Creating Clarity Amid the Operating Room Clamor: A Mixed Methods Analysis of Noise-Related Barriers and Facilitators to Effective Communication.

The operating room is one of the noisiest healthcare environments, creating critical challenges for patient safety, team efficiency, and surgical outcomes. Operating room nurses, essential for patient care and team coordination, face unique risks from noise exposure and impaired communication, yet their challenges remain underexplored. To assess hearing challenges and communication barriers in operating room teams from nurses' perspectives, with implications for patient safety and interventions. Cross-sectional survey. An electronic survey was distributed to operating room personnel, examining hearing difficulties, communication barriers, and current solutions using multiple-choice, Likert-scale, and open-ended formats. Quantitative and qualitative data were analyzed via descriptive statistics and summative thematic analysis. Among 225 participants, 51 were nurses (23%), with 25% reporting hearing loss, 63% no hearing loss, and 12% uncertain. All nurses with baseline hearing loss reported auditory challenges in the operating room, while half without hearing loss reported frequent struggles during surgery (p<.0021). Nurses with > 5 years' operating room exposure had over 5-fold risk of hearing loss (95% confidence interval: 1.3-21.2; p=0.028). Noise from suction devices, alarms, and music hindered communication. Self-accommodations included asking for repetition (62%) and modifying the environment (32%). Nearly all respondents (96%) emphasized improving communication, supporting ambient noise reduction, technology, or behavioral interventions like closed-loop communication. Operating room nurses, central to surgical safety and team efficiency, are disproportionately impacted by noise-related communication challenges. Their dual role positions them to lead the implementation of targeted noise mitigation and communication strategies, driving critical improvements in the surgical environment.