I’m sure most anyone reading this can relate to a time when you felt rushed. Many of us experience times when we feel our to-do list doesn’t seem to get any shorter as time begins to run out. That’s how I’ve felt this week as I prepare for back-to-back business trips. I’m excited to go, but with so much to do both at work and at home, it can be overwhelming.
When I feel rushed, my mind tends to lose focus easily. I’ll work on one project, but in my mind, I’ll be thinking how I need to finish this and move on to something else. It actually hinders my productivity to lose focus on one project by thinking about the next, and it often involves me taking a step back, inhaling a deep breath, and reminding myself to focus on one thing at a time. If I don’t, it could mean making a mistake, or not accomplishing everything I want to get done.
In some upcoming editorial coverage, we’ll take a deeper look at what it means for a surgeon or surgical team to not be completely focused on the task at hand—the operation. At first, one might question how that could even happen—a surgeon is about to cut open a patient, and his/her is mind elsewhere?
I’m not saying a surgeon’s mind is thinking about what he had for dinner last night as he’s about to make his first incision. However, when you think about the day-to-day operations in a surgical department, there is a lot for a surgeon to think about and with that, there is bound to be some overlap in a surgeon’s thought process as cases go in and out throughout the day.
Perhaps the surgeon is already running behind—is the time crunch crossing the surgeon’s mind as they ask for the scalpel to make the first incision? Or, maybe there were complications in an earlier case. When the surgeon goes to perform the same operation on a new patient a few hours later, will the complications from the first case still be in the surgeon’s mind?
The problem that occurs, then, when a surgeon’s mind is not completely set in on the case at hand, is that safety can be compromised. Communication barriers between the team are silently built. There is a greater risk of a mistake or a complication when the surgeon and the surgical team are not all on the same page due to the host of factors described above—feeling rushed, or overwhelmed with cases for the day, or distracted from a previous occurrence.
Surgeons, however, are still human and with their humanness comes occasions like this. The key, then, is to establish standards and protocols that streamline the surgical process and essentially force the surgeon and his surgical team to connect and communicate before the case starts. This has been the goal of established protocols such as the Joint Commission’s TIMEOUT process, and the WHO surgical safety checklist. But have they worked? Are they enough? Those are the questions being asked now.
There have been suggestions about establishing a “sterile cockpit” for surgeons (which you will soon read about more thoroughly in an upcoming First Cuts). The sterile cockpit is a rule used in the aviation industry where during crucial points of a flight, all conversion about anything other than the flight at hand is prohibited. There have been blogs and articles written about the need for a sterile cockpit for physicians—a time when all doctors and their teams need to focus on the case at hand, and only that case. That can be the only topic of discussion and everyone must be attuned to the situation.
As I finish this article, I try to not let my mind wonder to thinking about the other tasks I need to accomplish this morning before I catch my first flight. One project at a time—it’s my motto that keeps me productive and focused. For a surgeon, perhaps that’s the TIMEOUT, the surgical safety checklist, a sterile cockpit, or some other protocol that allows the entire surgical team to focus at the task at hand—this patient and this case—and set aside the distractions that can easily one’s mind on any given day in the OR.
How do you stay focused? E-mail me at firstname.lastname@example.org