SILENT TREATMENT Yacker Trackers, stoplight noise sensors that blink at various decibel levels, remind staff to tone down their talking.

Equipment beeps, instruments whir, cell phones vibrate, overhead pages boom, iPods pulsate and the conversation flows. Is it any wonder patient care sometimes gets lost in the din? If noise pollution is a problem in your ORs, here's how to turn down the volume.

Quiet in the room
Excess talking and noise may prevent caregivers from hearing important questions or directions. They may not be immediately aware of a negative turn in the patient's condition or able to focus on tasks during critical times in patient care: such as the patient's arrival in the OR, anesthesia induction and emergence, the pre-op time out, instrument and sponge counting, and calls from pathology.

Some of those tasks may be relatively simple, but they're also extremely important. When they're being performed, you need quiet in the room so communication is effective and everyone can be heard clearly and is able to focus without interruption.

As part of her research on the impact of noise pollution in the OR, one of our anesthesiologists, Rosalind Ritchie, MD, measured decibel levels in our suites. She says normal talking produces 40 to 60 decibels, while a rock concert generates as much as 140 decibels. The average OR produces 77 to 100 decibels, according to her research. That excessive noise in the OR can lead to miscommunication and errors. It can also heighten workplace stress for your staff, says Dr. Ritchie.

For her study, Dr. Ritchie surveyed 17 anesthesia providers, 23 surgeons and 13 nurses about their perceptions of noise levels in the OR. She says each member of the surgical team has different perceptions of excessive noise. In her study, most anesthesia pro-viders and nurses reported having difficulty hearing in the OR, compared with only about one-third of surgeons. About half of the anesthesia providers and nurses believe noise is generally excessive, but only 4% of surgeons seem to be bothered by noise levels.

Alarmingly, her research showed that average decibel levels were highest during critical stages of surgery: anesthesia induction and emergence, and the pre-op time out. The good news: It appeared as if surgeons, anesthesia providers and nurses are equally comfortable in asking for a team member to quiet down. Many respondents expressed strong opinions about noise levels during surgery, but Dr. Ritchie notes that many facilities don't evaluate or address the issue.

Dr. Ritchie says it's "paramount" that you address noise pollution in the OR, and take steps to eliminate controllable noise that interferes with effective communication and distracts from safe patient care.

VISUAL CUE If it gets too noisy, staff members can lift a quiet badge that attaches to a pull string on our ID badges.

Friendly reminders
Dr. Ritchie's findings sparked our interest in raising awareness of the issue and getting everyone to understand that each member of the surgical team has different perceptions of noise volumes at various times of the case. For example, nurses care very much about noise levels when they're performing final counts to ensure no objects have been left behind. The same goes for anesthesia providers during induction and emergence. That makes sense. You're likely sensitive to noise distractions when you're trying to focus on your own responsibilities. Establishing agreed-upon quiet times during the critical points of cases ensures everyone has the quiet they need when they need it most. Our efforts to turn down the volume at the front line include these creative solutions:

• Quiet badges. Each staff member carries a yellow "quiet" badge, which attaches to pull strings on our ID badges. When noise levels mount during critical phases of surgery, staff members are encouraged to lift the badge to remind their colleagues about our noise-reduction policy. Everyone knows and respects the badges, and we've found that they help empower staff to speak up against noise distractions.
• Yacker Trackers. These stoplight noise sensors let you adjust the lights to blink at various decibel levels. (You can purchase the devices at teaching supply stores.) The green light means noise levels are low; the yellow light means levels are rising but still acceptable; and the red light indicates noise has reached distracting levels. We placed the trackers at the surgery department's front desk and in pre-op, because that's where noise levels seem to escalate the most.
• Posters. We've hung "Quiet Time" and "Zone of Silence" reminders in pre-op and in ORs to serve as constant reminders for staff to manage noise levels.

Loud and clear
Most of our staff members appreciate the efforts we're making to reduce noise distractions. To be honest, some have resisted our attempts to turn down the music in the OR. We've emphasized that we're not trying to disrupt their personal choice of tunes, but that we want quiet during surgery's important stages so their focus is on patient care, not Taylor Swift.

I've worked in surgery for a long time. Noisy care is part of the culture, so much so that I believe surgical professionals have become desensitized to excessive sound. Step back and think about how much noise your staff generates during surgery. Loud voices and music can combine with already noisy medical equipment to jeopardize patient care. In loud ORs, people tend to project their voices even louder to compete. It turns into a loud and vicious cycle that we need to break and silence.