Archives of Gynecology and Obstetrics

, Volume 298, Issue 2, pp 313–318 | Cite as

The impact of distractions and interruptions during Cesarean Sections: a prospective study in a London teaching hospital

  • Matthew Willett
  • Orla Gillman
  • Esther Shin
  • Emma Sewart
  • Daniel Muller
  • Maud Nauta
  • Wai Yoong
Maternal-Fetal Medicine



During Cesarean Sections, distractions which interrupt task specific activities include auditory, equipment, theatre traffic, and irrelevant communication. Aims of this study were to investigate frequency and types of distractions and to assess impact on patient safety and theatre efficiency.


Prospective observational study in a London hospital in women undergoing elective and emergency Cesarean Sections. Distractions were recorded prospectively in primiparous women having uncomplicated elective and emergency Cesarean Sections over a 4 week period. Level of distraction is categorized as I: no noticeable impact on surgical team; II: ≥ 1 team member affected; and III: all members affected. Safety outcomes assessed included perioperative complications such as postpartum hemorrhage, organ injury, postsurgical pyrexia (first 48 h), return to theatre, readmissions, and postdelivery anemia < 7 g/dl.


Data from 33 elective and 23 emergency cases were collected. Mean number of level II/III distractions/case was 13.20 (± 6.93) and number of level II/III distracting events was greater during elective compared to emergency cases (mean 14.91 vs 12.00, p = 0.04). In total, 17.89% of distractions occurred during crucial part of surgery between skin incision and delivery of baby, while delays resulting from level II/III distractions accounted for 11.25% of total operating time. There were no intra- or postoperative complications observed in the cohort of cases.


Distractions did not culminate in perioperative complications, but disrupted surgeons’ task activity, prolonging mean procedure duration by 26.8%. Recognising sources and effects of distractions will enable measures to be taken to improve theatre productivity and patient safety.


Distractions Interruptions Cesarean Section Theatre efficiency 



The authors would like to thank Labor Ward theatre staff of North Middlesex University Hospital for their help and support for the duration of data collection by the five observers.

Author contributions

WM: data collection, data analysis, and manuscript writing/editing. GO: data collection and data analysis. SE: data collection. SE: data collection. MD: data collection. NM: manuscript writing/editing. YW: protocol/project development, data analysis, and manuscript writing/editing.


The authors did not receive any financial support for this study.

Compliance with ethical standards

Conflict of interest

Matthew Willett has no conflict of interest; Orla Gillman has no conflict of interest; Ester Shin has no conflict of interest; Daniel Muller has no conflict of interest; Maud Nauta has no conflict of interest; and Wai Yoong has no conflict of interest.

Ethical approval

This was a purely observational study and no additional procedures were performed on the study subjects. The study was originally intended as a quality improvement project to reduce the number of distractions during Cesarean Sections. The authors have discussed this study with the Chairperson of the Research and Development Committee of the hospital as well as the Quality Improvement Board and ethical approval was not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.UCL School of MedicineLondonUK
  2. 2.St George’s International School of MedicineGrenadaGrenada
  3. 3.Camden Health Improvement PracticeLondonUK
  4. 4.Department of Obstetrics and GynaecologyNorth Middlesex University HospitalLondonUK

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