Doctors, nurses link bad behavior in the OR with errors

The operating room is often a place of insults, a survey shows.

By Kevin B. O'Reilly, amednews staff. Aug. 21, 2006.

In operating rooms across the nation, disruptive behaviors such as yelling, abusive language and public berating are frequent and physicians, nurses and others in the OR believe the bad behavior can be linked to adverse outcomes and medical errors.

Those are the findings of a survey completed by more than 5,000 respondents from more than 100 hospitals and incorporated into a series of articles, with the most recent published in the July Journal of the American College of Surgeons.

"Everyone knew this was going on, but it was anecdotal," said Alan Rosenstein, MD, co-author of the study and vice president and medical director of VHA West Coast, part of a nationwide network of nonprofit community hospitals.

Even though 19% of the 244 OR team respondents from one major medical center said they were aware of an adverse event that occurred as a result of disruptive behavior, the tendency is not to speak up because of fear of the workplace consequences, Dr. Rosenstein said.

The first step to stopping the behavior is raising awareness, he said. For example, hospitals can create a nonpunitive environment where each member of the OR team can communicate about problems.

When consulting with hospitals on the issue, Dr. Rosenstein also advises that organizations set up training on appropriate behavior, adopt a zero-tolerance approach toward unwarranted disruptions and implement incident reporting systems.

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