Spending a night in the hospital is not only stressful -- it's loud. The constant beeps, whirrs and alarms ascend to a cacophony that produces anything but a relaxing, restful environment. Hospitals noise, in fact, is the top complaint of not just patients but also staff and visitors alike,
according to the Hospital Consumer Assessment of Healthcare Providers and Systems survey.
Noises emanate from a variety of sources at the bedside. Airflow, and the noisy machines controlling it, are kept on high to prevent pathogens from lingering near patients, and overhead pages alert staff of needs or announcements. Equipment alarms are the most egregious source, and although they're designed to alert staff to changes in the patient's condition, many also sound off when medication needs to be changed or when the battery is low.
Previous studies showed that alarms at a patient's bedside sound an average 133 times per day. Besides the obvious barrier to rest, high noise levels have been associated with changes in the patient's heart rate, respiration and blood pressure, all of which increase stress levels and may impair healing.
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It's not just a problem for patients. So many notifications can also create alarm fatigue among clinicians as well as hamper their communication with patients.
The noise can also impair communication between patients and staff. With so many alarms, staff often face alarm fatigue as well.
The Centers for Medicare and Medicaid Services initiated the HCAHPS survey in 2008 to assess consumer perception of healthcare providers and systems. Today, more than 5,500 hospitals contribute to the report, which consists of patients' responses on seven composite measures, including questions focused on room cleanliness and quietness.
The survey has teeth. Hospital value-based purchasing links up to 30 percent of CMS payments to hospitals across the country to the results of the survey.
Faced with a potential loss of money, hospitals have been developing and implementing noise control programs that can be broken into two categories: engineering and administrative interventions.
Engineering interventions aim to find ways to quiet the room. The solutions can be as simple as closing the door to a patient's room or as complex as installing acoustical absorption materials along the walls and ceiling to dampen the noise level. Administrative interventions focus on changing behaviors. Many hospitals have instituted quiet hours when doors are closed and voices are kept low.
One of the big changes during the past 10 years has shifted alarms from solely sounding at the patient's bedside to also alerting a central monitor at the nursing station. This approach improves the ability of staff to identify and respond to alarms set at a reduced volume.