Annoyances, disruptions, and interruptions in surgery: the Disruptions in Surgery Index (DiSI)

World J Surg. 2008 Aug;32(8):1643-50. doi: 10.1007/s00268-008-9624-7.


Background: Recent studies have investigated disruptions to surgical process via observation. We developed the Disruptions in Surgery Index (DiSI) to assess operating room professionals' self-perceptions of disruptions that affect surgical processes.

Materials: The DiSI assesses individual issues, operating room environment, communication, coordination/situational awareness, patient-related disruptions, team cohesion, and organizational issues. Sixteen surgeons, 26 nurses, and 20 anesthetists/operating departmental practitioners participated. Participants judged for themselves and for their colleagues how often each disruption occurs, its contribution to error, and obstruction of surgical goals.

Results: We combined the team cohesion and organizational disruptions to improve reliability. All participants judged that individual issues, operating room environment, and communication issues affect others more often and more severely than one's self. Surgeons reported significantly fewer disruptions than nurses or anesthetists.

Conclusion: Although operating room professionals acknowledged disruptions and their impact, they attributed disruptions related to individual performance and attitudes more to their colleagues than to themselves. The cross-professional discrepancy in perceived disruptions (surgeons perceiving fewer than the other two groups) suggests that attempts to improve the surgical environment should always start with thorough assessment of the views of all its users. DiSI is useful in that it differentiates between the frequency and the severity of disruptions. Further research should explore correlations of DiSI-assessed perceptions and other observable measures.

MeSH terms

  • Analysis of Variance
  • Clinical Competence
  • Communication
  • Environment
  • Humans
  • Medical Errors / prevention & control
  • Operating Rooms / organization & administration*
  • Patient Care Team / organization & administration*
  • Quality Assurance, Health Care / standards*
  • Safety Management