Prevalence and Characteristics of Interruptions and Distractions During Surgical Counts.

BACKGROUND: Surgical counting is a complex and safety-critical task that requires sustained attention by multiple members of the surgical team in order to prevent the occurrence of an unintentionally retained foreign object. Interruptions and distractions in the operating room are common and can negatively affect task performance. However, the prevalence and sources of interruptions and distractions during safety-critical tasks, such as surgical counting, have not previously been quantified. An understanding of the characteristics of these events could be used to inform targeted improvements to patient safety. METHODS: Observations were conducted of surgical procedures in order to quantify and describe interruptions and distractions during surgical counting activities. Analysis was separated into phases: the initial count, additions to the surgical field, removals from the surgical field, and closure counts. RESULTS: Thirty-six surgical procedures were observed. Interruptions occurred in 10.0% of initial counts, 15.4% of additions, 23.5% of removals, and 33.3% of closure counts observed. The source of 80.4% of interruptions was a surgeon, usually asking the scrub nurse for an item. Distractions were present in 46.7% of initial counts, 38.5% of additions, 41.2% of removals, and 40.9% of closure counts observed. Common sources of distraction included music, conversations, people entering and exiting the theater, and ringing phones. CONCLUSION: Interruptions and distractions are common during surgical counts and can significantly affect patient safety by jeopardizing the accuracy of the count. A number of suggestions are provided that could reduce interruptions and distractions and their consequences.

Melanophilin, a novel aldosterone-induced gene in mouse cortical collecting duct cells.

The molecular mechanisms of aldosterone-regulated Na+ transport are not entirely clear. The goal of this study was to identify aldosterone-induced genes potentially involved in the trafficking of the epithelial Na+ channel (ENaC). We report that the transcript levels of melanophilin (MLPH), a protein involved in vesicular trafficking in melanocytes, are rapidly increased by aldosterone in cortical collecting duct (CCD) cells. This effect was near maximal at physiological aldosterone concentrations, indicating that it is mediated by the mineralocorticoid receptor. De novo protein synthesis is not required for the induction of MLPH mRNA by aldosterone. To determine whether this induction has functional consequences on transepithelial Na+ current, we generated clonal CCD cell lines that express a tetracycline-inducible MLPH. Induction of MLPH in these cells led to a relatively modest, but statistically significant, increase in amiloride-sensitive Na+ current, suggesting the MLPH may be involved in ENaC trafficking. MyosinVc, the epithelial-specific class V myosin that is highly homologous to MyosinVa, another component of the melanosome trafficking complex, has putative consensus sites for serum and glucocorticoid-induced kinase 1 (SGK1), an early aldosterone-induced kinase that mediates some of aldosterone's effects on Na+ transport. Our results indicate that MyosinVc is phosphorylated by endogenous SGK1, suggesting that this complex may be involved in the aldosterone-regulated trafficking of ENaC in the CCD. These results suggest potential mechanisms by which aldosterone may regulate Na+ transport both directly, by increasing the abundance of MLPH, and indirectly by increasing the transcription of SGK1, which in turn regulates the activity of MyosinVc.