more than they have to. It's surprisingly easy to use more force than
necessary to accomplish a given job. And of course, if there's an
opportunity for somebody else to relieve the tech who's been holding
the retractor for a long time, that, too, can make a huge difference.
The cognitive piece
Cognitive overload is also a factor. Accidents are more likely if people
are talking about irrelevant things, or simply talking too much. Safety
requires concentration and the ability to focus fully on what's going
on at the moment.
At a teaching hospital, I concentrated even more on the cognitive
aspect, because of the presence of students and residents. Experts
may be able to function on autopilot, but for novices, everything is
new. When you're working with residents and students, you need to
be careful not to overload them. For example, if music was going to
be played in the OR, I encouraged the teams to stick to instrumen-
tals. Expert surgeons might be able to listen to their favorite songs
and stay focused, but because of the way auditory information enters
the brain, if residents and students hear words, they're not going to
be able to shut them out. And that's going to take up some of the
resources they need to fully pay attention.
We emphasized the importance of silence or task-related communi-
cation only, during critical phases. Oral feedback was also key.
Personnel needed to warn each other if they saw someone's hand get-
ting too close to a moving needle.
I also noticed that closing seemed to be accompanied by significant-
ly more opportunities for cognitive overload and distractions.
Everyone is relieved that the surgery is over, the music comes on and
the team starts talking, often about things that aren't relevant to the
immediate tasks.
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