•Smartphones must not interfere with patient monitoring devices or with other technologies required
for patient care.
• Whenever possible, members of the OR team, including the operating surgeon, should only engage in
urgent or emergent outside communication during
an operation. Personal and routine calls should be
minimized. All phone calls should be kept as brief
•Whenever possible, incoming calls should be forwarded to the OR desk or to the hardwired telephone
in the OR to minimize the potential distraction of
• Whenever possible, incoming calls and data transmissions should be forwarded to voice mail or to memory.
The ring tone should be silenced. An inaudible signal
may be employed.
•Whenever possible, a distinct signal for urgent or
emergent calls should be enabled. This signal may be
implemented via a “page” option in most smartphones.
Callers should be advised to use this function only for
urgent and emergent calls if the phone is unanswered.
•The use of electronic and mobile devices or their
accessories (such as earphones or keyboards) must not
compromise the integrity of the sterile field. Special
care should be taken to avoid sensitive communication within the hearing of awake or sedated patients.
•Communication using hardwired phones in the OR is
subject to the same discipline as communication using
electronic device technology.
•The use of electronic mobile devices to take and
transmit photographs should be governed by hos-
pital policy on photography of patients and by
government regulations pertaining to patient privacy
Distractions due to noise
There are many sources of noise in the OR. Some, like
music, may be relaxing or distracting, depending on
Critical alarms are distracting but crucial. They
are meant to focus attention, rather than to distract
attention, even though they do both. False alarms
are problematic. 6 The reduction of harm associated
with clinical alarms was identified as a 2014 National
Patient Safety Goal by The Joint Commission. 7 The
introduction of “smart alarms,” which are individualized to each patient’s needs, has been recommended
as one solution. 8
Surgical equipment noise, noise from visitors entering the OR from corridors, and noise transmitted
into the OR from other areas may be more difficult
to control. The problem of transmitted noise is an
architecture-based issue and must be addressed when
ORs are designed and maintained. Surgical equipment
noise cannot be controlled easily once a piece of equipment has been installed but should be a consideration
when equipment is selected.
Therefore the ACS recommends the following protocols to reduce noise:
•Surgeons should be sensitive to all members of the OR
team when selecting the music played during an operation (volume, genre, lyrics).
• Tools to assist in establishing alarm safety protocols are
widely available and should be implemented institution-wide, not just in the OR or perioperative areas. 9
• Traffic in and out of the OR should be controlled both
because of the potential for distraction and for purposes of infection control.
The surgical checklist was developed as an analogy to flight
crew checklists.... One important difference between the OR and
the cockpit, however, lies in the timing of critical events. They
are much more tightly concentrated during flight. In the OR,
critical events can and do occur throughout the operation.