Doctoring at a lower decibel


Where: Rochester General Hospital, a 528-bed teaching hospital in Rochester, N.Y.

The issue: Reducing noise in the hospital.

Background

Like many of their peers, administrators at Rochester General have been worrying about patient satisfaction scores. “We've been working on our patient experience over the last several years,” said Cheryl Sheridan, RN, chief nursing officer for the Rochester General Health System. “Where traditionally hospitals across the country have problems is around quietness of the hospital. We are no different.”

Where the hospital did differ from some is that they built an interdisciplinary team to focus on the issue. “They did an environmental assessment. As they walked around the hospital, where were the noises coming from?” said Ms. Sheridan. “Some of the team actually measured the decibels in certain areas.”

The team also reviewed research and recommendations, finding that the World Health Organization recommends a hospital noise level of 45 decibels during the day and 35 at night. The team set to work trying to get their noise closer to those levels.

How it works

Some components of the hospital could be made quieter without too much effort. “We changed wheels on a lot of carts,” said Ms. Sheridan. More carts were also added, so there would be less transit and less resulting noise. New communication technology—cell phones and computer alerts—also allowed the hospital to minimize overhead paging.

The noise issue was also approached from the hearer's end. Patients are given headphones and earplugs and are offered the option of having their doors closed.

“The other thing was our voices,” said Ms. Sheridan. “A normal conversation is 60 decibels.” From chitchat to handoffs, talking was adding to the volume, so the team started a new “Quiet at Night” initiative.

“We looked at doing things that could cue our team to lower their voices—our patients as well,” said Ms. Sheridan. Now, at 10 p.m., on most wards of the hospital (not the emergency department, for example) the lights dim and Brahms' “Lullaby” plays.

Challenges

Rochester found that some noise-reduction technologies did not work. “There are curtains that say, ‘We can reduce the noise by x percent’ so we looked into that, did a pilot, especially in areas like semi-private rooms, and it really made no difference,” said Ms. Sheridan.

And some causes of noise couldn't be eliminated. “We asked patients, ‘What are the noises that bother you?’ Alarms...We can't just turn them all down,” she said.

Results

The hospital is still gathering data on the effects of the initiative by surveying patients, but anecdotal reports have been positive.

“One of our patients actually commented that when she hears the lullaby that we play at 10 o’clock, it's kind of like that tucking-in feeling. It took her back to when she was younger, with her children,” Ms. Sheridan said.

Clinicians have also responded positively to the program. “Especially the staff on the evening shift says it's a great reminder, dimming the lights and the lullaby. It makes them stop for a minute and just take that cleansing breath,” she said.

There's also been widespread acceptance of the effort to bring the volume down around the clock. “If a physician, or I as a chief nursing officer, was on a unit and was talking loudly, the team feels comfortable coming up and saying, ‘We're trying to lower our voices,’” said Ms. Sheridan.

Next steps

Although information is provided at admission about the initiative, some patients are still taken by surprise when the lights dim and the lullaby comes on, so Ms. Sheridan and colleagues are working on expanded education efforts.

“We are in the process of creating little tent cards to tell them about it,” she said.

Now that awareness has been raised, quietness is a consideration in many decisions at the hospital. “When we purchase equipment, one of the things that we evaluate is, ‘How quiet is it?’” said Ms. Sheridan.

Words of wisdom

Any hospital that wants to tackle its noise problem needs to start with a thorough survey, Ms. Sheridan advised. “We can think what we want but at the end of the day, actually asking our patients, ‘What are those annoying noises?’ will be key to success,” she said.