Quiet O.R. request too obnoxious?

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Creflo

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I like to do my cases in a quiet o.r., with no music and no extraneous conversation. O.r. Staff doesn't like it. Apparently not many (if any) surgeons at my facility request this. Wanted to ask your forum any thoughts on appropriateness of this request.
 
Nothing better than a quiet OR.

I hate it when it looks like a nightclub.
 
I think it's reasonable to request quiet until patient is induced and airway is taken care of. After that, you're going to look like a Nancy if you ask people to quiet down.
 
I do love the wakeup protocol at my hospital - which includes obnoxious house music blasting with people slamming trays and instruments around... and booms, lights, C arms, etc all in my way or on top of the patient's face. It makes for a smooth emergence and safe extubation.

But on a more serious note, I had a surgeon request that I completely turn off the pulse ox sound. She said it was bothering her.
 
Noise doesn't bother me as much at the end of a long surgery. Nothing like finishing up with some Jock Jams at the end of a marathon case.
 
kidthor said:
I do love the wakeup protocol at my hospital - which includes obnoxious house music blasting with people slamming trays and instruments around... and booms, lights, C arms, etc all in my way or on top of the patient's face. It makes for a smooth emergence and safe extubation.

But on a more serious note, I had a surgeon request that I completely turn off the pulse ox sound. She said it was bothering her.
Click to expand...

I've had a surgeon who not only wants the pulse ox tone off, but also wants the chime that lets you know theirs a new bp off, and the Bair hugger off- the hum bothers him. He once said no one but him should have cell phones in the OR because it will bother him if they ring or even vibrate.
I obliged him on the pulse ox and BP chime, but the Bair hugger and phone get a big FU.

To answer the OP: No, you can't request a quiet OR. People won't be quiet for you and they'll think you're an ass.
 
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It looks like you're the surgeon.

Requesting a peaceful OR doesn't seem unreasonable. Silent though, like the bair hugger, phones and pulse ox tone is another matter.

If they insist on blaring rock music and you want no music, you should get it. They'll think you're a dick. Try to compromise with your favorite Kenny G at subtle volume?

Extraneous conversation is also something you can ask to limit, but you best not start answering your phone in the room, or they'll look at you like a hypocritical dick.
 
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I believe the pulse ox tone is considered an ASA standard. If the music is blasting you should still be able to hear the pulse ox over it. I would never allow a surgeon to tell me to turn off my monitor sounds.

I enjoy a quiet OR, but I don't mind the music of it's something good. I can't stand listening to the same old pop song over and over again.
 
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nolagas said:
I've had a surgeon who not only wants the pulse ox tone off, but also wants the chime that lets you know theirs a new bp off, and the Bair hugger off- the hum bothers him. He once said no one but him should have cell phones in the OR because it will bother him if they ring or even vibrate.
I obliged him on the pulse ox and BP chime, but the Bair hugger and phone get a big FU.

To answer the OP: No, you can't request a quiet OR. People won't be quiet for you and they'll think you're an ass.
Click to expand...
That's obnoxious. Just get rid of him.

I'll take music any day over the mindless conversation that goes on in the OR every day.
 
nolagas said:
I've had a surgeon who not only wants the pulse ox tone off, but also wants the chime that lets you know theirs a new bp off, and the Bair hugger off- the hum bothers him. He once said no one but him should have cell phones in the OR because it will bother him if they ring or even vibrate.
I obliged him on the pulse ox and BP chime, but the Bair hugger and phone get a big FU.

To answer the OP: No, you can't request a quiet OR. People won't be quiet for you and they'll think you're an ass.
Click to expand...
He must be autistic!
 
kidthor said:
But on a more serious note, I had a surgeon request that I completely turn off the pulse ox sound. She said it was bothering her.
Click to expand...

That is a switch.. Usually they ask you to turn it off... Which I happily oblige!!! I hate to hear that think go beep beep beep....

I also had a surgeon ask me a few weeks ago to turn the pulse ox on.... I was like WTF!!!!

In fact I actually turn all the ****ing monitors off.. I just leave the alarms on. The alarm is set to vibrate me off of the chair onto the floor.
 
From patient in the room until anesthesia declares turn over to surgery, I let the anesthesiologist decide (most want it quiet). Once the patient is turned over, I decide on the music. When I scrub out, I take my phone with me and the anesthesiologist gets to decide during wake up.

I did work with an anesthesiologist once who blasted hip hop music while getting lines in, etc.
 
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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.

http://www.medscape.com/viewarticle/849102
 
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.
 
Surgery. 2015 Jun;157(6):1153-6. doi: 10.1016/j.surg.2014.12.026. Epub 2015 Feb 28.
The association of noise and surgical-site infection in day-case hernia repairs.
Dholakia S1, Jeans JP2, Khalid U2, Dholakia S2, D'Souza C2, Nemeth K2.
Author information
  • 1Milton Keynes General Hospital, Buckinghamshire, United Kingdom. Electronic address: [email protected].
  • 2Milton Keynes General Hospital, Buckinghamshire, United Kingdom.
Abstract
INTRODUCTION:
Surgical-site infections (SSIs) are associated with an increased duration of hospital stay, poorer quality of life, and an marked increase in cost to the hospital. Lapses in compliance with aseptic principles are a substantial risk factor for SSI, which may be attributable to distractions such as noise during the operation. The aims of this study were to assess whether noise levels in the operating room are associated with the development of SSI and to elucidate the extent to which these levels affect the financial burden of surgery.

METHODS:
Prospective data collection from elective, day-case male patients undergoing elective hernia repairs was undertaken. Patients were included if they were fit and at low risk for SSI. Sound levels during procedures was measured via a decibel meter and correlated with the incidence of SSI. Data analysis was performed with IBM SPSS (IBM, Armonk, NY).

RESULTS:
Noise levels were substantially greater in patients with SSI from time point of 50 minutes onwards, which correlated to when wound closure was occurring. Additional hospital costs for these patients were £243 per patient based on the National Health Service 2013 reference costing.

CONCLUSION:
Decreasing ambient noise levels in the operating room may aid in reducing the incidence of SSIs, particularly during closure, and decrease the associated financial costs of this complication.
 
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BLADEMDA said:
Surgery. 2015 Jun;157(6):1153-6. doi: 10.1016/j.surg.2014.12.026. Epub 2015 Feb 28.
The association of noise and surgical-site infection in day-case hernia repairs.
Dholakia S1, Jeans JP2, Khalid U2, Dholakia S2, D'Souza C2, Nemeth K2.
Author information
  • 1Milton Keynes General Hospital, Buckinghamshire, United Kingdom. Electronic address: [email protected].
  • 2Milton Keynes General Hospital, Buckinghamshire, United Kingdom.
Abstract
INTRODUCTION:
Surgical-site infections (SSIs) are associated with an increased duration of hospital stay, poorer quality of life, and an marked increase in cost to the hospital. Lapses in compliance with aseptic principles are a substantial risk factor for SSI, which may be attributable to distractions such as noise during the operation. The aims of this study were to assess whether noise levels in the operating room are associated with the development of SSI and to elucidate the extent to which these levels affect the financial burden of surgery.

METHODS:
Prospective data collection from elective, day-case male patients undergoing elective hernia repairs was undertaken. Patients were included if they were fit and at low risk for SSI. Sound levels during procedures was measured via a decibel meter and correlated with the incidence of SSI. Data analysis was performed with IBM SPSS (IBM, Armonk, NY).

RESULTS:
Noise levels were substantially greater in patients with SSI from time point of 50 minutes onwards, which correlated to when wound closure was occurring. Additional hospital costs for these patients were £243 per patient based on the National Health Service 2013 reference costing.

CONCLUSION:
Decreasing ambient noise levels in the operating room may aid in reducing the incidence of SSIs, particularly during closure, and decrease the associated financial costs of this complication.
Click to expand...

Seriously blade? I can't believe that these people actually tried to study this, never mind write it up
 
BLADEMDA said:
Surgery. 2015 Jun;157(6):1153-6. doi: 10.1016/j.surg.2014.12.026. Epub 2015 Feb 28.
The association of noise and surgical-site infection in day-case hernia repairs.
Dholakia S1, Jeans JP2, Khalid U2, Dholakia S2, D'Souza C2, Nemeth K2.
Author information
  • 1Milton Keynes General Hospital, Buckinghamshire, United Kingdom. Electronic address: [email protected].
  • 2Milton Keynes General Hospital, Buckinghamshire, United Kingdom.
Abstract
INTRODUCTION:
Surgical-site infections (SSIs) are associated with an increased duration of hospital stay, poorer quality of life, and an marked increase in cost to the hospital. Lapses in compliance with aseptic principles are a substantial risk factor for SSI, which may be attributable to distractions such as noise during the operation. The aims of this study were to assess whether noise levels in the operating room are associated with the development of SSI and to elucidate the extent to which these levels affect the financial burden of surgery.

METHODS:
Prospective data collection from elective, day-case male patients undergoing elective hernia repairs was undertaken. Patients were included if they were fit and at low risk for SSI. Sound levels during procedures was measured via a decibel meter and correlated with the incidence of SSI. Data analysis was performed with IBM SPSS (IBM, Armonk, NY).

RESULTS:
Noise levels were substantially greater in patients with SSI from time point of 50 minutes onwards, which correlated to when wound closure was occurring. Additional hospital costs for these patients were £243 per patient based on the National Health Service 2013 reference costing.

CONCLUSION:
Decreasing ambient noise levels in the operating room may aid in reducing the incidence of SSIs, particularly during closure, and decrease the associated financial costs of this complication.
Click to expand...

There are studies showing decreased OR fatigue with music.
 
one of our liver guys blasts top 40, and honestly in the middle of the night when i'm hanging my 25th unit of blood, it's a welcome sound.

one of our cardiac guys demands total silence and will yell at residents for closing the drawers of the anesthesia cart too loudly.

two days ago for the first time ever i got the "please turn the pulse ox" down from one of our other cardiac guys. surprised me.

in a cardiac case, i turn all the alarms off and have nothing on but pulse ox. i'm watching closely the whole time anyways, i don't need alarms telling me when it's appropriate to get my ass in gear.
 
Ignatius J said:
There are studies showing decreased OR fatigue with music.
Click to expand...

I'm just trying to help the OP with some "evidence based" reasons for keeping the music at a reasonable level. I hate loud music in the O.R. as I find it distracting for patient care.
Some surgeons are arseholes about their ****ty music playing it so loudly you can't hear a word or even yourself think.
 
confusingleaf said:
one of our liver guys blasts top 40, and honestly in the middle of the night when i'm hanging my 25th unit of blood, it's a welcome sound.

one of our cardiac guys demands total silence and will yell at residents for closing the drawers of the anesthesia cart too loudly.

two days ago for the first time ever i got the "please turn the pulse ox" down from one of our other cardiac guys. surprised me.

in a cardiac case, i turn all the alarms off and have nothing on but pulse ox. i'm watching closely the whole time anyways, i don't need alarms telling me when it's appropriate to get my ass in gear.
Click to expand...

But, the "liver guy" is forcing someone else to listen to loud music. Music above a certain decibel should not be allowed in the O.R. (that's my opinion of course).
 
More recent studies have reaffirmed the escalation of the noisy atmosphere of hospitals and operating rooms. Average noise levels commonly are greater than federal limits for occupational noise exposure and frequently exceed those considered a hazard to health.
Noise levels of this intensity have wide-spread implications for healthcare workers and their patients.
 
Anesthesiology. 2013 Feb;118(2):376-81. doi: 10.1097/ALN.0b013e31827d417b.
Effects of divided attention and operating room noise on perception of pulse oximeter pitch changes: a laboratory study.
Stevenson RA1, Schlesinger JJ, Wallace MT.
Author information
  • 1Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA. [email protected]
Abstract
BACKGROUND:
Anesthesiology requires performing visually oriented procedures while monitoring auditory information about a patient's vital signs. A concern in operating room environments is the amount of competing information and the effects that divided attention has on patient monitoring, such as detecting auditory changes in arterial oxygen saturation via pulse oximetry.

METHODS:
The authors measured the impact of visual attentional load and auditory background noise on the ability of anesthesia residents to monitor the pulse oximeter auditory display in a laboratory setting. Accuracies and response times were recorded reflecting anesthesiologists' abilities to detect changes in oxygen saturation across three levels of visual attention in quiet and with noise.

RESULTS:
Results show that visual attentional load substantially affects the ability to detect changes in oxygen saturation concentrations conveyed by auditory cues signaling 99 and 98% saturation. These effects are compounded by auditory noise, up to a 17% decline in performance. These deficits are seen in the ability to accurately detect a change in oxygen saturation and in speed of response.

CONCLUSIONS:
Most anesthesia accidents are initiated by small errors that cascade into serious events. Lack of monitor vigilance and inattention are two of the more commonly cited factors. Reducing such errors is thus a priority for improving patient safety. Specifically, efforts to reduce distractors and decrease background noise should be considered during induction and emergence, periods of especially high risk, when anesthesiologists has to attend to many tasks and are thus susceptible to error.
 
upload_2016-6-17_12-54-47.png
 
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confusingleaf said:
one of our liver guys blasts top 40, and honestly in the middle of the night when i'm hanging my 25th unit of blood, it's a welcome sound.

one of our cardiac guys demands total silence and will yell at residents for closing the drawers of the anesthesia cart too loudly.

two days ago for the first time ever i got the "please turn the pulse ox" down from one of our other cardiac guys. surprised me.

in a cardiac case, i turn all the alarms off and have nothing on but pulse ox. i'm watching closely the whole time anyways, i don't need alarms telling me when it's appropriate to get my ass in gear.
Click to expand...


When I started my career there was an old Cardiac Surgeon who used to make rounds with a Cigarette in his hand. He would literally smoke between rooms. The times are changing and the concept that a surgeon should be able to jeopardize someone else's health for his own pleasure must end.

You are welcome to smoke weed, drink beer/vodka and dance naked listening to rock and roll at your own home or personal space but the operating room suite is not the place for it.
 
Creflo said:
I like to do my cases in a quiet o.r., with no music and no extraneous conversation. O.r. Staff doesn't like it. Apparently not many (if any) surgeons at my facility request this. Wanted to ask your forum any thoughts on appropriateness of this request.
Click to expand...


The music should be at a level where you can easily hear the nursing circulator talk from 5 feet away.
 
I used to work with a guy who had the tunes way up all the time. Then one day he was leaning over to get a straight look at the patients face and his fat gut engaged a bovie. Nobody heard it. The circulator smelled the smoke. Nice 2cm hole in patients belly. Pretty sure the lawyers got a piece of that one.
 
I always wonder how much damage to the patient's hearing happens with the suction catheter at rest on top of their face, the bovie usually just below their head, the bair on and music blasting.
 
Creflo said:
I like to do my cases in a quiet o.r., with no music and no extraneous conversation. O.r. Staff doesn't like it. Apparently not many (if any) surgeons at my facility request this. Wanted to ask your forum any thoughts on appropriateness of this request.
Click to expand...

It would depend on the surgery. Are you doing a complex hypervascular brain tumor removal or an appy? The former I can understand the latter makes you sound like a whiny bitch.


--
Il Destriero
 
There is nothing worse than watching a podiatrist put screw after screw in a foot or toe then add an external fixation on top of it all for the obvious billing benefits.
I'd honor your request for the first 30 minutes. After that the volume climbs every 15 minutes until you decide you have wasted enough of my time.
 
Noyac said:
There is nothing worse than watching a podiatrist put screw after screw in a foot or toe then add an external fixation on top of it all for the obvious billing benefits.
I'd honor your request for the first 30 minutes. After that the volume climbs every 15 minutes until you decide you have wasted enough of my time.
Click to expand...

I am so using that one. I think I'll make it some indie hip hop too which really seems to get under the skin of all my white sheltered suburban surgeons (which is pretty much all of em).
 
I think the bottom line is that the OR is full of adults who should all be able to reach a reasonable consensus. I'm fine either way. Music. Great. No music. Fine. Pulse Ox. I'm sorry- that is non-negotiable.
 
Ignatius J said:
I think the bottom line is that the OR is full of adults who should all be able to reach a reasonable consensus. I'm fine either way. Music. Great. No music. Fine. Pulse Ox. I'm sorry- that is non-negotiable.
Click to expand...
In my first gig the surgeons would ask the crna's to turn the pulse Ox sound off. When they did this they also managed to,silence the alarms. One night I rushed a crashing trauma into the OR with a pathetic 20g IV from the ER and crashed induced her. I then began to look for a a real IV. I forgot to flip the switch to turn on the vent. The surgeon rushed in after scrubbing and said,"wow, She looks blue." I knew exactly what had happened. I gave a couple big breathes and turned on the vent. She did fine. But after that one I made every crna (and myself) have the volume at least on. That's just stupid to turn off the pulse Ox volume unless it will alarm at low sats.
 
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I think properly set audible alarms are a requirement. I know this is now a big JC issue. I'm aware of 3 previously healthy kids/young adults that died in the PACU after routine surgery because of late detection of problems 2/2 alarms and/or volumes being off. 3 assassinations because people were too lazy to set correct parameters, so they shut the alarms off. If I know of 3 myself, from area hospitals, it must be a much bigger problem.
I'd tell the surgeon to go pound sand. Audible and properly set alarms are not negotiable. If he doesn't like it, maybe he can try to give it a go with local.


--
Il Destriero
 
I outfit my ORs with a set of JBL PA speaker/monitors, a set of JBL subwoofers and dual Crown amplifiers. I like to run them through a dbx DriveRack PA to protect the speakers.

OR 8 is particularly nice. The disco ball and laser projectors really make those all-night spine cases pass like nothing.
 
periopdoc said:
I outfit my ORs with a set of JBL PA speaker/monitors, a set of JBL subwoofers and dual Crown amplifiers. I like to run them through a dbx DriveRack PA to protect the speakers.

OR 8 is particularly nice. The disco ball and laser projectors really make those all-night spine cases pass like nothing.
Click to expand...


Do you find the pole dancers distract you?
 
IlDestriero said:
I think properly set audible alarms are a requirement. I know this is now a big JC issue. I'm aware of 3 previously healthy kids/young adults that died in the PACU after routine surgery because of late detection of problems 2/2 alarms and/or volumes being off. 3 assassinations because people were too lazy to set correct parameters, so they shut the alarms off. If I know of 3 myself, from area hospitals, it must be a much bigger problem.
I'd tell the surgeon to go pound sand. Audible and properly set alarms are not negotiable. If he doesn't like it, maybe he can try to give it a go with local.


--
Il Destriero
Click to expand...

Having an audible pulse ox during induction and wake up is necessary. Turning down the pulse ox volume in the middle of a case isn't ideal and requires you to watch the monitor more closely than otherwise, but it isn't really a safety issue. You can see the SpO2 number at least as well as you can hear the tone change. You have to commit to watching it though. I wouldn't routinely turn the pulse ox volume very low, but if you have an autistic/OCD surgeon a few times a year I'm willing to accomodate his disorder with a pt sitting there tubed, sating 100%, with railroad track vitals.
 
We are in 2016. Any individual who needs his crappy music to do his job can wear a tiny Bluetooth earpiece in one ear, and spare the rest of the staff from his musical "taste". This should actually be included in the OR regulations.

I am with Blade and OP here.
 
FFP said:
We are in 2016. Any individual who needs his crappy music to do his job can wear a tiny Bluetooth earpiece in one ear, and spare the rest of the staff from his musical "taste". This should actually be included in the OR regulations.

I am with Blade and OP here.
Click to expand...
This I like this
 
I'll accommodate requests to decrease the pulse of volume, but if I get asked to turn it off completely I'll say "Sure" then proceed to put it as loud as it goes and sit back down without another saying another word.
 
Music etc at a reasonable volume is great, gives you something to jam to. However, I hate, I mean hate, the surgery is done so now everyone in the room that isn't anesthesia is going to stand around slamming trays and gossiping and joking around like a high school locker room while I'm waking the patient up. Not only has it got to be disorienting to the patient whose senses are just coming back and they're trying to make sense of things but it's quite simply unsafe and unprofessional. If a surgeon can have the gall to ask for pulse ox sounds to be turned off I can ask for quiet during one of the most high risk portions of the entire case. It literally comes off like everyone thinks that once incision is closed nothing bad can happen so it's a party and you don't need focus or potentially help.
 
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