Day 6

Hospital noise is hurting patients and caregivers. These sound designers want to change that

Our medical systems are facing a reckoning thanks to COVID-19 — and musician Yoko Sen says it's time to rethink the way our hospitals sound. Sen is raising the alarm on the harms of hospital noise and shares how she and others are fostering a more healing sound environment.

Musician Yoko Sen became determined to transform the hospital soundscape after a harsh hospital stay

Electronic musician Yoko Sen embarked on a mission to improve hospital sound after she was hospitalized in 2012. (St Olavs Hospital)

As an ambient electronic musician, Yoko Sen spends much of her time building intricate, soothing soundscapes. 

But when she was hospitalized in 2012, she found herself immersed in a very different sound environment.

Already panicked by her health condition, she couldn't tune out the harsh tones of the medical machinery in her hospital room.

Instead, she zeroed in on two machines — a patient monitor and a bed fall alarm. Their piercing tones had blended together to create a diminished fifth, a musical interval so offensive that it was banned in medieval churches.

For Sen, it was both a moment of levity and a life-changing moment. 

"Our technology is getting better every day … but we are still, when it comes to the sound environment, not better than the medieval times," said Sen.

"I thought to myself, 'Why does it have to be this way?'"

Sen went on to start Sen Sound, a Washington, D.C.-based social enterprise dedicated to improving the sound of hospitals. 

'Alarms are ignored, missed'

The volume of noise in today's hospitals isn't just unpleasant. It can also put patients' health at risk.

According to Judy Edworthy, a professor of applied psychology at the University of Plymouth, the sheer number of alarms going off each day can spark a sort of auditory burnout among doctors and nurses.

"Alarms are ignored, missed, or generally just not paid attention to," says Edworthy.

In a hospital environment that's also inundated with announcements from overhead speakers, ringing phones, trolleys, and all other manner of insidious background sound, it can be difficult for staff to accurately locate and differentiate between the alarms.

Psychologist Judy Edworthy says the importance of medical alarm design has historically been overlooked by device makers. (Submitted by Judy Edworthy)

Worse yet, in many hospitals, many of the alarms ringing out across the ward are false. Studies have shown that as many as 99 per cent of clinical alarms are inaccurate

The resulting problem has become so widespread that a term has been coined to describe it: alarm fatigue.

Raising the alarm

Sen's company, launched in 2016, has partnered with hospitals and design incubators and even collaborates directly with medical device companies seeking to redesign their alarms.

Over the years, Sen has interviewed countless patients and hospital staff who share her frustration with noise. 

But when she first sat down with the engineers responsible for the devices' design, she found that they tended to treat the sound of their devices as an "afterthought." 

Musician Yoko Sen explains how a simple change in pitch can improve the sound of medical alarms. 0:38

Edworthy says that's been the case since the earliest days of medical technology.

"When people first started to develop medical devices … people thought it was a good idea to have one or two sounds to demonstrate or to indicate when, let's say for example, the patient's temperature … exceeded some kind of range," she said.

"There wasn't really any design put into this; it was just a sound that people thought would get your attention by being very loud and aversive and so on."

Sounds of nature, sound of water, voices of loved ones. It's all the sounds of life that people say they want to hear.- Yoko Sen, musician

According to Edworthy, the real problem arose as medical technology advanced, bringing an ever-increasing number of devices — and alarms — into the hospital environment.

"You get into a cycle of making the sounds louder and louder because, of course, the people who make the equipment don't want you to miss the alarm. So they dare not risk it being too quiet."

"It's happened kind of by accident, really."

Sound improvement

For Sen and her team at Sen Sound, redesigning the sound of the alarms is the first step to a more secure and healing hospital soundscape. But safety is the first priority.

Rather than risk confusing staff by radically changing the alarms overnight, she might recommend an adjustment as simple as altering the pitch of an alarm slightly.

Edworthy, who has spent decades studying medical alarm design, took things one step further this summer. In July, the International Standards Organization approved a new set of alarm designs, created by Edworthy, that mimic the natural hospital environment.

The standards, which are accepted by Health Canada, include an electronic heartbeat sound for alarms related to cardiac issues; and a rattling pillbox for drug administration. 

Judy Edworthy says her new alarm designs are more pleasant and easier to identify. 1:02

According to Edworthy, these new alarms will be easier for nurses and doctors to identify and localize while improving the overall sound of the hospital environment. While companies aren't required to use these sounds, she says we could start hearing them in hospitals within the next few years.

But that's not her ultimate goal.

"I don't want to substitute sounds with other sounds, really; I want to take them all away," she said. "And of course, you can take them all away, because you can monitor patients remotely."

A soundtrack for healing

Sen, too, is thinking about an alarm-free future.

Her team continues to work with companies to improve the sound of existing medical devices. But she has also begun to think more deeply about the long-term future of hospital sound — especially as it relates to the end-of-life experience.

"A study shows that hearing can be the last sense to go when we die," says Sen. 

"It's really beyond upsetting to think that many people end up dying in acute care hospitals and there are all these medical devices."

As part of her interviews with patients, Sen has asked what sounds they would most like to hear at the end of their lives — and she discovered a common theme in their responses.

Yoko Sen attends the End Well Symposium 2019 in San Francisco, CA. (Katie Ravas for Drew Altizer Photography)

"I asked this question in many different countries, but they are all sounds that symbolize life," said Sen. 

"Sounds of nature, sound of water, voices of loved ones. It's all the sounds of life that people say they want to hear."

As the pandemic continues to affect hospitals around the world, those efforts have taken on a new resonance — and Sen hopes the current crisis might serve as an opportunity to help usher in a more healing soundscape.

"My own health crisis almost gave me a new pathway in life," she said. 

"So I also hope that this challenge that we face as a society gives [opportunities] — sound being one of them, I hope."


Written and produced by Annie Bender.

Hear the full documentary above. Special thanks to Yoko Sen for providing the audio of her Last Sounds project. Her songs Pho and Laptop On Top Of Your Lap also appear in the piece.

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