The impact of distractions and interruptions during Cesarean Sections: a prospective study in a London teaching hospital

Arch Gynecol Obstet. 2018 Aug;298(2):313-318. doi: 10.1007/s00404-018-4810-9. Epub 2018 Jun 14.


Purpose: During Cesarean Sections, distractions which interrupt task specific activities include auditory, equipment, theatre traffic, and irrelevant communication. Aims of this study were to investigate frequency and types of distractions and to assess impact on patient safety and theatre efficiency.

Methods: Prospective observational study in a London hospital in women undergoing elective and emergency Cesarean Sections. Distractions were recorded prospectively in primiparous women having uncomplicated elective and emergency Cesarean Sections over a 4 week period. Level of distraction is categorized as I: no noticeable impact on surgical team; II: ≥ 1 team member affected; and III: all members affected. Safety outcomes assessed included perioperative complications such as postpartum hemorrhage, organ injury, postsurgical pyrexia (first 48 h), return to theatre, readmissions, and postdelivery anemia < 7 g/dl.

Results: Data from 33 elective and 23 emergency cases were collected. Mean number of level II/III distractions/case was 13.20 (± 6.93) and number of level II/III distracting events was greater during elective compared to emergency cases (mean 14.91 vs 12.00, p = 0.04). In total, 17.89% of distractions occurred during crucial part of surgery between skin incision and delivery of baby, while delays resulting from level II/III distractions accounted for 11.25% of total operating time. There were no intra- or postoperative complications observed in the cohort of cases.

Conclusions: Distractions did not culminate in perioperative complications, but disrupted surgeons' task activity, prolonging mean procedure duration by 26.8%. Recognising sources and effects of distractions will enable measures to be taken to improve theatre productivity and patient safety.

Keywords: Cesarean Section; Distractions; Interruptions; Theatre efficiency.

MeSH terms

  • Cesarean Section / adverse effects*
  • Cesarean Section / methods
  • Female
  • Hospitals, Teaching / methods*
  • Humans
  • London
  • Pregnancy
  • Prospective Studies