Noisy Operating Rooms May Jeopardize Patient Safety

Chatter, music and equipment sounds reduced surgeons' speech comprehension in small study

By Mary Elizabeth Dallas

Wednesday, May 15, 2013

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WEDNESDAY, May 15 (HealthDay News) -- Background noise in the operating room -- such as the sounds of surgical equipment, chatter or music -- can affect surgeons' ability to understand what is being said to them and might result in a breakdown of communication among surgical team members, according to a new study.
This is particularly worrisome since miscommunication is cited as a common reason for medical errors that could have been prevented, the study authors said. Surgeons have critical conversations during operations, and information on medications, dosing and blood supply could sound similar. The researchers emphasize that clear communication during surgical procedures is essential to ensure the safety of patients.
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 co-author Dr. Matthew Bush, an assistant professor of surgery at the University of Kentucky Medical Center, in Lexington, said in a journal news release. "To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the operating room."
The researchers gave an example of a possible miscommunication: A request for heparin might be heard as "Hespan," an entirely different drug.
In conducting the study, the researchers simulated a noise environment similar to the noise levels found in an operating room. Fifteen surgeons with between one and 30 years of experience were tested on their ability to understand and repeat words under four different conditions: quiet, noise filtered through a surgical mask, background noise without music and background noise with music.
The surgeons were tested while performing a specific surgical task as well as when they were not engaged in a task.
Noise interfered with the surgeon's speech comprehension when the words spoken to them were unpredictable, the study showed. This interference with speech comprehension was worse when there was noise in the operating room.
Background music also impaired the surgeons' ability to understand what was said to them while they were performing a surgical task.
The researchers concluded that background noise in operating rooms could impair surgeons' ability to process what they hear, particularly when music is being played. The situation becomes even more problematic when surgical teams are trying to communicate critical and unpredictable information.
"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," Bush said. "This effort means that the surgical team needs to work diligently to create the safest environment possible, and that step 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 researchers plan to continue their research on a larger scale and also examine the effects of operating room noise on anesthesiologists, nurses and surgeons who are hearing impaired.
"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," Bush said. "Another step from here is to not only see how noise affects our understanding of speech, but how it affects our tasks and how it affects our ability to perform surgical procedures efficiently and effectively."

SOURCE: Journal of the American College of Surgeons, news release, May 10, 2013

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