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Noise and Distraction in the Obstetric Operating Room
Abstract Number: F-05
Abstract Type: Original Research
Background: Anesthesiology was the first medical specialty to focus on patient safety and outcomes. Physical or auditory interferences may lead to medical errors and patient harm. Noise >77 decibels (dB) in the OR causes distractions, reducing mental efficiency and short-term memory of anesthesia residents . Cesarean delivery (CD) is a unique OR environment with additional noise and physical activity from an awake patient, crying newborn, visitors, pediatrics, and increased OR traffic. An observational quality improvement (QI) study to evaluate the frequency and severity of noise and interferences during CDs will help determine ways to minimize distractions and improve patient safety.
Methods: This IRB-waived departmental QI project included 50 prospective CD observations from 9/2015-1/2016 at Cedars-Sinai Medical Center. A sound meter continuously measured dB with major events (e.g. spinal, incision, delivery) recorded. The number of physical interferences violating the anesthesia workspace were noted. Interruptions distracting the anesthesiologist were scored using a modified Healy score . The primary outcomes of noise levels and interferences are described by mean, range, and standard deviation. A single-factor ANOVA test compared dB of major events for all CDs. The secondary outcomes compared maternal/fetal characteristics, presence of pediatricians, or music with dB levels and modified Healy scores using t-tests and Chi-squared or Fisher’s Exact tests.
Results: The average noise level of 50 CDs was 65.9dB (range 50.2-107.3, SD 5.6) for the case. Significant differences existed between major events in each CD with maximum dB occurring at delivery time, ANOVA (p <0.0001). Nursing caused the most physical interferences into the anesthesia workspace (mean 48.8, range 25-102, SD 15.7), followed by the patient’s visitor (mean 4.3, range 1-15, SD 2.7). Unscheduled CDs were associated with modified Healy score sum ≥50, Fisher’s Exact (p<0.05). In addition, presence of pediatrics significantly impacted the modified Healy scores involving the anesthesia team, Chi-squared (p<0.0001). The dB exceeded recognized levels of distraction (77dB) in 98% of cases. This safety limit was exceeded in 16/50 cases for ≥30% of the entire CD time and 7/50 cases for ≥50% of the entire CD time.
Discussion: Patient safety remains paramount in the OR. This QI study identified several areas for possible improvement in noise level and distraction of anesthesiologists. Noise routinely exceeds dB levels associated with distraction and memory impairment of anesthesiologists . Redesigning the OR workflow including limiting noise, number of visitors, and OR traffic to protect the anesthesia workspace from interferences may lead to less distractions to the anesthesiologist and improve patient care.
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2. Qual Saf Health Care,2007,16:2,135-9