E113 Su-Yin MacDonell on Noise in the Operating Room
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Chad Ball 00:12
Welcome to the Cold Steel podcast hosted by Ameer Farooq and myself, Chad Ball. We consider it an absolute privilege to bring you guests from around the world who are truly experts in their craft. Our mission is to offer you a combination of not only master classes on clinical surgery topics, but also insights into achieving personal growth, productivity, and fulfillment as a surgeon and perhaps more importantly, as a human.
Ameer Farooq 00:52
Before I started medical school, I thought the operating room would be incredibly quiet, like the inside of a church. But in actual fact, the operating room can be an incredibly noisy environment. Dr. Su-Yin MacDonell is an anesthetist specializing in periop[erative] medicine at St. Paul's Hospital in Vancouver. She's particularly interested in the concept of noise in the operating room, and how that can affect decision-making and focus in the OR [operating room]. We were privileged to hear about her research around noise in the OR and her thoughts about how we can improve the OR environment and communication across drapes. Dr. MacDonell, thank you so much for joining us on Cold Steel today. It's truly an honor to have you on the show and taking time out of your busy schedule. Could we just start by asking you to tell us a little bit about yourself and where you grew up? Where you did your training?
Su-Yin MacDonell 01:42
Well, thanks for having me. And so, I had an interesting kind of course or path to medicine. Actually, I'm from Nanaimo BC and that's on Vancouver Island. And, I actually was a professional ballet dancer and did that for a few years and then recognized that financially it wasn't sustainable and the future was pretty unknown. And so I decided to go to nursing school and I nursed for two years before going to medical school at UBC. And after my medical school, I went and did residency or anesthesia residency at UBC. And then post residency, I did a fellowship in perioperative medicine in Hamilton at McMaster University, critical care, ultrasound certification, and also did my masters in perioperative medicine through the University College of London. So I think that probably all of my experiences prior to residency ultimately led me to the current path that I have now.
Ameer Farooq 02:51
Yeah, it's a really neat path, you know, the fact that you were a professional ballet dancer, and had all these different experiences is so neat. What drew you to periop[erative] medicine? Why did you kind of get interested in that?
Su-Yin MacDonell 03:04
You know, to be honest with you, it's a little bit of an accident. And I think a lot of us end up doing this, in hindsight, probably my experience nursing on a general surgery floor allowed me to gain insight as to the patient experience. And I think when I was finished my residency, the unexpected path was basically, as I was looking for my ideal position, my ideal job, you start looking into fellowships, and at that time, perioperative medicine was well established internationally. But in fact, in Canada, it had just started emerging as a subspecialty in anesthesia. And, in starting to think about marketing myself for my dream job, which I ultimately got, I looked at all my options and kind of fell upon perioperative medicine and then sort of realized, you know, how important it is for patient safety and experience, and then fell in love essentially, and went forward with it through multiple routes to gain expertise. And I think now that fellowship and subspecialty is much more established - it's established nationally and also locally at two major academic centres. It's now part of a residency program, but I think I caught it at its infancy in anesthesia and was lucky to do so.
Chad Ball 04:35
Yes, it's a very interesting subspecialty and as you know, it's exploding across all specialties of medicine, whether that is internal medicine, surgery and of course anesthesia. So, lots of room for growth for sure. You know, we were hoping to talk to you today a little bit about noise, ambient noise per se, in the operating theatre and we realized that you have quite a neat and special interest in that topic. How did you get interested in that particular domain? And what was the genesis of it?
Su-Yin MacDonell 05:06
You know, I think the experience of noise in the operating room is partially related to culture and expectations of those who are working in the operating room. And I think ultimately, I decided to investigate and do a little bit more information-gathering before I initiated this QI [quality improvement] project. Based on a conversation I had with an anesthesia resident who was from out of province, who noted how noisy it was on induction at St. Paul's hospital. And I remember having a conversation with her and asking about her perception and why she thought it was so noisy, and she told me at the hospital that she was training, it was expected that all noninvolved - so surgical team, surgical assists, and nurses, porters, etc., had to leave the room for induction. And that it was very, very much expected that noise would be reduced during the time of induction. So that got me started on looking at our culture, which is very good at St. Paul's hospital, but specifically around the noise experience, and started to really look into the research and noted that there was really a lack of information about noise in the operating room. And I think it's starting to emerge now. But I think part of the reason why there wasn't a lot of literature is that noise has changed. It's changed in the hospital. Since the 1960s, we've researchers have noted a general increase in noise. And that's partially due to monitors and equipment. And I think that as the number of personnel in the operating room increases, probably people have started to pay attention, because prior to this noise was steadily increasing. And now it's getting to a level in which it's starting to potentially impact health care workers who are working regularly in the operating room. So that ultimately led me to development of this project. And I decided to do my master's thesis on it.
Ameer Farooq 07:20
It's so fascinating, because it's something that we all deal with on a daily basis, but don't really think about and haven't really thought about what impact it has. So, I actually wanted to just dive specifically into one of the papers that you just got recently accepted. This was a paper where you had actually evaluated noise levels in the OR, and specifically saw the changes in the levels of noise pre- and post-intervention from a quality improvement-type project. Could you walk us through this paper? And tell us sort of what you looked at and what you found?
Su-Yin MacDonell 07:56
Yeah, thanks. So, just because I have multiple kind of projects going on, I just want to clarify, this particular project I'm talking about is looking at noise on induction. And in fact, hopefully, I'll be publishing the noise on extubation. It's not for the duration of the surgery. And so for this, Noise on Induction: a Study, essentially, there are three main parts, preintervention, intervention and postintervention. And for the first and last part, so those are the interventions, it was subdivided into two separate parts. So it's a little bit confusing, but the preintervention is same as the postintervention. So I'll just talk about the preintervention just to make sure that that's fairly clear for those listening. The preintervention was divided into the anesthesia experience and the patient experience. So from the anesthesia experience standpoint, what was done was, patients were evaluated whether or not they could be included or excluded. So exclusion would include significant hearing impairment, cognitive impairment, and also any regional techniques, so solely a spinal or a block. But if you had a general anaesthetic and undergoing noncardiac surgery, you could be included. And the anesthesiologist would proceed as she or he would normally do, and evaluated and measured noise from essentially the patient entering the room to airway being placed. So that's either an LMA or an endotracheal tube. And this was measured via decibel meter. We tried multiple different decibel meters, but we ended up with an app that was validated on an iPhone. And after the induction, when it was safe and appropriate to do so, the anesthesiologist filled out a survey and the survey essentially looked at whether or not she or he thought that the patient had a significant anxiety disorder, whether or not medazepam was used, and then looked at the experience of noise from their standpoint. So specifically looking at - Was there care-related noise? Was there non-care or patient-related noise? So that's, for example, conversations about another patient, for example. And then the overall impression. So, was the anesthesiologist bothered by the noise? Was the noise distracting? And was the noise potentially reducible from their point? And so that was completed and then on a separate kind of path was a patient survey? So the patient survey looked at basically their satisfaction from an induction standpoint, so looked at things like fear, did noise bother them? Did they have an overall positive experience. And this was administered either on postop day 0 [zero], or postop day 1. We did have to evaluate whether or not patients were able to actually answer that questionnaire, which is sometimes tricky in the postoperative period. And then basically that was repeated in the postintervention phase. So we had about 100 patients and 100 anesthesiologist in the preintervention phase and the same for the postintervention phase. And the intervention itself was essentially education around the impact of noise in the operating room and ways to reduce it. So that was done via education to the surgeons, anesthesiologists, the nurses and other operating room staff, you know, that work with us - so porters, for example, cleaners, etc. And, there were discussions specifically about how you could reduce noise. So from an anesthesia standpoint, I can check my machine when the patient isn't in the room, turn off my suction, if it's not required for a rapid sequence induction, and decrease the alarm volume, making sure that I can still hear it, and then it's still able to overcome the ambient noise. And from a surgical standpoint, it was discussed, ways to reduce noise. And the main way to reduce noise for induction was actually to wait outside, because if you're standing in an operating room, and it looks like nothing's happening, but there are things happening, you know, it's hard not to engage in conversations and try and be efficient with your management of the day. And so waiting outside has a big impact on noise on induction, making sure that one answers phone calls or pages outside of the room. And then from a nursing standpoint, we implemented the change that the OR table and the equipment would be set up prior to the patient coming into the operating room. And we noticed that with all this kind of education, there was a decrease in noise in the postintervention phase. I hope that explains it. I know, it's a bit confusing.
Ameer Farooq 13:23
No, I think that's a very good explanation of your paper. And it makes it very clear. Just to give us a sense of like, what these numbers mean, because I think that the hard part for the reader maybe is understanding what these noise levels really are. So can you kind of break it down in terms of things that we would understand like, in the preintervention phase and postintervention phase - for your average noise levels. What does that really represent? Like the average numbers that you have here on your graphs? What does that actually translate out to being in terms of like, noise levels?
Su-Yin MacDonell 13:59
Yeah, I mean, noise is a result of air pressure fluctuations, a source creates and is expressed in a logarithmic scale, called a decibel. And this scale was created to best capture the human ear frequency due to the large range that we can hear. So we can hear from zero to 130 decibels. And we tend to hear higher-frequency noise better than lower-frequency noise. So sometimes what you'll see is - when you see the decibel - you'll see "a" after it, and that was basically created to deemphasize the low-frequency sound. So basically to capture our hearing that is seen by the ear essentially. And, what is important to recognize is by decreasing three decibels, you're halving the sound intensity. So, [inaudible] people are looking at these numbers and saying, Well, what exactly does that mean? So, for example, when we look at noise levels and the mean noise levels, preintervention, the mean noise level was about 66. And postintervention that was 63.5. So to put it in kind of a real-life situation, the difference in noise was essentially if you were standing by a highway, and so that would be a mean of 66. So hearing those cars whip by you, versus standing by an arterial road. So I would imagine that to be similar to Burrard Street. So that is the difference in noise experience. You know, another way to think of it is essentially, if you were comparing standing about two metres away from two people having a normal conversation, so that would be quieter than, for example, standing by a car that's going at 60 kilometres per hour past you. So, the noise difference, although it's only three decibels and sounds pretty small, it's pretty significant when you apply it to regular life.
Ameer Farooq 16:14
Yeah, that's a huge difference when you put it into those terms. It's a huge difference in noise levels. I think one of the interesting things I found from your paper was the patients didn't seem - from their satisfaction levels - didn't seem like they were particularly changed in terms of their satisfaction levels by the intervention pre and post. And you mentioned in the paper that there isn't really a noise-related patient satisfaction score that's been validated. Can you comment a little bit about that? Like, do you think that it was just hard to capture the patient satisfaction changes by noise levels? Or do you think that patients just had so many other things going on that the noise levels didn't really, really factor in?
Su-Yin MacDonell 16:56
Yeah, no, it's interesting, because that finding is not in keeping with a previous study in 2000, that looked at patient experience, and noted a significant negative impact of noise on their experience. So I think you've highlighted what we discussed this questionnaire that we developed was based on previous questionnaires on patient experience, but it's not a validated questionnaire for patient experiences, specifically around noise. And I do think that patients in general, were quite happy with their experience. I mean, I think we simply didn't have enough patients, to be honest with you, to actually understand their patient experience. But in looking at the actual patients based on subspecialty, we had a significant or majority representation of general surgery patients. And I would have to say from an anesthesiologist standpoint, in general, the general surgery patients do tend to have a lot more of the preoperative education and discussions. Mostly because a lot of them enter the ERAS protocol, and that at our hospital, as you know, there is involvement of not only the surgeons, but the anesthesiologists, the preadmission nurse, the ERAS nurse, the stoma nurse, potentially. And you can see by having all those personnel involved, there's the opportunity to have discussions and expectation management of what this experience of going to the operating room and postoperative will look like. And I think that is probably the most important thing when we talk about patient experience. It's not the actual noise experience; it's the expectation and understanding that when you come to the operating room, there's going to be multiple people, lots of noises, lots of alarms, etc. And with that knowledge, I think patients generally are satisfied. That being said, clearly it indicates that we're doing something right - that patients aren't bothered by noise. And so I think our job really is to find out, well, first of all, repeat this, hopefully, in a manner that may be able to actually detect true differences or understanding or experience. And if noise, in fact, isn't that significant of an issue from a patient perspective, looking at what negatively impacts that induction period from a patient perspective, and that's work that should be done, hopefully, in the future.
Ameer Farooq 19:39
It's super interesting. Like you almost think that maybe when patients come to the OR, they should almost get a preview or a taste of like, the entire sensory package that they're going to experience? And that's part of like our preoperative assessment and evaluation that we should be really kind of preparing people for the OR. I'm curious if there's anything in particular that stood out to you, as main contributors to noise levels. And you did mention the surgical team talking. Was that the main thing that was driving noise levels? Or was there anything else that stood out to you as being a really noisy thing in the OR?
Su-Yin MacDonell 20:16
You know, when we look at ambient noise and we spoke earlier about the general increase in noise over the past 60 years, 70 years, there are some sources of noise that simply are not modifiable. So, our cardiac monitors, for example, are at 50 to 55 decibels. The vacuum aspiration systems measure about 50 to 60 decibels, ventilation fans 60 to 65 decibels and surgical drills are about 75 decibels, and that's higher in the neurosurgical and ENT group. So, I think the reality is that what we notice during the postintervention anesthesiologist survey is that the experience of noise and that absolute noise reduction occurred. And when we looked at the surveys, a major change was essentially that nonpatient care, conversations or discussions. So, that brings in that concept of the sterile cockpit, which is borrowed from the aviation industry, which anesthesia tends to do a lot of, but it really discusses the concept that it's not completely silent, but there's only absolutely necessary conversations around for, well, what I can imagine, takeoff and landing. You know, it should really be restricted to essential activity. So, I do think that part of our intervention was asking the surgical team to leave, it was asking the nurses to set up prior to the patient coming into the room, and I don't think it's one thing in particular, I think it's all of those things. And I'm not saying that the surgeons are the only people contributing to those nonpatient-care-related conversations - that happens with anesthesiologists - that happens while we're teaching medical students and residents, etc. It happens among the nurses. I think we all contribute to noise levels.
Ameer Farooq 22:28
You know, I'm curious now that you've done all this research, what do you think we should be doing going forward? Particularly, I'm thinking about noise monitors, do you think like, I've heard that in some places, particularly pediatric hospitals, they actually have noise monitors in the OR? Do you think that's something we should be doing?
Su-Yin MacDonell 22:44
If the noise monitor actually helps to decrease the noise on induction and extubation - then absolutely, we should consider it. My caution is that it's another monitor. And what I think is that we could probably do some interventions that were discussed in that intervention phase that are pretty easy to implement to help reduce the noise on induction. Now, the noise during the surgery, and add extubation is a different story. But, certainly for inductions, simply asking those who aren't involved with actual induction to leave the room is a reasonable option. I think that probably would be your biggest reduction in noise. It's just getting the personnel that are not required to leave the room. I'm not sure that we need a monitor. And like I said, I think that if we can start to think about the experience of noise and look at it from a culture standpoint, it's probably best that we just start to implement some of the changes that were suggested in the paper, which include you know, checking your alarms, etc., and setting up equipment before the patient comes into the room. Now, that being said, it's unpublished, so I can't comment on it too much. But we did gather information about noise on extubation. And, what we know is that extubation is often ignored as being a critical period during the perioperative period. But when in fact, it's a very high-risk period, and from our standpoint, has more risk of patient complication than induction. But, the challenge will be during extubation often require multiple people to be around and be completing tasks and communicating with each other. And so maybe in that setting, a noise monitor might be useful as a gentle reminder. But again, I'm not sure that the monitor itself is not going to be another source of distraction for people. But, as a self-proclaimed noise expert, whatever reduces the noise works for me. So if in fact it does reduce the noise, I'm in all support of it. And I do think that noise during the actual surgical period is starting or has been studied. And so maybe we need to look at noise during the entire surgical experience and not break it up to induction or extubation; we should probably take a look at it throughout the anesthesia maintenance phase, which is where the surgical team does all our work.
Chad Ball 25:40
And those are really interesting comments; think about noise monitors in the context maybe of countdown clocks that we use in the trauma bay, for example, when a [inaudible] injured patient comes in and you start that clock at 10 minutes, and you say, we want to be in the scanner before it hits zero, that can really motivate the group and provide them with a goal. So, perhaps noise monitors may have a future, maybe not, it's hard to know. Having been around for quite a number of years now, anecdotally, my observation has been as time goes on, the noise in the operating theatres has gotten more intense and more of a problem. And again, purely anecdotally, it seems to be that as generations go on, trainees in particular, whether that's medical students on the service or rotating through junior residents, for example, seem to lose track a little bit of the operating environment and what's going on in terms environmental awareness. And it's something I think that, I personally battle sort of all the time, at least in Calgary and other places where I've worked. It's interesting, though, during the COVID era here, where everyone is exiting the operating theatre for intubation in particular and for extubation, as well, that really seems to have improved dramatically. I'm curious if you've noticed that in Vancouver, and what your thoughts are as well.
Su-Yin MacDonell 27:10
Absolutely, yeah. So, there were comments from my colleagues and myself about that, very obvious noise reduction on induction and extubation, for basically safety of the entire operating room team. And I think that really does highlight that the intervention of leaving the room has a profound effect on noise. And, I can say it, our hospital, there's the vascular surgical group preintervention and postintervention had a slight reduction in noise, but in general, they were a very quiet group for those two periods, of induction and extubation. And I think in talking with the group, the practice for them, even before I did this study, was to always leave the room. So they always leave the room for invasive line placement and induction and that is kind of the practice that they engage in, but also pass on to the trainees. So, we don't have to ask them to please leave the room if they're being overly noisy, because we have our group discussion and then they automatically leave the room. So I do think that the number of people in the room does correlate with noise. And this was seen in our extubation data that the noise increased significantly with the number of personnel in the room, and specifically the number of trainees. Now, that's not to say that trainees are the source of noise, specifically, but I do think that it's, again, the number of people in the room that greatly impacts the amount of noise that's experienced.
Chad Ball 29:10
You know, for those of us that work in multiple environments, like yourself, like myself and look after particularly critically ill patients, across different places, in the emergency department, maybe the trauma bay, different intensive care units and the operating theatre, the ambient noise during intubation, during extubation, during a lot of these critical times couldn't be more different. And I'm curious if you can comment on the cultural sort of realities of those different spaces and how we can improve them in places like the operating room, for example.
Su-Yin MacDonell 29:41
Yeah, so I mean, hopefully, this paper, once it's published, will generate some discussion for all those in the operating room. And certainly there is literature looking at the patient experience in the postoperative period and the ICU. And so hopefully this will allow for everybody who works in the hospital, all health care workers to start discussing noise and its impact not only on potentially patients depending on where you are, but also on us as health care workers. And, I think the biggest take-home point from this was the importance of clear communication. So I think that would be probably the thing that I would want to emphasize anywhere in the hospital in the setting of induction / extubation, or any critical event during the surgical period. And that simply looks like, "can I ask for quiet on induction, please, it's important for me to concentrate" or "I'm a little bit worried about the airway, and I'd like for those not involved with induction to leave the room and I'll call you if I need you." So just having those verbal cues, a reminder of the critical period that is going to be encountered and the importance of noise reduction. And I would say that, certainly at St. Paul's Hospital, there has been a general trend since this study to have those not involved with induction to leave. And it also empowered the anesthesiologist or the nursing staff or the surgical staff, to remind those who are in operating room who may not be familiar with that kind of shift in culture, about leaving the room or paying conscious attention to noise reduction. And so I think that all comes down to conversations, communication and information and just gentle reminders, the importance of potentially decreasing nonpatient-care-related conversations. It probably is the best way not only to provide a more quiet environment, but also to slowly work at that culture, slowly work at that noisy, noisy culture that we experience in the operating room. And then hopefully, what will happen is that new personnel coming into the operating room will just start to know that it is the practice - that it is quiet during induction / extubation or during a critical time during the surgery, which would be identified by the surgical team. And that I think, is probably the best way to sustain that noise reduction, rather than having a short reduction in noise that is very transient. Because what we want is, we do want noise to be reduced consistently, not only to reduce amount of distractions, but also because there are health implications for this noise, there is noise-induced hearing loss that is well documented and tends to develop early on in our career. So the anesthesiologist's career and that just happens to be studied. So, I think there's wide implications, and I think that change can be sustained.
Chad Ball 33:09
I think you've said that in such a lovely way. And, changing culture is not easy, but in this case, it's certainly worth the endeavor and the effort, I think, for sure. I want to switch gears. You know, Ameer and I really wanted to ask you in particular about your perceptions and how you frame music in the operating theatre and not really in intubation / extubation periods, but just during the surgical workflow. I think we're probably a little bit biased. There was a paper almost exactly 10 years ago that came up the Journal of the American College of Surgeons (JACS) that looked at this and a group of us in Calgary wrote back as a letter to the editor sort of disagreeing with it substantially quoting you know, a fairly reasonable body of literature that talks about surgeon comfort, surgeon performance, psychomotor links for people, and in surgeons in particular, that did like music in an operating room. Certainly, I think we have to understand that some people and some surgeons, for example, I'm sure many anesthesiologists don't like music and it doesn't hurt their performance per se and there's always that back and forth. But I'm curious what you think about music, in particular, in an operating theatre environment.
Su-Yin MacDonell 34:48
Yeah, so I mean, music is interesting in that you identified that each person probably has a different threshold for its impact on their skill. And, I think that music doesn't necessarily have to be a bad thing. I do think that it's A) important that everybody agrees on the type of music because I can tell you right now, if you're going to be playing hard rock during a case, induction maintenance extubation doesn't matter, that is going to be extremely distracting. So everybody in the room needs to agree on the type of music, I think that music should be able to be turned down or turned off readily. So, if there's a critical time, whether it be from an anesthesiologist standpoint, nursing standpoint, or a surgical standpoint, that the noise can be turned off, just to allow for no distractions to occur during that particular time. And, the last important aspect of music is that it should probably make sure that it's not too loud. So for example, when noise goes above 80 decibels, you need to speak loudly to be heard. So you can imagine that if it's too noisy, it's going to be difficult for you to raise your voice above that music to say, "can you turn down the music, or I'm having troubles or something's gone wrong." But there are some key things that one has to consider when playing music in the operating room. So the first is that it's agreed upon by all those listening to it. So, making sure that the type of music and the volume is shared amongst those listening to it. So making sure that it's not going to be overly distracting for any one member, because, for example, it's not enjoyed or it's triggering or anything along those lines. And the second thing is that the level should be adjusted to allow for conversations still to occur, and the ability to shut off the music, if required. So, you need to speak loudly to overcome noise over 80 decibels. And you need to shout if it goes over 85. So making sure that the noise itself isn't actually impeding your ability to converse. And, I agree that music sometimes is actually relaxing and conducive to work for those performing surgery or even for induction, for example. But what needs to be recognized is that noise does have the potential - so specifically music, if it's a source of noise - has the potential to impact communication, cognition, reaction time, and then this can subsequently, potentially negatively impact patient safety. So with all those things in mind, I think, again, it comes down to communication. So we're going to find that some people are totally agreeable and actually find it conducive to working. And for some people, it's actually going to impair their ability to function and work effectively. And I think a conversation might look like this in the operating room: "Do you mind if I play some music?" And the response should be: "Sure if you don't mind keeping it down and why don't we discuss what kind of music?" And maybe everybody agrees on country music, and that's fine, but it should be discussed amongst everybody in the operating room.
Chad Ball 38:26
I think that's well said and well described. I think probably that's typically how it goes at least in most of the ORs I've been in as well. You know, it's interesting, in Calgary, we have the National Music Centre, which is one of the federally funded, really big, beautiful, relatively new museums and experience centres. And in that place, in one of the large rooms, there's a display in it, it's quite interactive about noise and in particular music as related to noise in working environments. And there's a large visual picture of one of the pediatric surgeons at Sick Children's, and she's talking about how important music is to her operating life and how she couldn't imagine to go without it. And it's often interesting to sort of sit back and watch people read that and listen to what they chat about, because I think the average person wouldn't necessarily think that music gets played in an operating room. The last question I wanted to ask was that when I worked in the US, there was an anesthesiologist that had done a bunch of research. I don't really know how much he published, their group published or didn't at the end of the day, but he was a really big fan of asking of patient what type of music they liked, for their induction and their preparation to induction. He showed a lot of data that was even at a biochemical level, in addition to patient survey level that patients really enjoyed that process of selecting music, they felt empowered and interactive and cared about. And it also seemed to lower their overall stress. And I don't know if that's because of the psychological component of it or truly, because of the music part of it. But do you have any thought or sense of that at all?
Su-Yin MacDonell 40:14
Yeah, I think there has been some studies that looked at music from a patient experience. And, I think with a perioperative lens on, those involved with patients during the perioperative period, do not tend to ask exactly what the patient wants. And I think that the discussion that you had with your colleague is a perfect example that we should be asking what patients would like to help reduce any anxiety or stress or pain for induction, or even during the perioperative period. And I absolutely think there is a way actually to ensure that that experience or the patient experience is satisfied, while also decreasing the noise exposure for the health care professionals in the room. So something that we could consider doing is actually using headphones. So then really, we're getting the best of both worlds - the patient gets to have their experience of music, which potentially could distract them, or calm them, and maybe allow them to take off that kind of cognitive stress of undergoing, you know, entering a foreign environment and undergoing, arguably probably one of the most stressful experiences of their life. But also making sure that we as health care professionals in operating room are still able to converse with one another and ensure patient safety. So I think it's an excellent point. And I think that probably we should be asking patients more and more what they would like, and balance this with, you know, our patient safety and general kind of workflow requirements, and move forward with that. So I think it's a good point. I think music, like I said before, music doesn't have to be a negative thing. It just has to be the right type of music, not too loud, and able to have some variation with it. So turn it down or turn it off as need be.
Ameer Farooq 42:21
Dr. MacDonell, you've given us so much food for thought today. It's been such an interesting and fascinating conversation. Thank you again for joining us. If there was one message that you had to give to our listeners about promoting better communication and conversation across the drapes, what would that message be, after all the work that you've done both in periop[erative], and obviously, with your research on noise levels.
Su-Yin MacDonell 42:44
I think part of it is that all of us do this, we make assumptions, or maybe don't know why we're doing certain things. And sometimes there's conflict in that. So, for example, as an anesthesiologist, I may elect to insert invasive line for arterial monitoring, and that may affect the efficiency of the room. But, I think what it comes down to is getting curious about why a colleague is choosing a path or doing something a certain way, which then allows for all of us to remind ourselves of the common goal of ensuring the patient undergoing a safe and successful surgical experience and specifically being able to return home to their baseline kind of state. And, I think by taking on that curiosity stance, it allows for us to communicate better professionally, but also maybe allows us to have those relationship-building conversations where we get to remind ourselves of all of us being human and having interesting and fascinating aspects of our life outside of the operating room. So I think that's probably the most important thing that sometimes you forget, in the midst of all the stress of the operating room or even the stress of work, that there's often things that everybody doesn't understand why, you know, you're doing a certain thing and it's rarely intended to be negative for another person.
Ameer Farooq 48:18
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