Operating Room Music May Hamper Communication

Marcia Frellick

August 05, 2015

Music played during surgery can interfere with team communication, yet it is seldom recognized as a potential safety hazard, according to the authors of a study published online August 5 in the Journal of Advanced Nursing.

Sharon-Marie Weldon, RN, senior research officer/nurse from the Department of Cancer and Surgery, Imperial College London, United Kingdom, and colleagues studied video recordings from 20 surgeries in two operating rooms in the United Kingdom between 2012 and 2013. They compared how many times requests, such as for instruments, were repeated in settings in which music was playing with how many times requests were made in rooms without music.

Repeated requests were five times more likely to occur when music was playing, they found, which can result in increased length of surgery and heightened tensions resulting from frustration at ineffective communication. A repeated request can add 4 to 68 seconds each to operation time. Increased noise levels with music can also make it harder to hear distinctions between medications with similar names and dosing levels, the authors say.

Specifically, of 3585 requests made when music was playing, 63 (1.7%) were repeated. When music was not playing, 6 (0.3%) of the 1649 requests were repeated, for a risk difference of 1.4% (95% confidence interval, 0.008 - 0.2; P < .0001).

The operations were a mix of general, upper gastrointestinal, and bariatric surgeries. Cases were recorded at random through opportunistic sampling and included 14 cases (70%) that had music playing at some point during the operation and six (30%) that did not.

Often, the Surgeon Decides

Researchers also found that surgeons usually were the ones making decisions about whether music is played and what kind, as well as its volume.

"We recommend that nurses join the discussion and debate around this topic that is currently heavily represented by the views of surgeons," they write.

The authors note that previous research suggests music is played during surgery 53% to 72% of the time worldwide. They say that discussions should be happening among clinicians, managers, patients, and governing bodies surrounding introducing music to the OR and that recommendations and guidance should be set. They suggest that this conversation could be part of the World Health Organization's "time-out," as part of the Surgical Safety Checklist.

Some Say Music Calms

However, opinions are divided on whether music is distracting or useful in calming tensions, masking the white noise of the equipment, and helping the surgery team concentrate.

Alan Reznik, MD, a fellow with the American Academy of Orthopaedic Surgeons, who is in private practice with the Orthopaedic Group in New Haven, Connecticut, said the study misses some key considerations.

One is that with lengthy surgeries, teams need to fill in the time one way or another, and music may be a less disruptive way, he told Medscape Medical News.

"It's probably more passive to be listening to music than to actively be talking," Dr Reznik said.

Another aspect is that music helps with collegiality, he said, and helps cut the tension associated with the gravity of potential mistakes.

"When you hit the giant bleeder and blood is flying all over the place, you can't be panicked.... Music brings you to a calm state of mind," he said. Maybe, then, music could be more benefit than threat, he added.

With larger studies, he suggested, researchers could find out whether the music actually did increase the length of surgeries and whether it had an effect on outcomes.

Personally, he prefers music in the operating room — everything from opera to Taylor Swift — and he said his staff often chooses the tunes. Still, the study has important implications, he said.

He added that he was surprised to learn that decibels in the operating room already exceed standards. The World Health Organization recommends sound levels in operating rooms be no more than 30 decibels, but the researchers found average noise levels reached 65 decibels, rising to 74.2 decibels when music is playing.

That finding alone could inspire work to make operating rooms quieter, he said.

This study was funded by the Economic and Social Research Council. The authors and Dr Reznik have disclosed no relevant financial relationships.

J Adv Nurs. Published online August 4, 2015. Full text


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