A Human Factors Analysis of Personal Electronic Device Use and Cognitive Distractions in Orthopedic Surgery

Background The increasing ubiquity of personal electronic devices (PEDs) has introduced new cognitive challenges in high-stakes environments such as orthopedic surgery. While PEDs offer communication and informational utility, their misuse during clinical care has raised concerns about situational awareness, workflow disruption, and patient safety. Objective This study applies human factors methodology to quantify and classify PED-related distractions during orthopedic surgical procedures. Methods Structured observations were conducted during 40 orthopedic surgeries (hip and knee replacements), totaling 145 hours at a community hospital. PED-related events were documented in real time, and analyzed for their frequency, duration, and impact by team member role. Results A total of 487 PED-related events were observed, totaling 18.76 hours (12.93% of surgical time). Vendors (30.4%), circulating nurses (23.6%), CRNAs (20.33%), technologists (7.80%), anesthesiologists (6.37%), radiology technicians (5.54%), first assists (3.70%), and surgeons (2.26%) frequently used the PEDs during orthopedic surgical phases. Conclusions PED use in orthopedic settings poses measurable risks to operational performance and safety. Findings support the need for targeted human factors interventions, including role-specific usage guidelines, cognitive load mitigation strategies, and the redesign of intraoperative workflows to support attentional resilience and mitigate latent safety threats.