If you've stayed overnight in a hospital, you can probably recall how noise affected your experience. Whatever the sources – chirping alarms, nurses going about their tasks, neighboring patients’ conversations, or the sounds of distress – you likely ran a gauntlet of side effects, ranging from mild irritation to sleep deprivation.
And then there were the effects that you perhaps weren't so acutely aware of: elevated blood pressure, quickened heart rate, increased metabolism, to name a few. Add the consequences of poor sleep to that mix – agitation, delirium, weakened immune system, and impeded ability to generate new cells – and you haven't exactly got the elixir of health.
In fact, medical researchers have concluded that the physiological and psychological fallout of noise exposure can slow our recovery rates, lengthening hospital stays when all we really want to do is get back to our lives...not to mention our own beds.
So how can we address this problem?
As with most facilities, the majority of a hospital’s acoustical burden must be borne by the elements used in its design, such as absorptive ceiling tiles, a well-planned layout, and sound masking. But it’s also important to talk about how we can reduce or even eliminate noises. After all, an ounce of prevention is worth a pound of cure.
So, here’s my top ten. These strategies aren't in any particular order, but the first one is the best starting point. And given that patients really shouldn't have to think about anything other than getting better, most are intended for hospital staff.
1. Form a special committee to study and address noise. Members should then educate staff (not only doctors and nurses, but those involved in ancillary departments, like transport), patients and visitors in order to raise awareness of noise and its effects on healing. The committee should also develop and enforce policies related to noise reduction. The program should be evaluated on an ongoing basis (e.g. through patient satisfaction surveys) so that measures can be tweaked and added, as needed.
2. Post signs reminding staff, patients and visitors to consider their voice level. They should use hushed rather than normal speaking tones whenever possible and talk only in close proximity to the listener, not from a distance. This strategy can also help to improve speech privacy, which is key in healthcare settings. Some hospitals have topped anti-noise posters with clever acronyms like ‘SHHH’ (Silent Hospitals Help Healing) and ‘HUSH’ (Help Us Support Healing).
3. Provide training on handling loud/disruptive vocalization by patients and, when applicable, reduce common triggers, such as under-stimulation, overstimulation, immobility, pain or discomfort. The University of Iowa’s Iowa Geriatric Education Center provides tips (see page 3).
4. Purchase quieter equipment, such as hand towel dispensers and door hardware. Also fix or replace any faulty equipment, such as squeaky carts and creaking doors.
5. Reduce noise from electronic devices. Lower the ringer volume on telephones and set cell phones to vibrate. Also ask patients to use headsets with televisions and all personal electronic devices. Turn off unwatched television sets.
6. Designate ‘quiet time’ during which no routine checks are made unless medically necessary.
7. Restock supplies during the evening rather than at night when patients are trying to sleep.
8. Dim the lights in the evening to encourage quiet and help patients prepare for sleep.
9. Limit or eliminate overhead paging by equipping staff with personal devices.
10. Analyze the use of medical device alarms and reduce their occurrence. Currently, alarms pose one of the biggest obstacles to noise reduction strategies. One Johns Hopkins Hospital study, Using Data to Drive Alarm Improvement Efforts, showed that many existing devices are set up to be ‘overly sensitive,’ resulting in a high percentage of false alarms. Here are some results worth noting:
- The research team found that, in many cases, visual indicators would suffice for lower-priority or advisory alarms.
- Over a period of ten months, they worked diligently with staff in six units to lower the incidence of alarms.
- As a result, not only were noise levels decreased, but staff demonstrated better response due to reduced ‘alarm fatigue.’
Staff should also change IV bags before alarms sound and, of course, respond to alarms promptly.
Implementing these types of strategies will go a long way to reducing hospital noise, thereby creating more comfortable places in which patients can recuperate. A quieter workplace also benefits staff, in that it’s less distracting and tiring.
However, in the end, it’s impossible to eliminate all noises from a busy, round-the-clock healthcare environment. And that’s where design comes in. To learn more, check out my article “Hospital Quiet Zone: Controlling noise and improving privacy” in the January 2015 issue of Construction Specifier magazine.