Prevalence and predictors of exposure to disruptive behaviour in the operating room.

PURPOSE: Disruptive intraoperative behaviour ranges from incivility to abuse. This behaviour can have deleterious effects on clinicians, students, institutions, and patients. Previous investigations of this behaviour used underdeveloped tools or small sampling frames. We therefore examined the prevalence and predictors of perceived exposure to disruptive behaviour in a multinational sample of operating room clinicians. METHODS: A total of 134 perioperative associations in seven countries were asked to distribute a survey examining five types of exposure to disruptive behaviour: personal, directed toward patients, directed toward colleagues, directed toward others, or undirected. To compare the average amount of exposure with each type, we used a Friedman's test with select post hoc Wilcoxon tests. A negative binomial regression model identified socio-demographic predictors of personal exposure. RESULTS: Of the 134 organizations approached, 23 (17%) complied. The total response rate was estimated to be 7.6% (7465/101,624). Almost all (97.0%; 95% confidence interval [CI], 96.6 to 97.4) of the respondents reported exposure to disruptive behaviour in the past year, with the average respondent experiencing 61 incidents per year (95% CI, 57 to 65). Groups reporting higher personal exposure included clinicians who were young, inexperienced, female, non-heterosexual, working as nurses, or working in clinics with private funding (all P < 0.05). CONCLUSION: Perceived exposure to disruptive behaviour was prevalent and frequent, with the most common behaviours involving speaking ill of clinicians and patients. These perceptions, whether accurate or not, can result in detrimental consequences. Greater efforts are required to eliminate disruptive intraoperative behaviour, with recognition that specific groups are more likely to report experiencing such behaviours.

RéSUMé: OBJECTIF: Les comportements perturbateurs en salle d'opération vont de l'incivilité à l'abus. Ce type de comportement peut avoir des effets délétères sur les cliniciens, les étudiants, les institutions et les patients. Les études précédentes de ce type de comportement se sont servies d'outils sous-développés ou de cadres d'échantillonnage restreints. Nous avons donc examiné la prévalence et les prédicteurs d'une exposition perçue à un comportement perturbateur dans un échantillon multinational de cliniciens de salle d'opération. MéTHODE: Au total, on a demandé à 134 associations périopératoires issues de sept pays de distribuer un sondage examinant cinq types d'exposition à des comportements perturbateurs : personnel, dirigé vers les patients, dirigé vers des collègues, dirigé vers les autres, ou non dirigé. Afin de comparer le nombre moyen d'expositions à chacun de ces types de comportement, nous avons utilisé un test de Friedman accompagné d'une sélection de tests de Wilcoxon réalisés post-hoc. Un modèle de régression binomiale négative a identifié les prédicteurs sociodémographiques d'exposition personnelle. RéSULTATS: Parmi les 134 organismes contactés, 23 (17 %) ont accepté de distribuer le sondage. Le taux de réponse total était estimé à 7,6 % (7465/101 624). Presque tous (97,0 %; intervalle de confiance [IC] 95 %, 96,6 à 97,4) les répondants ont rapporté avoir été exposés à des comportements perturbateurs au cours de l'année précédente, un répondant moyen subissant 61 incidents par année (IC 95 %, 57 à 65). Parmi les groupes rapportant une exposition personnelle plus élevée, les jeunes cliniciens, ceux avec peu d'expérience, les femmes, les non-hétérosexuels, le personnel infirmier ou les personnes travaillant dans des cliniques privées (tous P < 0,05) ont été identifiés. CONCLUSION: L'exposition perçue à des comportements perturbateurs était élevée et fréquente, les comportements les plus souvent rapportés étant la médisance à l'égard des cliniciens ou des patients. Ces perceptions, qu'elles soient vraies ou non, peuvent entraîner des conséquences délétères. Des efforts plus importants sont nécessaires afin d'éliminer les comportements perturbateurs en salle d'opération, en reconnaissant que certains groupes vulnérables sont plus à risque de rapporter avoir subi de tels comportements.

Appropriateness of Language Used in Patient Educational Materials from 24 National Anesthesiology Associations.

BACKGROUND: Patient education materials produced by national anesthesiology associations could be used to facilitate patient informed consent and promote the discipline of anesthesiology. To achieve these goals, materials must use language that most adults can understand. Health organizations recommend that materials be written at the grade 8 level or less to ensure that they are understood by laypersons. The authors, therefore, investigated the language of educational materials produced by anesthesiology associations. METHODS: Educational materials were downloaded from the Web sites of 24 national anesthesiology associations, as available. Materials were divided into eight topics, resulting in 112 separate passages. Linguistic measures were calculated using Coh-Metrix (version 3.0; Memphis, USA) linguistic software. The authors compared the measures to a grade 8 standard and examined the influence of both passage topic and country of origin using multivariate ANOVA. RESULTS: The authors found that 67% of associations provided online educational materials. None of the passages had all linguistic measures at or below the grade 8 level. Linguistic measures were influenced by both passage topic (F = 3.64; P < 0.0001) and country of origin (F = 7.26; P < 0.0001). Contrast showed that passages describing the role of anesthesiologists in perioperative care used language that was especially inappropriate. CONCLUSIONS: Those associations that provided materials used words that were long and abstract. The language used was especially inappropriate for topics that are critical to facilitating patient informed consent and promoting the discipline of anesthesiology. Anesthesiology associations should simplify their materials and should consider screening their materials with linguistic software before making them public.