An analysis of video footage, taken during 20 operations, suggests that some operating theatre teams are negatively affected by background music, during surgery. Researchers suggest that the decision to play music during an operation should be made by the entire team, taking into account both the benefits and the risks.
The study, published in the Journal of Advanced Nursing, suggests that communication within the theatre team can be impaired when music is playing. For instance, requests from a surgeon to a nurse for instruments or supplies were often repeated and there was qualitative evidence of frustration or tension within some of the teams.
Sharon-Marie Weldon, a lead author of the study from the Department of Surgery and Cancer at Imperial College London, said: “Music can be helpful to staff working in operating theatres – where there is often a lot of background noise, as well as other distractions, it can improve concentration. That said, we’d like to see a more considered approach, with much more discussion or negotiation over whether music is played, the type of music, and volume, within the operating teams.”
Dr Terhi Korkiakangas, the other lead author from UCL Institute of Education, said: “In the operating theatres we observed, it was usually the senior medics of the team who made the decision about background music. Without a standard practice of the team deciding together, it is left up to junior staff and nurses to speak up and challenge the decisions of senior doctors, which can be extremely daunting.”
Dr Korkiakangas added: “Public perception of music in operating theatres is shaped by media portrayals of surgical teams always working to a background of smooth music. We found that often dance and drum and bass were played fairlyloudly.”
Using innovative video technology, the study investigated how music impacted on nursing and theatre staff during real time surgical operations. Video recordings, from multiple cameras placed at strategic points, gave researchers an insight into the verbal and non-verbal communications between operating teams as operations happened. Twenty operations (in total lasting approximately 35 hours) were analysed, 70% of which had music playing.
How the music was played and controlled was important, too. If playback volume from digital sources was not standardised, there could be sudden increases in volume, between tracks. Sometimes staff turned up a popular song, again leading to a sudden increase in volume that could mask instructions and other verbal communications.
The study recommends that surgical teams hold frank discussions about playing music during an operation, with particular emphasis on taking into consideration the views of nurses. An ideal opportunity would be during the ‘Time Out’ section of the World Health Organization (WHO) Surgery Safety Checklist. This is used to make sure that everyone has introduced themselves by name and role; all involved are clear on the details and plan for the operation; all information, materials, and checks are in place. Introducing a standard check, at this point, to voice concerns about music and for teams to ensure that music remains at a volume low enough to create a sound working environment also for colleagues who may be more sensitive to noise.
Based on their broader body of research, the team has developed a training model – Video Supported Simulation for Interactions in the Operating Theatre (ViSIOT) – that aims to improve communication and includes strategies to mitigate problems associated with music.
A spokesperson for the Royal College of Surgeons said: “This is a very small study and there is no evidence that loud distracting music is a widespread issue in NHS hospitals. There are also studies which suggest music can sometimes help to create a calm atmosphere in the operating theatre. If music is played during surgery it must not be a distraction for any members of the surgical team and must not discomfort patients.”
