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TAIPEI, TAIWAN ( - Introduction and Objectives: Instruments utilized during endourologic surgery may contribute significantly to ambient noise in an operative theater. This study seeks to determine ambient noise, noise contributed by endourologic equipment, and the interference in verbal communication resulting from this noise.

wceMethods: Ambient noise in the endourologic suite determined by a digital decibel meter was compared to noise from normal conversation, a high-pressure suction system, an ultrasonic lithotripter, and background music. Furthermore, the noise increase produced by the addition of each factor was determined. Additionally, four subjects—the surgeon, surgical assistant (0.8 m from the surgeon), anesthesiologist (1.8 m), and the circulator (2.5 m)— were positioned in the operating room to simulate the surgical team. Five trials with 20 differing medical words/phrases were spoken by the surgeon. Trials were performed with only ambient sound, ambient/ suction/ lithotripsy, ambient/suction/lithotripsy/music. Statistical analyses were performed using a student t-test.

Results: The average baseline noise was 53.49dB(A). As conversation, suction/lithotripsy, and music were added, noise levels were 61.82dB(A), 77.96dB(A), and 87.33dB(A), respectively. At baseline noise, the assistant, anesthesiologist and circulator correctly recorded 100%, 100% and 96% of the words, respectively. The correct response rate by the subjects decreased to 97% (p = 0.172), 81% (p < 0.001) and 56% (p < 0.001) with suction/lithotripsy and 90% (p = 0.006), 48% (p < 0.001) and 13% (p < 0.001) with suction/lithotripsy/music.

Conclusions: As this study demonstrates, barriers to effective communication exist and are perpetuated by increased noise associated with surgical instruments, distance from the surgeon, and background music. Errors in communication may compromise operating room safety and efficiency.

Source of Funding: None

Listen to an interview with D. Duane Baldwin, one of the authors of this study.

 Presented by Nazih Khater, Hayley Mowery,
 Muhannad Alsyouf, Roger Li,
 Michelle Lightfoot, David Tryon, 
Herbert Hodgson, Carol Conceicao, Gaudencio Olgin, Daniel Faaborg, 
Javier L. Arenas, and D. Duane Baldwin at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan

Loma Linda University Medical Center, Loma Linda, CA USA 


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