Here’s how to reduce noise in your ED
If you think that dealing with a noisy ED is just part of your job, you’re mistaken, argues Michael Buelow, RN, CEN, an ED nurse at InteliStaf, a staff relief agency based in Phoenix. "Avoid allowing other priorities to push noise management out of awareness," Buelow urges. Noise levels in some EDs are sufficient to cause serious adverse psychological and secondary physical effects on staff, says Buelow.
There is no evidence that the body adapts to continuous noise, adds Buelow. "So the entire time one is in a noisy environment, one’s body is under this assault," he says. Here are some effective ways to reduce noise in your ED:
• Use sound-absorbing materials.
If your ED is being built or remodeled, use as many sound-absorbing materials as possible, says Buelow. These include carpeting, acoustic ceiling tiles, padded partitions, and solid doors that are routinely kept closed, he adds. "A closed sliding glass door reduces sound transmission without preventing observation of a critically ill patient," he notes.
Carpet in the main ED treatment areas is not feasible due to cleanliness, but it can be used at the nurses’ station, says Laura J. Roepe, RN, MA, CEN, quality systems analyst for United States Surgical/Tyco Healthcare and former administrative manager of the ED at Norwalk (CT) Hospital. "Consider carpeting the walls as well," she suggests. "We did this in the psychiatric holding area, and it worked very well."
Design the central station to be surrounded by transparent thermoplastic or with high countertops, Roepe recommends. "Then those sitting behind the countertop are generally at head level with it," she says.
• Disconnect telephone ringers.
Contact your telephone company to substitute ringers with a flashing light or gentle gong, advises Buelow.
• Set cardiac monitors carefully.
Careful setting of the monitors will reduce the number of false alarms, says Buelow.
• Reduce noise caused by overhead paging.
Eliminate overhead paging in each room by removing the speakers, Roepe recommends. "Have only speakers in the hallways of the department," she says.
• Use handheld radios.
Handheld radios can reduce noisy overhead paging, says Roepe. "A message can be sent without the recipient having to stop what they are doing to pick up a phone," she says. "The ambulance dispatcher can be put through automatically."
The triage nurse, unit secretary, charge nurse, physician, and other individuals can communicate by radios, says Roepe. "When a call comes in or a particular person is needed, the message goes out over the radio instead of the overhead speaker," she explains. "Even if the message goes to all radios, it still is less noise than an overhead."
For example, if the triage nurse needs a bed for a patient, she radios the message, "Charge nurse, call triage," says Roepe. Likewise, if a primary care physician is returning a call from the ED physician, the secretary radios the message, "Dr. Smith, Dr. Jones is on line four." Phone extensions in each room and the hallways are a wise investment, says Roepe. "The radio can relay the message of a caller, and the provider can pick up the phone from wherever they are," she says.
Direct phones significantly decrease the number of overhead pages by allowing the individual to directly call the person they wish to speak to, says Christine Clare, RN, MS, CEN, CNA, director of critical care at Kaiser Permanente Harbor City (CA) and former nurse manager for express care at Loma Linda (CA) University Medical Center. "This decreases the overhead pages as you don’t have to figure out which individual paged which person, or who is going to give report on a specific patient, particularly if that individual left the work area for a few moments," says Clare. She estimates that overhead pages can be decreased by 40% by using direct-call phones.
There are times when the caller can’t wait any longer for the individual to return the call, so he or she calls the ED again, says Clare. "This results in another overhead page," she says. "In addition, if the individuals don’t respond immediately to the initial overhead page, they are again paged repeatedly until they answer the call." Since direct calling allows for an immediate response, overhead paging is decreased even more, says Clare.
• Speak more quietly.
Making sound control part of your department’s culture is a slow process, but it will provide the greatest results, says Buelow. He suggests introducing the concept of noise control at orientation, providing inservices on the importance of noise reduction, and insisting that all conversations be muted.
Most noise in the ED is from people’s voices, which are raised in response to stress, says Buelow. "When you are in a hurry, it is difficult to take the extra steps to be near the person you’re addressing," he says. "Instead, we tend to speak loudly across the room." A single loud conversation requires others to raise their voices to be heard, Buelow adds. "Soon, everyone is shouting," he says.
Sources
For more information about reducing noise in the ED, contact:
• Michael Buelow, RN, CEN, 3018 W. Villa Theresa Drive, Phoenix, AZ 85053-1117. Telephone: (602) 439-9059. E-mail: [email protected].
• Christine Clare, RN, MN, Kaiser Permanente Harbor City, 25825 S. Vermont Ave., Harbor City, CA 90710-3599. Telephone: (310) 517-4370. Fax: (310) 517-4374. E-mail: [email protected].
• Laura J. Roepe, RN, MA, CEN, United States Surgical/Tyco Healthcare, 195 McDermott Road, North Haven, CT 06473. Telephone: (203) 492-6334. Fax: (203) 492-6661. E-mail: [email protected].
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