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Making Noise Reduction Strategies Stick

Publish Date: July 14, 2021


“Sound Check.”

This simple phrase brings immediate quiet to operating rooms at Vanderbilt University Medical Center in Nashville, Tenn. It’s only used for one purpose—to snap every team member to attention when a member of the team feels distracting noise is jeopardizing safety.

Noise-related distractions are widespread in the OR environment and too often team members simply talk over the noise, becoming normalized to decibel levels that can progressively damage hearing, trigger cardiovascular symptoms, boost stress and distract concentration for important tasks, such as accurately counting surgical items, or other critical times in the surgical case.

“The OR is one of the noisiest places in the hospital, with alarms, frequent air exchanges, banging and clanging of surgical instruments and multiple conversations often happening at once … and that’s all before a physician requests to turn on music to help them focus on the surgery,” explains Glendyle Levinskas, BSN, RN, CNOR, a staff perioperative nurse at Vanderbilt University Medical Center Health System. “However, there is OR noise we distinguish as unwanted and disruptive, such as loud conversation.”

Four years ago, Levinskas decided to take on the problem of OR noise as a nurse-led project to develop evidence-based noise reduction strategies that engaged all team members in shaping sustainable solutions. She recruited the help of evidence-based practice expert Elizabeth Card, APRN, FNP-BC, CPAN, CCRP, FASPAN, a research nurse specialist at Vanderbilt.

“Nurses are naturally innovative, and we are in a perfect space in the OR to drive a quieter and safer OR environment through team collaboration and sharing the evidence,” Card says.

Distinguishing Disruptive OR Noise

With so many necessary noises in the OR, they say it’s important to know the difference between necessary noise and distracting noise …

Necessary Noise

Distracting Noise

An alarm or pulse ox monitor beep

Conversation about non-procedure related topics

Anesthesia machine

Music (especially loud music)

Movement of carts or C-arm

Unnecessary clanging of instruments or through-traffic

Instruments being opened on the back table

Sounds from phones, pagers, or non-alarm equipment such as suction

“The more you read in the literature about noise, the more you realize it goes beyond just being an irritant, it can have serious health effects, even when you hear constant noise at lower decibels,” Card says.

Working Toward A Quieter OR

To understand how noise was affecting their colleagues, Levinskas, Card and a team of perioperative members and physicians conducted a survey among all surgical team members.

They learned that almost 47% of their colleagues were stressed and distracted by the current OR noise levels.

With this knowledge and armed with evidence in the literature about the harms noise can inflict for staff health and patient safety, Levinskas and Card began a three-year process to create a culture shift that reduces distracting OR noises. They formed a multidisciplinary OR noise reduction team (including 30 members) and shaped ongoing OR-wide education and in-services to raise awareness about noise risks to health and patient safety.

The team also agreed they needed an alert phrase to easily call attention to noise. They surveyed all OR staff members and after several rounds agreed on the phrase “Sound Check.”

“Our ultimate goal is to empower everyone in the OR with education and a mechanism to call out when noise levels impair communication and concentration,” Levinskas says. “It’s been rewarding to see staff beginning to put this alert phrase into practice.”

Levinskas and Card agree that the number one key to successfully implementing noise reduction is team engagement. “The solution had to come from staff to shape our own noise reduction strategies,” Card acknowledges.

AORN Global Surgical Conference & Expo

Both nurses will be sharing their strategies for implementing sustainable noise reduction in perioperative settings on Monday, Aug. 9 from 4-5 p.m. during the AORN Global Surgical Conference & Expo in Orlando, Fla.