The Impact of Operating Room Distractions, Interruptions, and Disruptions (DIDs) on the Length of Operative Time in Adults in Acute Hospitals: A Systematic Review
Abstract
A systematic review examining the relationship between operating room distractions, interruptions and disruptions, operative duration, patient safety, team performance, workflow and reported mitigation strategies in adult acute-hospital surgical settings.
Distractions and interruptions in the operating room are increasingly recognised as significant threats to patient safety, team performance and surgical efficiency. While some interruptions are clinically necessary, many are avoidable and contribute to cognitive overload, communication failures and procedural errors.
This systematic review aimed primarily to examine the impact of operating room distractions, interruptions and disruptions on operative time in adults undergoing surgery in acute hospitals, and secondarily to synthesise their sources, associated clinical and team outcomes, and reported mitigation strategies.
A systematic literature review was conducted following PRISMA guidance. Peer-reviewed studies were identified through systematic searches of major biomedical databases, with no restriction on publication date. Studies examining intraoperative distractions, interruptions, environmental noise, workflow disruptions and associated outcomes were included. Data were synthesised using qualitative thematic analysis because heterogeneity in study designs and outcome measures precluded quantitative meta-analysis.
Thirty-six studies met the inclusion criteria. Distractions were commonly categorised as communication-related, equipment- or technology-driven, environmental and workflow-related. Evidence consistently demonstrated associations between frequent interruptions and increased operative time, higher error rates, elevated cognitive workload and reduced team communication quality.
System-level contributors including staffing levels, organisational culture and task design were identified as important determinants of interruption frequency and impact.
Distractions and interruptions in the operating room represent a multifactorial systems issue rather than isolated behavioural lapses. Addressing them requires integrated interventions encompassing workforce planning, human factors training, environmental optimisation and leadership-driven safety culture. Future research should prioritise standardised measurement tools and intervention-based studies to inform sustainable improvements in surgical safety.
PRISMA-guided evidence synthesis.
Studies met the final eligibility criteria.
Thematic synthesis due to study heterogeneity.
Acute-hospital surgical environments.
Communication-Related DIDs
Communication-related distractions and interruptions were among the most consistently reported categories and were associated with workflow inefficiencies, cognitive burden and reduced team communication quality.
Equipment & Technology Disruptions
Equipment malfunction, device-related interruptions and other technology-associated disruptions were reported as important sources of workflow interruption and delay within operating rooms.
Environmental Distractions
Background conversations, noise, movement, door openings and other environmental factors contributed to interruptions of attention and operative workflow.
Longer Operative Time
Across the available evidence, frequent DIDs were consistently associated with increased operative duration and workflow inefficiency.
Higher Error Risk
Interruptions were associated with higher error rates and safety concerns, particularly when occurring during high-workload or technically demanding stages of a procedure.
Increased Mental Demand
DIDs may increase cognitive workload by forcing clinicians to switch tasks, reorient attention and recover interrupted procedural sequences.
More Than Individual Behaviour
The review identified organisational culture, staffing levels, task design and environmental factors as broader system-level determinants of interruption frequency and impact.
Multilevel Interventions
Potential mitigation strategies include human factors training, structured communication, environmental optimisation, workforce planning and leadership-driven safety initiatives.
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Systematic Review
This article systematically synthesises evidence on operating room distractions, interruptions and disruptions, with a primary focus on operative duration in adults undergoing surgery in acute hospitals.
PRISMA-Guided Review
The review was conducted using PRISMA guidance to structure study identification, screening, eligibility assessment and inclusion.
Adults in Acute Hospitals
The review focused on adults undergoing surgical procedures in acute-hospital operating room environments.
Operative Duration
The principal outcome was the association between operating room distractions, interruptions and disruptions and the length of operative time.
Safety, Workflow & Team Performance
Secondary outcomes included workflow efficiency, error risk, cognitive workload, communication quality, patient safety and reported mitigation strategies.
36 Included Studies
Thirty-six studies met the review’s final inclusion criteria and were incorporated into the evidence synthesis.
Qualitative Thematic Analysis
Substantial heterogeneity in study designs, definitions and outcome measures precluded quantitative meta-analysis. Findings were therefore integrated using qualitative thematic analysis.
Four Major Domains
The review identified communication-related, equipment- or technology-related, environmental and workflow-related distractions, interruptions and disruptions.
Systems-Level Patient Safety Issue
The review interprets DIDs as a multifactorial systems problem shaped by organisational culture, staffing, workflow design, environment and team communication rather than isolated individual behaviour.
Standardised DID Measurement
Future research should prioritise standardised definitions and measurement tools and prospective intervention-based studies evaluating strategies to reduce avoidable operating room interruptions.
Sole Author
The author conceived, wrote, revised and approved the final manuscript.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest.
Funding:
No funding received by the author.
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CC BY 4.0
This article is published by The Operating Room Global
Journal under the Creative Commons Attribution 4.0
International licence.
DOI: 10.64573/torgj2601005
Volume 2 · Issue 1 · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Systematic Review.
Article DOI: 10.64573/torgj2601005.
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