White Coat, Black Art

Noisy hospitals are putting patients at risk. Here's why.

A noisy hospital can make it hard to sleep. But studies show noise can make it hard to heal too. And when hospital staff experience "alarm fatigue" patient safety is at risk. Find out what alarm fatigue is, and meet an MD who is making the ICU of the future. It's quieter and safer, and it's modelled on your iPhone.
According to Dr. Peter Pronovost is a world-renowned patient safety expert says the excessive noise from alarms in hospitals could be costing people their lives. He's recruited engineers to help design a quieter, safer ICU. 1:12
Listen26:29

We get a lot of complaints about how hospitals work, or don't work, at White Coat, Black Art.  You might think that the food or the steep parking fees top the list. But you would be wrong.

It's noise.

You're driven to distraction, and sometimes literal delirium by rising hospital noise. Since 1960, the average daytime noise level in hospitals has gone up 200 percent.   But noise isn't just a nuisance that keeps you from sleeping. Studies have shown that when you aren't rested, you're not healing.

Rhonda Wyskiel is the Patient Safety Innovation Coordinator at the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore. 

She tells Dr. Brian Goldman that it took a stay in the hospital after the birth of one of her children to really make her empathize with patients who complained about noise.

"I was very sick and I was struggling to sleep and I didn't want to take sleeping medication, because I wanted to be there for my child who was in the NICU (Neo-natal Intensive Care Unit)," Wyskiel says. 

Her room was right next to a nursing station, where the laughter and loud talking seemed unrelenting. 

"It was so upsetting during this time, when I was incredibly stressed and trying to heal...And I realized, I was that nurse." she says.

There were occasions when working as an ICU nurse, she found it hard to concentrate, including during critical tasks. 

"The ventilator was going off, their alarms were going off...And I was so concerned I was going to make an error, I literally had to get another nurse to stand with me," she says on this week's program. 

"Here I was a very senior nurse, and I couldn't even focus." - Rhonda   Wyskiel , patient safety expert at Johns Hopkins Medicine on the impact of noise in the ICU. 

Those competing alarms add up to something called "alarm fatigue," says Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality. 

He says "without a doubt" patients have been compromised, and even died as a result of the phenomenon. 

Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, looks on, as a colleague points to a display. (Johns Hopkins )

Part of the problem is that hospitals buy monitors and machines that don't talk to each other. 

"You would think the most dangerous alarm should get our most attention, but that's not the way we designed them," says Pronovost.

He calls it an "alarms race" where manufacturers try to make their alarms the most "annoying and attention-getting as possible." 

The result? 

"Our nurses now answer a false alarm every 90 seconds," says Pronovost.

"We've seen clinicians either be distracted by an unimportant alarm....and they've missed a real critical issue." 

Pronovost, known for creating a vital patient safety checklist, is working with submarine and spacecraft engineers and physicists to re - engineer the ICU. 

"In every other industry the monitors...whether in the cockpit, submarine or nuclear facility, the alarms are central and they're prioritised, based on what the operators or users of that system say is most important." 

He says he'd like to "do for the ICU what Steve Jobs did for the iPhone" and create a fully integrated ICU that hospitals could one day buy and install anywhere in the world.

"You'd get that same playlist no matter where you are, like an iPhone." 

It may be a hard sell to cash-strapped hospitals, but Pronovost says it will save money by being more efficient.  

The Ottawa Hospital uses a device called the SoundEar to measure noise levels in the hospital, in an effort to bring down noise. (Brian Goldman)

In the meantime, many hospitals are implementing more simple solutions.

The Ottawa Hospital,began calling patients to find out how they felt about their stay. Debra Bournes, the Chief Nursing Executive at the hospital, says the message was loud and clear.

"We kept hearing they couldn't sleep....We thought, we have to do something about this," Bournes says.

They brought down the noise is by installing something called a SoundEar.  It's a device that measures the decibel level in the hospital. It lights up when noise rises, giving staff a visual cue.

Bournes says the feedback from patients has been positive, and staff are more aware of the importance of quiet time. 

"It's not that anyone is trying make noise, you just don't really know how noisy it is until you're lying in the bed trying to sleep." - Debra Bournes, Chief Nursing Executive at The Ottawa Hospital.

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