The noisy hospital

Ask any person who has ever been hospitalised or stayed at the bedside of a loved one,and most will agree that hospitals are busy,noisy places. Patients have criticised the clatter for years,but their complaints have largely been ignored because hospital administrators,doctors,nurses and other staff have believed that a quiet environment is less critical for patient care than the alerts from the multitude of alarms,whistles and buzzers and the information garnered from frequent patient checks.

What patients endure,it turns out,borders occasionally on deafening. A study from the University of Chicago found that average noise levels in a hospital room easily exceeded 30 decibels,slightly louder than a whisper,recommended by the World Health Organization,and peak noise levels sometimes approached levels of a chain saw. Not surprisingly,patients in the loudest rooms suffered the most,losing almost an hour or more of sleep a night compared with those in the quietest rooms. And for every hour of sleep lost,the patients blood pressure increased by as much as six points.

A study published more recently revealed that not all hospital noises are created equal. Researchers looked at the brain wave and cardiac responses to isolated hospital sounds an ice machine disgorging its cubes,a laundry cart rolling,an intravenous infusion pump beeping,people discussing good and bad patient outcomes and then calculated just how disruptive those sounds were to patients who were asleep. The researchers found that while the responses differed depending on stage of sleep,people were more consistently aroused by electronic alarms from monitors and infusion devices and ringing from telephones. Each time they woke,their heart rates jumped.

There is a threat perceived in those noises, said Orfeu M Buxton,lead author of the study and an assistant professor in the division of sleep medicine at Harvard Medical School,and hospitalised patients are probably in a high state of threat vigilance.

Manufacturers of monitoring and medication infusion devices have not turned a deaf ear to the problem. The industry has begun sponsoring and conducting research on the amount of noise generated by medical devices. Some firms,for example,have tapped into the increasing use of wireless technology,designing monitors,pumps and nursing call systems that do not buzz or beep,but rather channel the alarms only to the doctor or nurse responsible.

But,many companies and hospitals remain reluctant to switch over to the newer designs. The holy grail is that a pump would never sound its alarm while near a patient, said Tim Vanderveen,vice president of the Center for Safety and Clinical Excellence at Carefusion,a medical technology company that produces infusion pumps and other health care devices. But what would happen if a hospitals wireless system went down?

The most challenging obstacle in the quest for quiet,however,appears to be not the machines but rather the approach to patient care. Doctors and nurses often wake patients up in the middle of the night or during afternoon naps to assess a non-urgent blood pressure or temperature,draw blood or administer medications that could safely be delayed by a couple of hours.

To change this culture,some health care systems are now considering campaigns,with names like Shhh Silent Hospitals Help Healing,Hush Help Us Support Healing or simply Too Loud, that institute mandatory quiet times and designate noise reduction teams to encourage compliance.

It is still too early too know whether any of these initiatives will succeed,but it is now clear that patient complaints about noise and lack of sleep are critical to quality of care. Sleep is a powerful source of resilience, Dr. Buxton said. Its absence results in a degradation of that resilience.