Study Examines Intra-Operative Reading during Anesthesia Care
What is considered acceptable or professional behavior and activities during periods of low clinical workload during anesthesia care are controversial. During a routine operation, it is acceptable practice for anesthesia providers to peruse materials that are directly related to patient care (i.e., review medical records). However, the reading of materials unrelated to the patient could be viewed as decreasing the quality of care. This study sought to ascertain the incidence of intra-operative reading and measure its effects on clinicians' workload and vigilance. Investigators studied 172 routine surgical cases involving general anesthesia conducted between 4/98 and 4/02 at two teaching hospitals in San Diego. Anesthesia providers included residents, certified registered nurse anesthetists, post-doctoral fellows, and faculty anesthesiologists. A trained observer sat in the operating room and categorized the clinician's activities into numerous possible tasks (e.g., reading, observing monitors, IV adjustment, medication preparation). Clinicians' vigilance was measured by the time it took to respond to the random illumination of a red alarm light.
Findings show that anesthesia providers read during 60 of the 172 cases observed (35%). Reading was observed during the maintenance period, not during induction or emergence, thus it occurred when workload was low and did not appear to affect vigilance. However, when reading, anesthesia providers spent less time conversing with others, performing manual tasks, and record-keeping. In addition to reading, anesthesia providers were observed doing other non-patient care tasks, including talking on the telephone and computer interactions. The authors suggest that with electronic patient care information increasingly available intra-operatively, the opportunities for electronic non-patient care activities (e.g. use of the Internet) also are increasing. They suggest further research on the association between intra-operative distractions/interruptions and patient outcomes.
Slagle J and Weinger M. Effects of intraoperative reading on vigilance and workload during anesthesia care in an academic medical center. Anesthesiology February 2009;110(2):275-283.
This study was partly funded by HSR&D. The authors are part of the Geriatric Research, Education and Care Center at the Middle Tennessee VA Healthcare System.
