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Hospitals bring down 'da noise

Constant noise threatens the wellbeing of hospitalized patients. @NightshiftMD explains why forward thinking hospitals are finding imaginative ways of turning down the volume.

If you think hospitals are 'quiet' zones, you probably haven't been in one recently. Beeping monitors, ventilators and constant chatter from hospital staff annoy patients and in some cases, endanger their health.

Since 1960, the average daytime noise level in hospitals has gone up 200%.  Over the same period, the noise level at night has gone up 400%. The World Health Organization says that for optimal health, the noise level in a patient's room should be no higher than 35 decibels during the day, and 30 decibels at night. That's the level of quiet conversation. As reported by the Ottawa Citizen, a 2012 study by researchers at The Ottawa Hospital found that the noise level on one unit averaged 76 decibels the noise level of a vacuum cleaner.  A 2009 study found the noise level in hospital intensive care units averaged between 50 to 75 decibels, with a peak level of 103 decibels – about as loud as a motorcycle.

Studies have found that interrupted or disturbed sleep affects the immune system and delays recovery from major surgery and from heart attacks. A 2005 study by researchers in Sweden found that patients with heart disease who were hospitalized in noisier rooms had higher blood pressure readings, and also had higher rates of readmission after they were discharged from hospital. The 2009 study of noise levels in intensive care units found high rates of sleep deprivation among patients. Researchers have even documented increased heart rate and breathing rate and lower oxygen levels among premature babies admitted to the neonatal intensive care unit. 

Now, there's growing movement to tone it down. As reported by CBC News, Woodstock Hospital in Ontario went the design route.  The walls and the ceiling tiles absorb sound instead of reflecting it.  More private rooms mean that only one patient is disturbed instead of several.   They replaced the main nursing station – typically, a loud beehive of activity – with small satellite stations staffed by fewer nurses working much closer to the patient.  Less congregating and less talking across a large space means less noise.  As reported in the Ottawa Citizen, the Ottawa Hospital has experimented with a device called a 'SoundEar" a large ear-shaped array of lights located at or near the patient's bedside that shines green with when it's quiet, and turns red when the noise level rises. 

As reported in USA Today, Hospitals in the U.S. have instituted quiet hours for napping in the afternoon, and up to eight hours at night. Some hospitals have banned floor cleaning and especially floor polishing after 11 p.m.  Mount Sinai in New York identifies patients who don't need to be disturbed with vital signs and monitoring over night.

These and other measures aren't there just to eliminate a nuisance.  The study from Sweden that looked at acoustics and health found that ceiling tiles that absorb instead of reflect sound lower the blood pressure and heart rate of patients.  A 2010 study published in the Journal of Hospital Medicine looked at measures to reduce the number of times patients are disturbed at night to get vital signs as well as dosages of medication.  Researchers found that when patients weren't being disturbed at night, their use of sleeping pills was cut in half.  A 2009 study from Harvard found that small changes in hospital routine that reduce the number of noisy interruptions could have a big impact.

If this is such a big health problem, you might wonder why haven't hospitals done something about it before. I think medical culture was blind to the impact of noise and sleep deprivation on patients because we didn't want to see it. It's embedded in modern medicine to put the needs of health professionals first – especially physicians.  Saving lives – and being noisy while at it – seems a lot more heroic than being quite.

If that's your worldview, it's not going to register just how soul destroying it is for patients to be inundated with noise.

With the movement towards patient and family centred care, those who work in health care are finally starting to see the adverse impact of noise.  One way to accelerate the move to quiet is for noisy health professionals to hear things from the patient's point of view.

Now that might change things in a hurry.  

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