None of this is a surprise to hospitalists. “I’ve discussed this with at least 30 employees in hospitals—especially nurses—and they all agree it’s a problem,” says Douglas Cutler, MD, regional medical director, Phoenix and Tucson, for IPC The Hospitalist Company.
Indeed, Dr. Cutler could hardly be heard during a telephone interview. In the background phones rang, announcements blared, and people talked and laughed loudly. He was calling from the nurses’ station, an area he estimated at about five feet square and which contained—at that moment—at least seven people.
“I think it’s a terrible problem, but so far it’s been pretty much ignored,” says Burke Kealey, MD, chief of professional services for hospital medicine at Regions Hospital in St. Paul, Minn.
Regions is now building a new hospital (see The Hospitalist March 2006, p. 30), and Dr. Kealey has raised the issue in design sessions, so far with little success. Money is tight, and noise-reducing materials and designs are seen as expendable. “It’s way down on the list of priorities,” he notes.
Worst Offenders
In the Johns Hopkins study, the air-conditioning and overhead paging systems were among the biggest culprits. Human speech was also at the top of the list.
Lakshmi Halasyamani, MD, chair of the Hospital Quality and Patient Safety Committee for SHM, recalls one instance in which she and a resident couldn’t talk to a patient because of a loud conversation about another patient that occurred in the hallway just outside the room. In fact, the incident made her take a new look at patient privacy and confidentiality issues. She now makes a point of including patients in all such conferences whenever possible.
These may be the worst offenders, but anything that hums, rattles, vibrates, squeaks, beeps, ticks, or otherwise makes itself heard contributes to the general racket. Even something as innocuous as placing a chart in its holder can be disruptive, says Cheryl Ann Cmiel, BAN, RN, a staff nurse on the surgical thoracic intermediate care nursing unit at St. Mary’s Hospital, a Mayo Clinic-affiliated hospital in Rochester, Minn.
Cmiel and another team member, Dawn Marie Gasser, ASN, RN, spent an informative—and sleepless—night in a patient room as part of a sleep-promotion study. She found a portable chest X-ray unit to be the biggest single problem, especially because the technician wheeled it in at 3:15 a.m. In general, the noise was loudest during shift changes (AJN. 2004;104(2):40-48).
Squeaky Wheels
Perhaps the best way to start a noise-reduction program is by asking patients what bothers them the most. “Staff members kind of filter out the noise, so we don’t hear it all the time,” Cmiel tells The Hospitalist.
The next step is to remain vigilant and use common sense. “As we move forward with team-based care, noise will become more of a problem,” says Dr. Halasyamani. At night, “we must remember that the patient’s goal is to sleep, unless they’re having an acute problem.”
Remind staff members to keep their voices down. On wards, keep all conversations patient-centered and include the patients in them whenever you can. If possible, designate certain areas away from patient rooms as areas for collegial staff chats.
Simply remembering to close a patient’s door can make a difference, adds Dr. Kealey. Whenever it’s appropriate, he also orders that a patient not have her vital signs checked or receive medication at night. If a patient requires particularly close watching or is at risk of wandering or falling, he recommends video monitors, centralized alarms that sound at the nurses’ station rather than the bedside, and low beds that minimize the risk of falls. He and his colleagues are also trying to emphasize to residents the importance of keeping the noise level down.