Navigating diversions in the obstetric operating room: focusing amidst distractions

Abstract

Background

Distractions in the operating room (OR) are known to disrupt surgical workflow and compromise patient safety. However, little is known about the nature and impact of intraoperative distractions during cesarean deliveries, which involve dual-patient care and complex team dynamics. This study aims to characterize the frequency, type, and severity of distractions in the obstetric OR and examine associations with surgical duration and complications.

Objective

To systematically characterize the frequency, types, and severity of intraoperative distractions during scheduled cesarean deliveries, and to evaluate their association with surgical duration and maternal or neonatal complications. The study hypothesizes that higher distraction scores are associated with longer procedure times and increased clinical complications.

Study Design

We conducted a prospective observational study of 97 scheduled cesarean deliveries at ≥37 weeks’ gestation from March 2023 to December 2024. Distractions were recorded in real time using a published distraction categorization tool and grading system by severity (mild, moderate, severe). A weighted distraction score was calculated per case. Clinical data included procedure duration, staff count, and presence of maternal or neonatal complications.

Results

Across 97 cases, 8113 distractions were documented (mean: 81 per case). Door movement and teaching conversations were the most common types of distraction type. While mild distractions were most frequent, moderate distractions contributed the largest portion of the total distraction burden (44.5%). Severe distractions occurred in all cases. No significant correlation was found between surgery length and distraction score. Cases with NICU admissions (n=11) had higher average total distraction scores (98.8) and more severe distractions (mean: 3.56).

Conclusions

Distractions in the obstetric OR are frequent and varied, with moderate distractions representing a key contributor to cognitive load. Higher distraction scores may be associated with neonatal complications, underscoring the need for distraction-reduction strategies to optimize safety in cesarean deliveries. Although distractions were not associated with prolonging surgical length, healthcare providers should be cognizant of the amount and type of distractions that can occur that may impact patient outcomes.