In Response

Abstract

We thank Brustowicz et al1 for their encouraging Letter to the Editor, “Distraction-Free Zones Need To Be Respected,” regarding our recently published article “Distraction-Free Induction Zone: A Quality Improvement Initiative at a Large Academic Children’s Hospital to Improve the Quality and Safety of Anesthetic Care for our Patients.”2 We are encouraged that this project has initiated important conversations at the national level, especially owing to publication difficulties, as they point out. Brustowicz et al1 mention loud conversations as one factor young patients report as contributing to fear when entering the operating room. We appreciate their remarks on this important concern. Although we did not place emphasis on fear in the study, it was one of the major factors that helped us engage leadership support and obtain staff buy-in on multiple levels. When the project began, our institution’s Family Advisory Council reported that children had complained about loud music, types of music, loud instruments, and multiple conversations that had nothing to do with them in the operating room. Although fear was reported by many children, it was omitted as an end point in our study because we lacked an objective measurement of it at the time. All parents at the Family Advisory Council meeting agreed that music in the operating room can often be overwhelming for children and recommended quiet during induction of anesthesia. We therefore agree that a distraction-free induction is important for a minimally fearful, and maximally safe, quality anesthesia experience. Our department is committed to improving the quality and safety of anesthetic care we provide our pediatric patients. We believe there is more to be done in multiple areas to achieve this goal in the operating room, such as decreasing distractions during emergence, instrument counting, and during other critical parts of the operation. Our next project, as part of this commitment, will be focused on decreasing distractions during emergence. Our hope is that our efforts continue beyond our institution and inspire a national initiative so that other institutions undertake similar quality improvement initiatives focused on reducing distractions during critical periods of anesthesia, surgery, and other areas of patient care. Christy J. Crockett, MDBrian S. Donahue, MD, PhDDeana C. Vandivier, CRNADepartment of AnesthesiologyVanderbilt University Medical CenterNashville, Tennessee[email protected]