On 5th August, many newspapers in the UK reported on negative aspects of playing music in the operating theatres.
I am a co-author on this observational study, published in the Journal of Advanced Nursing.
Our video-based research found that surgeons had to repeat their instructions to nurses more frequently when music was playing during surgical operations.
This meant that music got loud enough to impair communication: nurses did not always hear the requests issued for instruments, supplies or other assistance. The need for repeated information led to visible frustration or tension within some of the teams.
Why is there any music in the operating theatre? Many surgeons highlight that music can bring comfort to patients. Indeed, some literature suggests that music can be beneficial during awake surgery by reducing anxiety levels in patients.
Music is also played when patients are fully anaesthetised. As patients are asleep, music is played for the clinical staff rather than the patients. These are the kind of operations we observed.
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. It can also fill silence.
During our fieldwork in a London teaching hospital, we noted that music was often played through mobile phones and iPods, with modern theatre suites being equipped with docking stations and speakers. Sometimes volume could change rapidly between songs; sometimes staff turned up the volume on a popular song.
We observed how music and increasing volume had an impact on team communication. Usually when music got fairly loud, nurses started to prompt surgeons to repeat themselves, as instructions or requests were not properly heard over the music. There were times when music was deliberately turned up, notably when surgeons were finishing off an operation. Yet, this was critical time for nurses, who were undertaking counts for the instruments and swabs used in the operation. It is imperative that nurses can hear each other properly during the counts, as any mistakes can become costly to patient safety: retained surgical items are more common than thought.
The key is to understand 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.
Key message: Regulations for music in the operating theatre
Our study recommends regulations so that music will not hamper teamwork and potentially jeopardise patient safety. Currently no formal regulations are in place regarding music, as checked with the Royal College of Surgeons of England, Royal College of Nurses, and Royal College of Anaesthetics.
The regulations can be simple with a view to preserving music in the operating theatre, if teams so wish:
1. Teams should review the playing of music at the start of each operation. The ‘time-out’ period of the Surgical Safety Checklist could provide an excellent opportunity for team discussion and voicing out any concerns some might have.
2. There ought to be a cap on the volume control ensuring that music stays in the background, creating a sound work environment for all.
We are hoping to open up wider discussion, including operating theatre professionals, clinical managers, clinical educators, and policy makers. We invite nurses to join the discussion, as the views on music in the operating theatre are currently heavily represented by surgeons.
Listen to the editor Roger Watson discussing our paper in the podcast of the Journal of Advanced Nursing.