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Curing the Hospital Noise Epidemic


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Managing hospital noise and creating a quieter environment for patients is a challenge that’s now being measured against HCAHPS scores and tied to Medicare reimbursements. It’s a factor that affects both patient satisfaction and outcomes as well as staff satisfaction and performance. Susan Mazer looks at the cultural factors behind noise and offers some solutions for managing noise in hospitals.

Published in: Health & Medicine, Business

Curing the Hospital Noise Epidemic

  1. 1. Curing the Epidemic in Hospitals
  2. 2. The Therapeutic Environment may exist in nature, but it is not inherent to institutional care…to the hospital room.
  3. 3. The Hospital Environment must be designed to be therapeutic…it does not happen by accident.
  4. 4. Florence Nightingale wrote: “What is the difference between a room with unchanging yellow walls and a prison cell?” “Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient harm...” “...Unnecessary noise is the cruelest absence of care.”
  5. 5. Today’s Hospital Environment is… Defensive: Infection control High-Tech: Technologically-dominated Efficient: Treatment-based logistics Generic: One-size-fits all motto Disease-focused: Symptomatically driven Provider-based: Patients must adapt
  6. 6. When patients enter the hospital… They know no one. They do not know the rules. They are acutely ill.
  7. 7. Patients learn about the hospital culture by looking and listening… and then putting together what it all means to them.
  8. 8. They hear so much. Such as…
  9. 9. They hear so much. Such as… Telephones Waiting area talk Paging Construction Patient care Conflict resolution Outpatient appointments
  10. 10. And…so much more.
  11. 11. Everything the patient hears... …is assumed to be true …is assumed to be intentional …states an attitude …becomes an expectation
  12. 12. Not all Noise is Equal! What? Machine vs. person Who? Friend, foe, or “other” When? Night, day, or worst Where? Home, hospital, car Why? Neglect or intention, relevant or irrelevant
  13. 13. Noise contributes to… ICU psychosis Medical errors Hospital-borne infections Higher costs/less satisfaction Increased need for pain medication Staff burn-out /high staff turnover
  14. 14. “Oops!” = Startle Reflex
  15. 15. “Oops!” = Startle Reflex facial grimacing muscular flexion increased blood pressure increased respiratory rate increased heart rate vaso-constriction
  16. 16. High noise causes… Altered memory Increased agitation Less pain tolerance Isolation Sleep deprivation
  17. 17. A healing environment takes responsibility for… …everything the patient hears and overhears …everything within line of sight of the patient …everything that the patient feels when touched …everything the patient smells and tastes
  18. 18. EPA says 35 dB at night, but…often 75-80 dB Too quiet or too noisy? Depends on who you are! Decibels vs. Perception
  19. 19. Sound “travels,” it is not “fixed” Auditory environment is a series of intersecting pathways Sound can be managed, not controlled Most hospital noise is behavioral, not mechanical
  20. 20. Quiet by Policy The myth of noise abatement Mandating behavior works Acoustic technologies lessen the “loud” Sound meter devices are effective Is the least effective method Don’t change the “what” Red lights ignore the “what” DOESN’T WORK!
  21. 21. Quiet by Design Be sensitive to the needs of both patient and caregiver and their relationship Provide positive distractions Minimize the negative impact of necessary sounds, sights, smells, and touches Minimize unnecessary noise Take responsibility for everything the patient hears and overhears
  22. 22. Quiet by Decision Address the diverse needs of diverse population Offer flexibility in managing varied sound sources and recipients Support health and general wellness Respect both objective and subjective experiences Prioritize patient/staff perceptions above objective measurement
  23. 23. Quiet by Management Acoustic treatments: higher specifications Barriers not blinders: plexi-glass, not walls Communication technologies: phones, pagers, alarms Purchasing standards: demand auditory impact specifications Maintenance schedules: support patient care
  24. 24. Quiet by Practice Values: every sound represents the hospital culture Set behavioral standards by modeling and integration without blame Set communications policies with every device Conduct auditory awareness training
  25. 25. The bottom line? Why does all this matter? Because….
  26. 26. The patient’s perception is
  27. 27. Susan E. Mazer, Ph.D. President and CEO Follow my blog: Connect with me: www.linkedin/in/susanmazer