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Background Within the OR, distractions occur on a regular basis, which affects surgical workflow and results in discontinuation of urgent tasks. In addition, engaging into distractions in the OR may not only increase stress and workload, but also impair teamwork performance. This study aimed to observe the occurrence of intra-operative distractions in ORs and to evaluate associations between distractions, teamwork, workload and stress. Methods This observational cross-sectional study was conducted in Sahloul University Hospital; more specifically in four different surgical units: orthopedic, urology, emergency and digestive surgery and over a period of 3 months in 2018. Using validated observation sheets, distractions and teamwork were recorded and rated in real-time during the intraoperative phase of every case. Besides, stress and workload of OR team members were measured at the end of each operation. All ethical considerations were taken into account. Results Fifty cases were observed and 160 participants were included in this study. In total, we recorded 933 distractions that occurred once every 3 minutes, on average. The mean global teamwork score was 3.85 (SD = ±0,67) on a scale of 0 to 6, the mean workload score was 58.60 (±24,27) and the mean stress score was 15.29 (SD = ±4,00). The highest rate of distraction was significantly related to external staff entering or exiting the OR during non-teaching cases (M = 9.43, SD = 3.56; p = 0.006). Surgeons also experienced significantly higher workload with a mean of 66.88 (SD = 25.98,p&amp;lt;0.01). Conclusions This study highlighted a serious problem which is, often, ignored or underestimated. Taking into consideration the results, we recommend the implementation of systemic interventions on a daily basis to reduce the number of distractions in the OR. Key messages Distractions happened in all of the included operations. Stress and workload among nurses got higher as work environment distractions increased.

Evaluation of the impact of intra-operative distractions on teamwork, stress and workload