The impact of intra-operative interruptions on surgeons’ perceived workload: an observational study in elective general and orthopedic surgery Matthias Weigl • Sophia Antoniadis • Costanza Chiapponi • Christiane Bruns • Nick Sevdalis Received: 16 December 2013 / Accepted: 31 May 2014 Ó Springer Science+Business Media New York 2014 Abstract Background and aim Surgeons’ intra-operative workload is critical for effective and safe surgical performance. Detrimental conditions in the operating room (OR) envi- ronment may add to perceived workload and jeopardize surgical performance and outcomes. This study aims to evaluate the impact of different intra-operative workflow interruptions on surgeons’ capacity to manage their work- load safely and efficiently. Methods This was an observational study of intra-oper- ative interruptions and self-rated workload in two surgical specialties (general, orthopedic/trauma surgery). Intra- operative interruptions were assessed via expert observa- tion using a well-validated observation tool. Surgeons, nurses, and anesthesiologists assessed their intra-operative workload directly after case completion based on three items of the validated Surgery Task Load Index (mental demand, situational stress, distraction). Results A total of 56 elective cases (35 open, 21 laparo- scopic) with 94 workload ratings were included. Mean intra- operative duration was 1 h 37 min. Intra-operative interrup- tions were on average observed 9.78 times per hour. People who entered/exited the OR (30.6 %) as well as telephone-/ beeper-related disruptions (23.6 %) occurred most often. Equipment and OR environment-related interruptions were associated with highest interference with team functioning particularly in laparoscopic procedures. After identifying task and procedural influences, partial correlational analyses revealed that case-irrelevant communications were negatively associated with surgeons’ mental fatigue and situational stress, whereas surgeons’ reported distraction was increased by case-irrelevant communication and procedural disruptions. OR nurses’ and anesthesiologists’ perceived workload was also related to intra-operative interruption events. Conclusions Our study documents the unique contribu- tion of different interruptions on surgeons’ workload; whereas case-irrelevant communications may be beneficial for mental fatigue and stress in routine cases, procedural interruptions and case-irrelevant communication may contribute to surgeons’ mental focus deteriorating. Well- designed OR environments, surgical leadership, and awareness can help to control unnecessary interruptions for effective and safe surgical care. Keywords Interruptions Á Distractions Á Surgery Á Workload Á Observation Á Operating room There is growing interest regarding the potentially detri- mental impact of interruptive operating room (OR) envi- ronments on surgical performance [1, 2]. Previous investigations showed that interruptions occur frequently in ORs, across various surgical specialties, and bear different M. Weigl (&) Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany e-mail: matthias.weigl@med.lmu.de S. Antoniadis Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital Munich, Munich, Germany C. Chiapponi Á C. Bruns Department of General-, Visceral- and Vascular Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany N. Sevdalis Department of Surgery and Cancer, Imperial College London, London, UK 123 Surg Endosc DOI 10.1007/s00464-014-3668-6 and Other Interventional Techniques