title: Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study.
abstract: BACKGROUND
  Operating rooms are identified as being one of the noisiest of clinical environments, and intraoperative noise is associated with adverse effects on staff and patient safety. Simulation-based experiments would offer controllable and safe venues for investigating this noise problem. However, realistic simulation of the clinical auditory environment is rare in current simulators. Therefore, we retrofitted our operating room simulator to be able to produce immersive auditory simulations with the use of typical sound sources encountered during surgeries. Then, we tested the hypothesis that anesthesia residents would perceive greater task load and fatigue while being given simulated lunch breaks in noisy environments rather than in quiet ones. As a secondary objective, we proposed and tested the plausibility of a novel psychometric instrument for the assessment of stress.
  
  
  METHODS
  In this simulation-based, randomized, repeated-measures, crossover study, 2 validated psychometric survey instruments, the NASA Task Load Index (NASA-TLX), composed of 6 items, and the Swedish Occupational Fatigue Inventory (SOFI), composed of 5 items, were used to assess perceived task load and fatigue, respectively, in first-year anesthesia residents. Residents completed the psychometric instruments after being given lunch breaks in quiet and noisy intraoperative environments (soundscapes). The effects of soundscape grouping on the psychometric instruments and their comprising items were analyzed with a split-plot analysis. A model for a new psychometric instrument for measuring stress that combines the NASA-TLX and SOFI instruments was proposed, and a factor analysis was performed on the collected data to determine the model's plausibility.
  
  
  RESULTS
  Twenty residents participated in this study. Multivariate analysis of variance showed an effect of soundscape grouping on the combined NASA-TLX and SOFI instrument items (P = 0.003) and the comparisons of univariate item reached significance for the NASA Temporal Demand item (P = 0.0004) and the SOFI Lack of Energy item (P = 0.001). Factor analysis extracted 4 factors, which were assigned the following construct names for model development: Psychological Task Load, Psychological Fatigue, Acute Physical Load, and Performance-Chronic Physical Load. Six of the 7 fit tests used in the partial confirmatory factor analysis were positive when we fitted the data to the proposed model, suggesting that further validation is warranted.
  
  
  CONCLUSIONS
  This study provides evidence that noise during surgery can increase feelings of stress, as measured by perceived task load and fatigue levels, in anesthesiologists and adds to the growing literature pointing to an overall adverse impact of clinical noise on caregivers and patient safety. The psychometric model proposed in this study for assessing perceived stress is plausible based on factor analysis and will be useful for characterizing the impact of the clinical environment on subject stress levels in future investigations.
authors.affiliation: From the *Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, Florida; and †Music Engineering Technology, Frost School of Music, University of Miami, Miami, Florida.
authors.forename: Richard R
authors.initials: RR
authors.lastname: McNeer
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Roman
authors.initials: R
authors.lastname: Dudaryk
mesh_terms: D000328:Adult; D000758:Anesthesia; D000776:Anesthesiology / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D004777:Environment; D005163:Factor Analysis, Statistical; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007432:Intraoperative Period; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D009622:Noise / Q000009:adverse effects*; D016273:Occupational Exposure / Q000706:statistics & numerical data; D009873:Operating Rooms / Q000458:organization & administration; D011594:Psychometrics; D018570:Risk Assessment; D013315:Stress, Psychological / Q000523:psychology; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult