In University Health operating rooms, sound is under the microscope, thanks to two UMKC professors and their research team. This project, backed by a $1.9 million, five-year research grant from the Agency for Healthcare Research and Quality, seeks to improve patient outcomes from surgery, all by changing the sound environment in the operating room.
Identifying the Problem
The grant is the result of a collaboration between School of Medicine Associate Dean of Women’s Health and professor Gary Sutkin, M.D., and Conservatory professor Paul Rudy, DMA.
The main goal?
“Make it easier for people to work in the operating room,” Sutkin said.
The main challenge? Noise.
“You really have to be very careful about how you communicate in the operating room,” Sutkin said. “One of the causes of miscommunication is just that the operating room is super loud. I mean it literally. There are loud machines that are at the noise level of dishwashers, garbage disposals or power mowers. We have to talk over those machines and there may be three or four conversations going on at the same time.”
All this noise contributes to the sound environment, which is where Rudy’s expertise lies. He’s been studying sound for more than 20 years.
“We live in a really noisy world, and I want everyone to be aware of the sound environment and how they contribute to it,” Rudy said. “Sound is a cognitive drain because our brains are always processing it, even while we’re asleep.”
Rudy likes to compare a surgical team to an orchestra performance. Both settings require discipline and focus, but within different areas. It’s second nature for musicians to operate in ways that don’t add any extra noise to their environments. That level of awareness is what makes Rudy instrumental to this research project.
“Until Gary brought me into this project, I’d never imagined using my sound research and composer skills in this kind of way,” Rudy said. “It’s a unique experience for me, and it’s really pushed me to think differently and get curious about things that I may not have before.”
One of the first steps to improving communication in the operating room is changing that sound environment. Noisy machines may stand between a surgeon and the nurse or anesthesiologist, making it harder to hear each other. Line of sight, or lack thereof, can also hinder communication.
“We can’t see each other between all the machines,” Sutkin said. “If you do have a line of sight, you can look at each other and acknowledge each other even though you’re wearing a mask. You can’t lip read, but you can still tell by body language if someone’s listening.”
Sutkin, Rudy and their team have identified these challenges by observing and measuring dozens of surgeries and documenting each time there is a communication breakdown.
“We need to collect all those miscommunication events so we can better understand why they happen,” Sutkin said. “Miscommunication is very much like speeding when you drive. It happens all the time, and patients do just fine. We speed all the time, and we don’t get into accidents. And yet, we know from large-scale studies that speeding is the number one cause of driving accidents. Similarly, miscommunication is fine for the patient until it isn't, until there’s a crash.”
By recording all these observations, they can better understand what happens when there’s a ‘crash’ or when a patient has a poor outcome because of a miscommunication.
“Many of the sounds in the operating room are necessary, such as machines beeping and conversations between the surgical team,” Rudy said. “So, I observe these surgeries through the lens of minimizing unnecessary sounds. Something such as crumpling up a piece of plastic and throwing it in the trash at the wrong time can interrupt an important conversation and prevent anything else from being heard.”
Creating Solutions
With five years of funding secured, this team has the breadth to experiment with dozens of different ideas on how to “solve” these miscommunications.
“We have about 30 possible solutions,” one student said.
Some of these solutions are as simple as turning off extraneous machines or creating new check-in protocols amongst a surgical team. In the long-term, Rudy envisions new standards for the manufacture of hospital equipment that both eliminate noise and create a more harmonious atmosphere through an improved sound environment.
While the work is centered around trying these solutions at University Health right now, there are plans to implement the most promising ones in Children’s Mercy’s operating rooms to compare the results.
“If it works at two hospitals, then we’ve got the basis for successful intervention styles.” Sutkin said.
Scaling a project like this for operating rooms across the country requires flexibility. Not all operating rooms are the same size, run the same equipment or have personnel with the same needs and preferences.
“We could show them what worked for us sure, but they must consider things that will work specifically for their institution,” Sutkin said. “Take what works and leave what doesn’t.”
This research has the potential to revolutionize the way operating rooms are run, and is yet another display of the strong collaboration between the UMKC School of Medicine and University Health.
“This is all about patient safety at University Health, and we couldn’t do it without all the incredible people there,” Sutkin said. “I’m hoping that we will reward their enthusiasm and investment with improving patient safety.”
