Operating theatre teams should review use of background music, study suggests

An analysis of video footage shows 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 today 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.”

Music was first introduced into operating theatres in 1914 to relieve the anxiety of patients. Today patients are placed under anaesthetic outside of the theatre and music is routinely played for the benefit of clinical staff. New theatre suites are often equipped with docking stations and MP3 players and portable speakers are routinely used during operations.

Dr Korkiakangas said: “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 fairly loudly.”

Using innovative video technology, the study investigated how music impacted on nursing and theatre staff during 20 ‘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 per cent 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 Organisation (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, and suchlike. 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.

See the press release of this article