Prevalence of Potentially Distracting Noncare Activities and Their Effects on Vigilance, Workload, and Nonroutine Events during Anesthesia Care

Slagle JM, Porterfield ES, Lorinc AN et al.

Anesthesiology. 2018; 128: 44-54. doi:10.1097/ALN.0000000000001915



Aim of the Study

To investigate the effect of non-patient care activities of anaesthetists during the perioperative period on workload and vigilance.

Design and Location

Observational study; Single Mid-south academic medical centre (USA).


A single trained observer recorded 79 possible intraoperative tasks bundled into 9 groups. Tasks were timed using computer prompt which helped to time each task. Internet usage was timed. Video recording was done. Each participant was questioned at the end about non-routine events that happened.

Primary Outcome

Effect of self-initiated activities on vigilance, workload and non-routine events during anaesthesia.


All quantitative data summarized as median, interquartile range and range.

Wilcoxon rank sum test to compare the percentage of total case time, average task duration and other quantitative data.

Regression analysis for effects of case type and duration on workload and vigilance latencies.


Cases were divided as distraction and non-distraction cases.

Distraction happened in longer cases. Almost half of the distractions were personal in nature. In every case with distraction, there were also periods without any distraction, which were significantly longer.

Workload was significantly less in distraction cases. Vigilance latency was less in distraction cases but not statistically significant.

Non-routine events occurred in 51% of distraction and 71% of non-distraction cases. Although none of distractions were believed to contribute to the event.


It was conducted in a single centre, so cannot be generalized to other centres with different cultural, environmental and technological attributes.

Hawthorne effect.

Discussion from Journal Club Meeting

Does performing a secondary task during boredom improve alertness and performance?

Distraction variability: some distractions like browsing, can be quickly terminated, whereas some intense, mentally absorbing distractions, like reading a book or playing videogames in a smart phone can be difficult to terminate.

Person variability: some people can multitask easily.

Ethical consequences of the distractions: they are unprofessional and may lead to litigations.

The stated study limitation: Hawthorne analysis.

Are there any observational blinded studies happening in our institution?

Summary by Dr D Subramaniam. Journal Club Meeting 17 May 2018.




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