How music impacts communication during surgery

In early August 2015, newspapers in the UK reported on negative aspects of playing music in the operating theatres. A new study found that surgeons had to repeat instructions to nurses more frequently when music was playing. Sometimes music got loud enough to impair communication: nurses did not always hear the requests issued for instruments, supplies or other assistance. This led to frustration or tension within some of the teams.

I was a co-author on this study. In this post, I explain some of the key issues raised by the study in regards to music and team communication. My current work as British Academy Post-Doctoral Fellow (2014-2017) includes the development of communication training for operating theatre professionals on a range of issues.

Music has a long history in the world of surgery. Dating back to 1914, music was played through a gramophone to relax surgical patients. Rules were in place for not playing jazz or sentimental tunes; instead, soft smoothing music was deemed acceptable. Today many surgeons highlight that the main reason for playing music during surgery is to bring comfort to patients. Literature suggests that music can be beneficial during awake surgery by reducing anxiety levels in patients.

Music is also often played when patients are fully anaesthetised. As patients are asleep, music is played for the clinical staff rather than patients. A body a work suggests that surgeons perform better when music is playing: it can help concentration and make surgeons operate faster. Some surgeons tell us how music masks white noise and other distracting talk in the theatre.

In 2012-2103, I was involved in an observational project on teamwork in the operating theatres of a London teaching hospital. Among other things, we noted that music was often played through mobile phones and iPods, with modern theatre suites being equipped with docking stations and speakers. Sometimes music volume could change rapidly between songs; sometimes staff turned up the volume on a popular song. We observed this having an impact on team communication.

Surgeons have been often portrayed as operating to a background of soothing classical music. The music styles we observed ranged from classical music to popular tunes and drum and bass. Clearly, the music played in the theatre will reflect the personal preferences of those who choose the music. In our observations, it was usually the senior medics (often the lead surgeon) who made the decisions on the music and whether it was played at all. There was little discussion about music prior to operations started, and nurses were hardly ever included in such talks. While we did not assess the impact of music styles themselves, our observations suggested that the overall loudness sometimes made communication less effective.

Usually when music got fairly loud in the theatre, nurses started to prompt surgeons to repeat themselves, as instructions or requests were not properly heard over the music. Music was sometimes turned up when surgeons were finishing off the operation. Yet, this was a critical time for nurses undertaking counts for the instruments and swabs used during the operation. Any mistakes during closing counts could become costly to patient safety: retained surgical items are more common than thought.

Using video recordings we were able to analyse in detail how interactions unfolded. Video allowed a repeated access to the operations so that we could identify and map the frequency of repeated verbal exchanges between surgeons and nurses. Such issues are likely to pass unnoticed by the staff themselves when immersed in their work. We saw that disruptions in communication caused visible frustration and tension in some of the team members.

The key is to identify both the benefits and losses of playing music in the operating theatre. Without a doubt, music can be beneficial at an individual level to those surgeons who prefer to listen to their favourite tracks while operating. However, when not controlled, music can have a less desirable impact at the team level when instructions go unnoticed or are picked up slowly. Some team members can be more sensitive to loud music; hard of hearing problems can make it more difficult to work in an environment with additional noise.

Our study recommends regulations so that music played will not hamper teamwork and potentially jeopardise patient safety. The regulations can be simple and preserve music in the operating theatre if teams so wish. First, team briefings at the start of each operation (‘time-out’ period of the Surgical Safety Checklist) could provide an excellent opportunity for teams to discuss playing music together and to voice out any concerns some might have. Second, a cap on the volume control is ought to be established ensuring that music stays in the background, creating a sound work environment for all. Currently no formal regulations are in place regarding music as checked with the Royal College of Surgeons of England, Royal College of Nursing, and Royal College of Anaesthetists. We are hoping to open up wider discussion, including operating theatre professionals, clinical managers and educators, and policy makers.

Dr Terhi Korkiakangas played a key role in an Economic and Social Research Council (ESRC) funded project on teamwork in the operating theatres of a London teaching hospital (2012-2013). As current British Academy Postdoctoral Fellow, her work extends the study of communication in the operating theatre from a ‘multimodal’ perspective, focusing on verbal and nonverbal interactions. Terhi is developing and implementing a training model for improving different aspects of communication during surgical operations. The ViSIOT (Video-supported Simulation for Interactions in the Operating Theatre) model includes strategies that can also mitigate problems associated with distracting music. The project website can be found at https://terhikorkiakangas.wordpress.com. Terhi has completed PhD, MSc and BSc in Psychology and is specialised in the study of social interaction. 

Reading

Korkiakangas, T., Weldon, S. M., Bezemer, J., & Kneebone, R. (2015). Video-supported simulation for interactions inthe operating theatre (ViSIOT). Clinical Simulation in Nursing, 11(4), 203-207.

Weldon S-M., Korkiakangas T., Bezemer J. & Kneebone R. (2015). Music and communication in the operating theatre. Journal of Advanced Nursing (Early online).