Doctors, nurses link bad behavior in the OR with errors

The operating room is often a place of insults, a survey shows.

By Kevin B. O’Reilly — Posted Aug. 21, 2006

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In operating rooms across the nation, disruptive behaviors such as yelling, abusive language and public berating are frequent and physicians, nurses and others in the OR believe the bad behavior can be linked to adverse outcomes and medical errors.

Those are the findings of a survey completed by more than 5,000 respondents from more than 100 hospitals and incorporated into a series of articles, with the most recent published in the July Journal of the American College of Surgeons.

"Everyone knew this was going on, but it was anecdotal," said Alan Rosenstein, MD, co-author of the study and vice president and medical director of VHA West Coast, part of a nationwide network of nonprofit community hospitals.

Even though 19% of the 244 OR team respondents from one major medical center said they were aware of an adverse event that occurred as a result of disruptive behavior, the tendency is not to speak up because of fear of the workplace consequences, Dr. Rosenstein said.

The first step to stopping the behavior is raising awareness, he said. For example, hospitals can create a nonpunitive environment where each member of the OR team can communicate about problems.

When consulting with hospitals on the issue, Dr. Rosenstein also advises that organizations set up training on appropriate behavior, adopt a zero-tolerance approach toward unwarranted disruptions and implement incident reporting systems.

For all of the focus in patient safety on changing technological systems to make errors less likely, "more work needs to be done on the human factor side," he said. "Addressing culture, relationships and communication is more difficult to do."

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Operating procedures

Behavior ranging from yelling to physical abuse all too often disrupts the operating room, according to a recent survey of health professionals at a major medical center.

Who's disruptive?

Percentage of respondents who said they had witnessed disruptive behavior among the following professionals in the OR.

Surgeon 75%
Anesthesiologist 64%
Nurse 59%
Nurse anesthetist 30%
Surgical technologist 30%

What is happening?

Percentage of respondents who said they have witnessed a behavior.

Yelling/raising voice 79%
Disrespectful interaction 72%
Abusive language 62%
Berating in front of peers 61%
Condescension 55%
Insults 52%
Abusive anger 36%
Physical abuse 5%

How do these disruptions affect patients?

Percentage of respondents who believe disruptive behaviors are linked to certain clinical outcomes.

Impaired quality 68%
Adverse events 67%
Medical errors 67%
Compromises in safety 58%
Mortality 28%

Source: "Impact and Implications of Disruptive Behavior in the Perioperative Arena," Journal of the American College of Surgeons, july

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