Pa Patient Saf Advis 2015 Mar;12(2):84.
Letter to the Editor: Working to Reduce Distractions in the Operating Room
Healthcare Executive/Administrator; Other Licensed Professionals; Nurse; Physician
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We read with great interest the article “Distractions in the Operating Room” in the June 2014 edition of the Pennsylvania Patient Safety Advisory. Here in Australia, we have been working on a project to reduce noise and distractions while promoting situational awareness and directed focus in our operating theatres. Our initial research led us to conclude that the airline industry had made outstanding advancements in flight safety with the development of the “sterile cockpit” concept. It was from this work in aviation that we adopted the term “Below Ten Thousand” for use in the operating room environment. As described in your article, we identified critical times during operative procedures that were in essence our “Below Ten Thousand” moments and that required quiet and directed focus to the task at hand. These critical times are induction/intubation, surgical counts, completion of the surgical safety checklist, and extubation.

“Below Ten Thousand” is a phrase that surgical team members can use to promote situational awareness during times of heightened procedural complexity or to signal that distractions are recognized to be hampering the performance of an individual. When used by surgeons, “Below Ten Thousand” simply and effectively communicates to the team that the surgeon is performing a complicated task and needs everyone in the “cockpit” to be on high alert and focused. We chose the phrase “Below Ten Thousand” because it was iconic, safe, nonconfrontational, easily communicated, and would not arouse concern in a conscious patient that the team was compromised by the noise and/or the distractions around them.

We are excited and encouraged that despite the large gulf of land and water that divides our nations, we can draw similar conclusions about the importance of eliminating distractions in the operating room and are promoting similar safety protocols.

John Gibbs, BN & Pete Smith, RN
Clinical Nurse Specialists in Anaesthetics and Recovery
University Hospital Geelong
Victoria, Australia

Editor’s Note

Thank you for contacting the Pennsylvania Patient Safety Authority and sharing information on the very important work you have been doing in Australia. It is so wonderful to know that the patient safety work we have been charged to perform in our state is reaching an audience around the world. We applaud you for raising awareness of this important issue and for your innovative efforts to address patient safety within your operating theatres.


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