Patient-centered care may be noisy ride to recovery
July 1, 1999 3 minutes read
Patient-centered care may be noisy ride to recovery
While more and more technology is being brought to the patient’s bedside in critical care, some clinicians are concerned about the unintentional negative effects that patient-centered care may be having on the ability of patients to improve.
The growing trend of bringing diagnostic resources such as pathology testing and imaging to the bedside rather than taking the patient to them has significantly reduced the amount of patient stress. But the benefits can bring with them the harmful potential of increased noise levels, according to researchers at the pulmonary, sleep, and critical care division of Rhode Island Hospital in Providence.
Noise may interrupt sleep patterns
Researchers worry that noise associated with bedside monitoring and testing may be interfering with normal and necessary patterns of restful sleep for patients. "One of the consequences of this noise pollution is sleep deprivation and fragmentation," observes Carol C. Carlisle, RN, AB, a critical care nurse at Rhode Island Hospital, who helped track the problem in her ICU.
Noise coming from monitoring and intubation equipment may be unavoidable, but a great deal of avoidable noise is disturbing the peace in ICUs too, according to Carlisle and her team. It’s this additional preventable noise that bothers the research team.
ICU noise levels exceed federal standards
After studying the source of avoidable ICU noise such as telephones, radios, and human speech, Carlisle and her colleagues suggested physical and behavior changes for clinicians such as more private patient rooms, smaller televisions, pillow speakers, and designated conference areas away from patients as helpful options.
The team also recommended thorough staff training, a constant awareness of efforts to reduce avoidable noise, and adherence to a strict unit noise abatement policy.
The noise levels associated with a typical ICU are generally quite high, according to conclusions drawn in a study conducted at Rhode Island Hospital.1 The study found that noise levels in the 750-bed hospital’s respiratory and medical ICUs dramatically exceeded guidelines set by the federal Environmental Protection Agency (EPA) in Washington, DC.
The EPA recommendation for hospitals falls at or below 45 dBA during the day and 35 dBA at night. A dBA is a unit of sound defined as an A-weighted decibel. The Rhode Island Hospital study found that peak noise levels in its ICUs were greater than 80 dBA most times.
Researchers also found a strong correlation between the existing noise levels and incidence of sleeping disturbance among patients. They identified 12 individual noises that contributed to the high peak sound levels. The mean peak sound level for these noises ranged from 74.8 dBA to 84.6 dBA. (The chart, left, shows the 13 identified noises.)
| Leading Causes of ICU Noise at Rhode Island Hospital | ||
| Noise |
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| Air conditioner
IV alarm Ventilator Monitor alarm Television Ventilator alarm Telephone Nebulizer Oximeter alarm Intercom Miscellaneous Beeper Talking |
0.9 8.0 20.0 23.0 5.0 0.8 0.6 5.0 0.5 7.0 0.9 26.0 |
77.3 +/- 2.0 78.0 +/- 1.1 79.0 +/- 0.7 79.1 +/- 0.5 79.7 +/- 1.3 79.9 +/- 2.5 80.6 +/- 0.6 81.1 +/- 1.6 83.7 +/- 2.1 84.0 +/- 1.1 84.3 +/- 5.5 84.6 +/- 0.7 |
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*Percent of total observation time of 160 minutes Source: Kahn DM, Cook TE, Carlisle CC. Identification and modification of environmental noise in an ICU setting. Chest1998; 114:535-540.
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Reference
1. Kahn DM, Cook TE, Carlisle CC. Identification and modification of environmental noise in an ICU setting. Chest 1998; 114:535-540.
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