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Ssshhh! Hospital Noise Levels Are Being Monitored


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Nurses can help lower hospital noise levels, improving patient healing and raising HCAHPS scores

By Jennifer Larson, contributor

Would you recognize if the hospital noise level was too high? Or would you know what to do to keep it down?

The World Health Organization (WHO) recommends that the average noise level in a hospital room not exceed 30 decibels. But as the authors of a 2012 research letter in the Archives of Internal Medicine noted, “objectively measured hospital noise can range as high as 67 dB in the intensive care unit to 42 dB in surgical wards.” When that happens, patients have trouble getting the rest they need, and they tend to mark hospitals down on HCAHPS scores.

Most units are a lot louder than you might realize. Machines, alarms, footsteps on tile floors, pages echoing overhead, cell phones…they’re all part of the cacophony of noises in a typical hospital. Human voices are responsible for creating a lot of the hospital noise, too.

For several years now, reimbursement rates have been linked to patient satisfaction ratings via the HCAHPS, or Hospital Consumer Assessment of Healthcare Providers and Systems, scores. The survey specifically asks patients to assess how quiet the environment around their room was kept at night during their hospital stay. Many hospitals have found that patients aren’t pleased with the noise levels--and are increasingly likely to say that the noise bothers them.

Along with research that shows that noise can impede a patient’s healing process and elevate stress levels among staff, the HCAHPS provides a major impetus for hospitals to find effective ways to turn the volume down.

They could start by monitoring the actual hospital noise that occurs.

“A full assessment of your auditory environment and the organizational culture on which it is grounded is an important place to start your course to a quiet hospital and reinforce the importance of awareness in addressing this issue,” wrote Jason Wolf, PhD, and Gary Madaras, PhD, in “Charting a Course to Quiet: Addressing the Challenge of Noise in Hospitals” for the Beryl Institute in 2012.

Measuring the noise in real time is a great way to get a handle on the noise that is actually occurring, not just what people may perceive it to be, according to John Bialk, CEO of Quietyme, a Wisconsin-based company that developed a series of sensors to track noise with a service that monitors and analyzes the results.

His company’s system records decibel levels and distinguishes between various types of noises. Then it provides the data to the hospital and makes recommendations on ways the hospital could reduce some of the noise.

“It’s really up to them to make the change,” said Bialk.

Another company that conducts hospital noise audits and analyses is Chicago-based Making Hospitals Quiet, which provides acoustic recommendations and helps hospitals develop sound improvement plans. Hospitals that complete the process become “Quiet-Certified.”

What’s happening in your hospital?

Many hospitals have embarked on campaigns to reduce noise and then analyze their patient satisfaction scores to gauge the effectiveness of their efforts.

Some are even going as far as to make architectural changes. Others are eliminating overhead pages at night, implementing “quiet hours,” providing earplugs to patients, putting in white noise machines, talking to patients upon admission, and educating staff about the need to keep their voices down. Some also post signs reminding everyone to be quieter--Bialk noted that his product has a feature that reminds hospital to rotate signs so they don’t become invisible and get ignored after a couple of weeks.

Marion Daku, RN, BSN, CCRN, an ICU staff nurse at Lehigh Valley Hospital-Muhlenberg in Pennsylvania and a participant in the American Association of Critical-Care Nurses’ AACN Clinical Scene Investigator (CSI) Academy program said, “We are constantly educating and reeducating our staff on the importance of rest and sleep for our patients. We try to change the signage frequently so that staff don’t become too accustomed to the signs and ignore them.”

It is challenging to have people consistently remember to keep their voices down, but it’s worth the effort.

“While mandating staff behavior has long been known to be the least effective method of managing noise, behavioral standards should nevertheless be modeled and extended organizationally,” wrote Susan Mazer, PhD, in the white paper “Hospital Noise and the Patient Experience” for Healing HealthCare Systems, Inc.

“Expectations have to be hard-wired into daily practice,” said Daku, whose team project was called HUSH: Helping Understand Sleep Heals.

Soumaly Rattanasavanh, RN, BSN, CCRN, who participated in AACN’s CSI Academy, working on “The Noise Pollution Solution” project at Seton Medical Center-Williamson, in Round Rock, Texas, recommends that nurses be more cognizant of their patients’ need for sleep during their hospitalization.

“Assess how your patients sleep at night,” she suggested. “When they’re conscious, ask them what they do at home to get some sleep--their answers may surprise you.”

What is your employer is doing to reduce hospital noise levels? If you’re not sure, ask. While not every hospital may be able or willing to invest in new infrastructure, they can still take steps to reduce some kinds of noise--namely, the human factor. You may be able to share some strategies from previous travel nurse assignments, too.

Bialk suggested a couple of simple strategies for reducing the volume of conversations. When you enter a patient’s room, close the door behind you. And the next time you start to call out to a fellow nurse or other staffer, consider how much space is between the two of you.

“If you can’t touch them, go stand next to them,” he said.

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