sucked into doing things the way they've always done them. We often think one more safety practice is needed when perhaps we should look at current practices from a different angle. Since the Needlestick Safety and Prevention Act passed in 2000, we've done a tremendous amount of work to reduce sharps injuries. Safer instru- ments and hands-free passing are excellent safety practices, but we must look at human factors. We must recognize wound closure as an important and vulnerable time that presents several risks for patients and staff. As much as we love to multitask, we're limited by our human capabilities. Slowing down during the closure, staying mindful and realizing our human potential for error can help us further prevent frightening and potentially serious sharps injuries. OSM Dr. DiTullio (bditulli@bidmc.harvard.edu) is a senior clinical operations liaison at Beth Israel Deaconess Medical Center in Boston. ADDED DANGER Interruptions add up to what researchers term a "threat window," which is the accumulation of disruptions over time.