Distractions in Health Care

Distractions in Operating Rooms

Understanding and mitigating the negative effects of intraoperative distractions in the operating rooms

Operating rooms (ORs) are complex, dynamic, and high-risk environments that require the team members the sustain focused attention on the surgical tasks. Previous research has shown that distractions occur frequently in the OR and may be related with surgical errors. We are collaborating with the International Centre for Surgical Safety to analyze a naturalistic dataset collected via the novel intraoperative data collection platform OR Black Box® by Surgical Safety Technologies at the St. Michael’s Hospital, Toronto. The ORBB platform records audio and video of the OR environment and laparoscopic images, and other data from medical devices. These raw recordings are later reviewed by subject matter experts for annotating technical and environment-related data.

The main goals of the current project are to understand the negative effects of OR distractions on surgical errors and to mitigate the effects by implementing the most suitable strategies. We will explore the effects of distractions through focus groups with OR team members and support hypotheses by analyzing the OR Black Box® data. Both of these qualitative and quantitative approaches will provide support for identifying harmful distractions to inform the second part of this research: mitigating the negative effects. We will conduct a systematic review on the effectiveness of distraction mitigation strategies. With the results of this systematic review, we will be able to select the most suitable strategy against the harmful distractions identified.


The Effect of Intraoperative Distractions on sever Technical Events in Laparoscopic Bariatric Surgery
Watch research presentation here.




Understanding and mitigating the negative effects of intraoperative distractions in the operating rooms
View preliminary findings on door activity here.


Student PI(s): Suzan Ayas

In Collaboration With: St. Michael’s International Centre for Surgical Safety


Distractions in Intensive Care Units

Systematic investigation of positive interruptions in healthcare

The objectives of this project are to examine and differentiate between positive and negative interruptions in a healthcare environment. Interruptions were studied extensively in the past but with a focus on their negative effects. Although many types of interruptions result in a break-in-task, in some cases interruptions communicate important information associated with patient’s safety. The majority of previous interruption research use a reductionist approach to minimize or prevent interruptions, and minimal attention has been given to the differentiation between positive and negative interruptions. This approach to the study of interruptions is a novel one and will have implications for how interruptions are approached in healthcare settings.

Sponsor(s): NSERC (PGS D)



Distractions in Operating Rooms

Ayas, S., Gordon, L., Donmez, B., & Grantcharov, T. (2020). The effect of intraoperative distractions on severe technical events in laparoscopic bariatric surgerySurgical Endoscopy.

Ayas, S. (2019). Understanding and mitigating the effects of operating room distractions (MASc Thesis). University of Toronto.

Distractions in Intensive Care Units

Sasangohar, F., Donmez, B., Easty, A. C., & Trbovich, P. L. (2015). Mitigating non-urgent interruptions during high-severity ICU tasks using a task-severity awareness tool: a quasi-controlled observational study. Journal of Critical Care, 30(5), 1150.e1-1150.e6.

Sasangohar, F. (2015). Understanding and mitigating the interruptions experienced by intensive care unit nurses (PhD Dissertation). University of Toronto.

Sasangohar, F., Donmez, B., Easty, T., Storey, H., & Trbovich, P. (2014). Interruptions experienced by cardiovascular intensive care unit nurses: an observational study. Journal of Critical Care. 29(5), 848-853.

Sasangohar, F., Donmez, B., Trbovich, P., & Easty, T. (2012). Not all interruptions are created equal: positive interruptions in healthcare. In Proceedings of the Human Factors and Ergonomics Society 56th Annual Meeting, Boston, MA.