AJOG at a Glance
- AWhy was this study conducted?
- •Noise in healthcare settings leads to impaired communication and medical errors
- •Little is known about the noise environments of cesarean delivery rooms
- •
- BWhat are the key findings?
- •Noise at the time of a cesarean delivery exceeds levels recommended by the W.H.O. and the noise level attained may impact communication and health care providers’ concentration
- •Rapid increases in noise during cesareans, detected by retrospective analysis, may cause startle responses in surgical team members and patients, and could lead to anxiety and uneasiness
- •Isolated use of visual alarms in the operating room theaters are unlikely to be useful as a noise mitigation strategy
- •
- CWhat does this study add to what is already known?
- •A novel technique for the comprehensive analysis of noise in the operating room environment is described
- •Cesarean delivery room noise levels are excessive and may contribute to impaired communication by the operating team
- •
Abstract
Background
Cesarean deliveries are the most common major surgery worldwide. Noise in healthcare
settings leads to impaired communication, concentration, and stress among health care
providers. Limited information is available about noise at cesarean delivery.
Objectives
Our aim was to achieve a comprehensive analysis of noise that occurs during cesarean
deliveries. Sound level meters are used to determine baseline noise levels and to
describe the frequency of acute noise that is generated during a cesarean that will
cause a human startle response. Secondarily, we will evaluate the effectiveness of
a visual alarm system to mitigate excessive noise.
Study Design
We completed a pre-intervention/post-intervention observational study of noise levels
during cesarean deliveries before and after introduction of a visual alarm system
for noise mitigation between 2/15/2021 to 8/26/2021. There were 156 cases included
from each study period. Sound pressure levels were analyzed by overall case median
decibel levels and by time epoch for relevant phases of the operation. Rapid increase
noise events capable of causing a human startle response, “Startle events” were detected
a by retrospective analysis, with quantification for baselines and analysis of frequency
by case type. Median noise levels with inter-quartile ranges [I.Q.R.] are presented.
Data are compared between epochs and case characteristics with non-parametric two-tailed
testing.
Results
The median acoustic pressure for all cesarean deliveries was 61.8 [58.8, 65.9] dBA
(median [I.Q.R.]). The median dBA for the full case time period was significantly
higher during cases with NICU team presence, 62.1 [60.5, 63.9]; neonatal admission
to the NICU, 62.0 [60.4, 63.9]; 5-minute APGAR score less than 7, 62.2 [61.1, 64.3];
multiple gestations, 62.6 [62.0, 64.2]; and intraoperative tubal sterilization, 62.8
[61.5, 65.1]. The use of visual alarms was associated with a statistically significant
reduction of median noise level by 0.7 dBA, from 61.8 [60.6, 63.5] dBA to 61.1 [59.8,
63.7] dBA, (p<0.001).
Conclusions
The noise intensities recorded during cesarean deliveries were commonly at levels
that affect communication and concentration, and above the safe levels recommended
by the W.H.O. Although noise was reduced by 0.7 dBA, the reduction was not clinically
significant to reduce noise a discernible amount (a 3dB change) nor in reducing “startle
events”. Isolated use of visual alarms during cesarean deliveries is unlikely to be
a satisfactory noise mitigation strategy.
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Article info
Publication history
Accepted:
January 31,
2023
Received in revised form:
January 26,
2023
Received:
January 20,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
