Modulating operating room music volume with the CanaryBox: A quality improvement initiative to improve anesthesia clinicians’ response times to alarms to improve quality of anesthetic care

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Music is commonly played in the operating rooms and contributes to overall noise level. High noise levels in the operating room, often surpassing the National Institute for Occupational Safety and Health recommendations, affect clinician communication and vigilance. This study's primary aim was to reduce anesthesia provider response time to alarms to improve quality of care to patients undergoing general anesthesia. The aim of this quality improvement project was to reduce anesthesia provider response time to vital sign alarms with the tested intervention of the CanaryBox device to modulate music volume in the OR by August of 2021. Utilizing improvement science methods including the Model of Improvement and tested interventions via the Plan-Do-Study-Act cycles, we utilized the CanaryBox in the pediatric orthopedic operating rooms at Monroe Carell Jr. Children's Hospital at Vanderbilt. This device modulates music volume according to the severity of patient vital sign deviations. Timestamps of onset and response to patient vital sign alarms, recorded by the Philips IntelliVue Information Center system, were collected for 12 control (pre-intervention) and 58 intervention (with the CanaryBox) cases. Median and average response times were calculated for pre- and post-intervention cases. There was an associated decrease (improvement) in average anesthesia provider alarm response times from 30.2 seconds in pre-intervention cases to 23.6 seconds with CanaryBox intervention cases. Improved anesthesia provider response times with implementation of the CanaryBox imply less distraction due to unnecessary noise levels at critical periods. This improved vigilance and decreased response time indicate anesthesia providers deliver higher levels of patient care when the CanaryBox is modulating music volume.