title: The Effect of Noise Distraction on Emergency Medicine Resident Performance During Intubation of a Patient Simulator.
abstract: BACKGROUND
  The environment in the Emergency Department (ED) is chaotic, and physicians are expected to perform procedures amongst distractions.
  
  
  OBJECTIVE
  Our aim was to prospectively determine the effects of various levels of noise distraction on the success and time to successful intubation of a simulator.
  
  
  METHODS
  Forty-five Emergency Medicine, Emergency Medicine/Internal Medicine, and Emergency Medicine/Family Medicine Residents were studied in background noise environments of <50 decibels (noise level 1), 60-70 decibels (noise level 2), and of >70 decibels (noise level 3). Residents attempted three intubations on a simulator in succession, with three randomized noise levels. Time, in seconds, to intubation was measured in each of the successful intubations. Generalized linear models were employed to examine associations between noise level and time to intubation by attempt.
  
  
  RESULTS
  Time to intubation decreased with each attempt (median = 25.9, 17.9, 14.4 for attempt numbers 1, 2, and 3, respectively). Decibel noise level was not associated with time to intubation (p > 0.6) or success rate (p > 0.1). Attempt number did not modify the association between noise and time to intubation (p-for-interaction = 0.16).
  
  
  CONCLUSIONS
  Noise level did not have an effect on time to intubation or intubation success rate, suggesting that noise levels in the ED do not affect provider ability to perform procedures. However, knowing that increased noise levels increase stress and impair the ability to communicate with team members, further study needs to be done to definitively conclude that noise does not affect provider performance in the ED setting.
authors.affiliation: Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.
authors.forename: Leila P
authors.initials: LP
authors.lastname: Getto
authors.affiliation: Christiana Care Health System, Newark, Delaware.
authors.forename: Debra
authors.initials: D
authors.lastname: Marco
authors.affiliation: Christiana Care Health System, Newark, Delaware.
authors.forename: Mia A
authors.initials: MA
authors.lastname: Papas
authors.affiliation: Christiana Care Health System, Newark, Delaware.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Fort
authors.affiliation: Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.
authors.forename: Jenna
authors.initials: J
authors.lastname: Fredette
mesh_terms: D002983:Clinical Competence; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards*; D007828:Laryngoscopy / Q000592:standards; D009622:Noise / Q000009:adverse effects*; D016273:Occupational Exposure / Q000009:adverse effects*; D011446:Prospective Studies; D011897:Random Allocation; D013997:Time Factors
keywords: airway; noise distraction; procedural performance; resident education; simulation