SHHH takes NY hospital 'back to the basics'
Patient complaints sparked effort
To enhance patients' satisfaction levels — not to mention their ability to rest and heal — Montefiore Medical Center in Bronx, NY, has gone "back to the basics," says Elodia Mercier, RNC, MS, ANM, administrative nurse manager.
Evoking the time of Florence Nightingale and the image of a nurse raising a finger to her lips and whispering, "Shhh," the hospital has taken aim against the rising decibel levels of modern health care, she explains.
"We have so much new technology and equipment, which is a great thing, but sometimes we forget the concept of the quiet zone, that state of quiet that was part of providing care."
A program called Silent Hospitals Help Healing (SHHH) came about because of patients expressing concern — both in conversations and in Press Ganey patient satisfaction surveys — that the hospital was getting too noisy, Mercier says. "Since it was important to the patient, it was important to us."
In an effort spearheaded by Mercier, who works in one of Montefiore's med-surg pavilions, staff began to identify the barriers to a quieter environment and how to tackle them, she adds. "The goal was not to eliminate noise — that's impossible — but when possible, to reduce noise."
The No. 1 complaint, employees discovered, was about the sound made by the heavy metal hammer-like pill crusher, especially when it was used in the middle of the night. Now, Mercier says, nurses use a small, hand-held pill crusher instead.
Nurses complained that the cart taken around to check patients' blood sugar "sounded like the 'D' train going through at 5 in the morning," she says. "It would wake up the whole floor. The wheels were horrible."
When she asked nurses why they put up with the disruption, Mercier adds, the answer was, "It's always been like that." A trip to the bioengineering department, however, resulted in new wheels and a lube job, and that problem was solved, she says.
"It's simple, basic things," Mercier says. "Some physicians and nurses were wearing clogs that made a clicking sound in the hallway, and they converted to soft-sole shoes."
Much of the problem was due to what she calls "the cocktail-hour effect," where overhead pages are being broadcast, alarms are going off, and staff are talking louder and louder because they can't hear each other.
When four patients are in a room and each turns up the volume on the television in order to hear over the other person's TV, the result is "four TVs blasting into the hallway," Mercier notes. The simple solution: headphones for the televisions.
To reduce the intercom noise, she says, the hospital now has two systems — a major one, used for announcing cardiac arrests, and an individual intercom on each nursing unit. "With re-education, the secretary now knows to talk in a low tone of voice."
Plans are to eventually have a Star Trek-style system, Mercier says, whereby nurses can hear their own pages individually, rather than having them announced throughout the unit. Another noise-reducing change has been setting beepers to vibrate, she adds.
Previously, Mercier says, the nursing floors often reverberated with the sound of keys jangling interspersed with people yelling out, "Who has the keys?" as nurses took medicine from the narcotics cabinet. Now the hospital has a computerized system that allows nurses to punch in an individual access code and take out the drugs that are needed for their assignment of patients.
Reducing that kind of noise, she points out, allows clinicians to better hear the ambient sounds — such as a ventilator alarm or an air mattress alarm — that help them take care of patients.
Reducing the decibels
In 2004, the hospital began monitoring decibel levels on a monthly basis, Mercier notes. For comparison, the noise from a train or motorcycle is about 95 decibels, and the decibel level in a library is about 50, she adds. "Sometimes in certain hospitals at the change of shift, it can go as high as 113 decibels."
From a starting point of between 90 and 115 decibels (equal to the roar of a subway car), Montefiore has reduced its noise range to between 55 and 60 decibels, as measured by the hospital staff using sound-measuring devices, Mercier says.
"We have been working aggressively to maintain this, and the staff are doing a wonderful job," she says. "To get patients and families to buy in, we have buttons that we like to hand out. Instead of saying, 'You have to be quiet — we have a SHHH program,' we say, 'We have a SHHH program on the floor, and we want to provide you with very good care. We will make you an honorary member for helping us with that program by using headphones for your television.'"
In the admissions area, Mercier says, there is likely to be a television on as a service for customers, and perhaps a radio as well. "When you add the noise from different offices and from staff coming in, laughing and having a good time, the noise level can be quite high."
Staff can help create a calmer and more restful environment for patients who are waiting for service by simply "toning it down," she suggests. "Walk up to each other and talk as opposed to yelling across the room."
To kick off the SHHH program, Mercier notes, the hospital held a contest to choose the design of a promotional poster and button. The winning entry, she adds, showed a close-up of someone's mouth, with a finger over the lips, and the words, "Quiet, please. Silent hospitals help healing."
Now there is a huge copy of that poster on the elevator that goes to her floor, Mercier says. "I didn't think people paid much attention to it, but one day I was in the elevator and a gentleman got in with his son, who was talking loudly and making a lot of noise.
"The father looked down at the boy and said, 'Patients are healing, we have to talk quietly,'" she recalls. "That made me feel really good."
(Editor's note: Elodia Mercier can be reached at [email protected].)
To enhance patients' satisfaction levels -- not to mention their ability to rest and heal -- Montefiore Medical Center in Bronx, NY, has gone "back to the basics," says Elodia Mercier, RNC, MS, ANM, administrative nurse manager.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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