Issue 1 : Noise Levels in the ED

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1. Define in 10-20 words.

  • Noise level in the ED needs to remain at an acceptable level to ensure patient privacy and comfort and to help the staff to be focused and not distracted by noise around them while treating a patient.


2. Research: What information were you able to find on the web or from readings?

  • Noise is a primary cause of sleep deprivation and disturbance among patients www.psqh.com Cmiel, et al., 2004
  • “Unnecessary noise is the most cruel abuse of care which can be inflicted on either the sick or the well,” Florence Nightingale wrote in her 1859 book, Notes on Nursing
  • A recent study by Blomkvist et al. (in press, 2004) examined the effects of poor versus good sound levels and acoustics on coronary intensive-care patients in a large university hospital in Stockholm, Sweden, by periodically changing the ceiling tiles from sound-reflecting to sound-absorbing tiles. When the sound-absorbing ceiling tiles were in place, patients slept better, were less stressed (lower sympathetic arousal), and reported that nurses gave them better care
  • From the Experts:

Noise causes the staff to be unfocused. It is unpleasant for patients. In addition hearing yelling and screaming can cause for patients to distress which may put their health in more danger if their blood pressure rises or something of that nature. Noise interferes with communication between all players in the ED and it makes handoffs difficult and safe hand-offs are important for patient safely and continuity of care in the hospital.

3. How can the problem be measured?

  • By decibel rate throughout the different parts of the hospital and recording those levels.
  • Patient Satisfaction.
  • Overall level of noise transmitted from room to room.
  • What are the noise generators? Can they be stopped or reduced?
  • What environmental factors play a role in the noise problem?

COMMENTS: There is a large body of literature on the effects of noise on all sorts of things. There is a smaller body on the effects in medical care and even a few bits of research on the effects in the ED. In ICUs (particularly pediatric ICU) increased noise has measurable physiologic effects on patients. Error rates amongst pharmacists are higher with increasing noise. WHO has noise guidelines ... I have yet to be in an ED where the noise from the ventilation system was less than the recommended noise level for patient care areas. I would focus more narrowly - if ambient sound levels resulting in patient discomfort and errors are your primary concern I would not persue the privacy issue. Presumably reducing ambient sound would improve privacy because we wouldn't have to yell to be heard and you would somehow reduce transmission of sounds from one place to another. Once again, patient satisfaction is a very weak surrogate measure for a measurable physical entity that has known physiologic consequences. If you have an idea of how staff is effected you can measure it - physiologic monitoring, time to completion of tasks, time to recognition of patient monitoring alarms, completeness of documentation, recognition of known physical exam findings....

Bibliography

  • www.psqh.com Cmiel, et al., 2004
  • Notes on Nursing, Florence Nightingale