OR Background Noise May Impair Surgical Team Communication

Laurie Barclay, MD

May 14, 2013

High levels of background noise in the operating room (OR) may disrupt surgeons' auditory processing, according to a prospective study by T. Justin Way, MD, from the Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, and colleagues. The disruption appears to be worse in the presence of music and when the communication involves unpredictable, critical information.

The study was published in the May issue of the Journal of the American College of Surgeons.

"The operating room is a very fast-paced, high-demand, all senses running on all cylinders type of environment," study coauthor Matthew Bush, MD, from the University of Kentucky Medical Center, Lexington, said in a news release. "To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the OR."

The investigators tested 15 surgeons with normal peripheral hearing sensitivity and from 1 to 30 years of operative experience. The team used the Speech in Noise Test–Revised to assess the surgeons' ability to understand and repeat words in different conditions simulating typical OR environments. The conditions included quiet, filtered noise through a mask; background noise with and without music; and tasked and untasked situations.

Auditory performance was substantially poorer with music than with quiet or OR noise. However, music was only a significant barrier to speech comprehension when the surgeon was engaged in a task. Performance in both conditions was worse when the sentences were low in predictability.

Noise in the OR "can cause a decrease in auditory processing function, particularly in the presence of music," the study authors write. "This becomes even more difficult when the communication involves conversations that carry critical information that is unpredictable. To avoid possible miscommunication in the OR, attempts should be made to reduce ambient noise levels."

Turn Music Down or Off?

Limitations of this study include a small sample, reliance on a simulated environment and tasks, and failure to account for the Lombard effect, in which people subconsciously increase vocal volume in noisy situations.

Despite the limitations, the findings have significant application to the actual operating environment because surgical teams have critical discussions during surgical procedures regarding medications, dosing, and the need for blood transfusion. To avoid medical errors, clear communication is essential.

"Our main goal is to increase awareness that operating room noise does affect communication and that we should foster the best environment in which we can communicate better," Dr. Bush said in the release. "This effort means that the surgical team needs to work diligently to create the safest environment possible, [which] may mean either turning the music off or down, or limiting background conversations or other things in the environment that could lead to communication errors and medical mistakes."

The investigators plan to study the effect of background noise in a larger population of surgeons, including those who are hearing impaired, as well as on anesthesiologists, nurses, and other OR staff.

"I think it's important to demonstrate the effect of environmental operating noise on communication on a variety of different players in the operating room setting," Dr. Bush said in the news release. "Another step from here is to not only see how noise affects our understanding of speech, but how it affects...our ability to perform surgical procedures efficiently and effectively."

The authors have disclosed no relevant financial relationships.

J Am Coll Surg. 2013;216:933-938. Abstract

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