Sound the Alarm: Making Music in the OR Smarter

Kendall J. Burdick; Joseph J. Schlesinger, MD

Disclosures

July 13, 2017

Music in the OR: Is There a Middle Ground?

Does music help or hinder performance in the operating room (OR)? Recent Medscape articles (Music in the OR: Turn It Up, or Turn It Off?[1] and The Surgical Soundtrack: The Effects of Music in the OR[2])  have debated whether music in the OR is helpful and relaxing for staff or a distraction that can result in surgical error and bad patient outcomes.

Brandon Cohen investigated the vast opinions of surgeons, anesthesiologists, and nurses regarding music's presence in the OR in his recent article on Medscape.[1] There were many who supported music in the OR, defending the view that it was relaxing and improved their performance. One plastic surgeon added, "I like music in the OR. I play it for the benefit of patients. Many times, patients comment that the music is relaxing." Cohen cites one anesthesiologist who goes so far as to claim, "Patients come off bypass with a heart rate that matches the rhythm of the music we were playing at the moment." If this were physiologically true, there could be some real health implications of music for both providers and patients.

On the other hand, there is a dark side to the surgical concerto. Cohen references a nurse who argues, "I'd rather be able to hear the communication in the room. We have plenty of time between patients to rock and roll." Obviously, communication in the OR is crucial and often very time-sensitive, so elimination of obstacles to communication is always encouraged. Concentration required at a certain time varies by provider, peaking at induction and emergence for anesthesiologists, while the operative phase is a high-stress point for surgeons. A 2013 study claims that noise, specifically music, decreases auditory processing and therefore increases difficulty of communication.[3]In another study, which surveyed anesthesiologists,[4] 54% told researchers that music is a distraction when a surgical issue comes up. In the same study, 26% of anesthesiologists claimed that music reduced their own vigilance and complicated staff communication.

Although individual opinions on the presence of music in the OR vary, the need for ORs to be functioning at their highest efficiency and safety is inarguable. The question is: Is there a middle ground that incorporates the positive effects of music's presence while also being tailored to the focus needed during intense and problematic episodes?

Advances in Technology and Alarm Sensors

One possible option is to introduce the interconnectivity of the "Internet of Things (IoT)" into healthcare devices and workflows. The bottom line of IoT is the intent to connect all devices, vehicles, electronics, and so on, to create a concerted flow of data and output. The phenomenon of IoT is flourishing as the availability of the Internet, smartphones, technology, and sensors is skyrocketing. Forbes.com[5] claims that the future's rule will be: "Anything that can be connected, will be connected." The opportunity for IoT is limitless, ranging from connecting an alarm clock to turning on the coffee machine, to optimizing traffic congestion in real time.

The opportunity of IoT in the medical world advances the degree of interoperability and response to medical emergencies and crisis prevention.

IoT technology is already on the market and rapidly advancing. One particular interest of IoT is connected cars. Car evolution, once considered high-tech with the introduction of General Motors OnStar© and Ford SYNC©, has advanced to completely different heights, such as radios that mute until seatbelts are buckled and vehicles that drive themselves.[6]

The development of "smart homes" is another avenue into which IoT is expanding. The Nest© Thermostat, uses room sensors to manage and adjust a home's heat distribution.[7] By being completely interconnected with a phone and a home's Wi-Fi, Nest can communicate with other devices to turn off lights if the house is empty, turn on sprinklers in case of fire, and utilize Google Home or Amazon Alexa for voice control. There are over 100 other apps and devices that can sync with the Nest. The connection between phone and device is maximized in the emergence of smart homes. This new IoT technology provides constant data analysis, on a level unattainable by humans, and is able to accurately make judgements and reactions to save money, time, and, in the case of medical IoT, lives.

New Devices That Trigger Medical Alarms

The opportunity of IoT in the medical world advances the degree of interoperability and response to medical emergencies and crisis prevention. In some emergency situations, such as anaphylaxis, the window to react appropriately may be very small. Research at the Wyss Institute at Harvard University, coupled with Boston Children's Hospital and the KeepSmilin4Abbie Foundation, is using IoT to address this issue through its Project ABBIE.

Project ABBIE was inspired by the story of Abbie Benford, a fellow classmate of mine [Kendall J. Burdick], who died from anaphylactic complications just 8 days before her 16th birthday. The Wyss Institute has developed an interconnected, wearable device that facilitates an automatic reaction cascade to prevent anaphylactic shock. At the first sign of anaphylaxis, the wearable device is programmed to alarm the patient, send a signal to caregivers to call 911, and autoinject epinephrine. The integration of immune response with injection and emergency contact has the potential to save many lives, and could have saved Abbie's. This device should serve as a model for the wide range of potential interconnected medical devices that improve both the care and safety of the patient.

Where Project ABBIE is reactive, other IoT technology can be proactive. MD PnP, a program based out of Massachusetts General Hospital, is pioneering the integration of IoT into clinical environments. Their open-platform software, OpenICE, is focused on increasing the capability of smart apps that process medical data and create a response that assists medical decisions and treatment. Their Pulseless Electrical Activity (PEA) detection app[8] is an example of an integrated clinical environment (ICE) app. This PEA detection app automatically reads data from monitors (ECG, heart rate, blood pressure, etc), detects possible onset of a complication, and displays the PEA treatment page of the Stanford Emergency Manual cognitive aid. This app and other ICE apps directly increase the quality of treatment and safety for the patient and provider. Furthermore, the vast degree of ICE apps' implementation opportunities opens the door to other lifesaving IoT devices.

Novel Device Mutes Music in an Emergency

The intersection of this advanced technology and the debate over music in the OR lies in the work of Canary Sound Design. This innovative music-integration company is blazing the trail for IoT technology that boosts the intelligence of the OR while allowing for the benefits of music. The device, the CanaryBox©, uses vital-sign algorithms to mute music in times that require focus and quiet. The device also monitors a combination of heart rate, oxygen saturation, and blood pressure. It works with an ever-expanding list of major OR monitors (currently five) and has adjustable settings to focus on as many or as few vital signs that the user desires. It may be the solution for both parties─ those who relax with music, and those who need silence to concentrate at high-stress periods.

The debate over whether music should be allowed in the OR is valid, and it also opens the door to questions of how interoperability and "smart monitors" can be used to improve overall OR performance. Going beyond the OR, what are the implications of healthcare taking advantage of IoT and other rapidly advancing modern technology? The doctor-computer integration era awaits us.

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