Sound stages

HD, Jan 2003 by Mazer, Susan E

Susan E Mazer says that noise levels in healthcare environments are an urgent concern and recommends eight steps to tackle "auditory predators.

In the past decade, US healthcare designers have established a new industry benchmark in which the physical environment is a major factor in defining quality healthcare services. Ongoing research has verified that the environment of care has a direct relationship to patient medical outcomes, as well as patient and staff satisfaction. However, while hospitals have used architecture, interior design, and other disciplines to be able to provide safer and more effective environments, noise remains a dilemma as yet unsolved by regulations, building codes, policy, or practice.

Increased patient populations, communications technologies, remote monitoring devices, televisions, pagers, beepers, and buzzers render the clinical sound environment uncontrollable. At any given time at most hospitals anywhere in the world, noise levels are likely to exceed guidelines or be inappropriate to the objectives and needs of patients and staff.

Hidden among the risks regarding hospital noise, confidentiality and privacy are sacrificed more by accident than intent. Patients overhear medical diagnoses of other patients, families overhear physicians' reports to other families and staff overhear each other's interactions. Furthermore, sounds of suffering patients become the context in which other patients and families undergo their own healthcare experience.

Regardless of cause, noise can increase use of requested pain medication, heighten anxiety levels, and weaken safety protocols. It also contributes to staff stress, medical errors and miscommunication.

EIGHT STEPS TO SONIC HEAVEN

So how can the sound environment of hospitals be improved? Eight steps may be suggested to help control the problem:

Establish a committee

A good first step is to establish a multidisciplinary sound quality committee. Besides people from the facilities management staff, it is also important to include clinical, as well as other non-clinical staff. There is no 'one-size-fits-all' sound level for all hospitals or all hospital areas.

Assess the sonic environment

The first task of the sound quality committee is to make an assessment of the sound environment. An easyto-read, portable digital decibel meter can measure the sound levels at specific areas of the hospital to account for impact on patients, visitors, and staff. Sounds generated from equipment should be measured at distances relative to the listener.

The noise factor arises in communication devices, specifically paging and sound systems. Reevaluate the overhead speaker systems and note that use of mobile phones to replace overhead paging requires policies and protocols to avoid issues of overuse and lack of confidentiality.

Establish standards

After the data have been collected, the sound quality committee should establish qualitative sound standards that can be measured and maintained. While the recommended standard is an average of 50 dB, it is more effective to use the information regarding each area to determine what is appropriate.

Sound levels vary as a response to a changeable 'noise floor - the level of continuous sound that characterises an area at any given time. If an errant sound rises 30 dB above the noise floor, it can cause a ,startle response.' However, if the sound level is too low, third-party conversations and unavoidable sounds become distractions if not irritants. Therefore, when goals are set, both the optimum continuous volume level and the maximum level for incidental sounds must be taken into account.

Set up maintenance and purchasing standards

Once standards or goals have been set, recommendations should be made for modifying equipment, changing staff practices, and altering purchasing policies. Require that all vendors specify the auditory impact data along with all other relevant specifications and repair and maintenance policies should be reviewed to include quieter operation.

Much of the noise caused by the auditory predators in the hospital can be significantly reduced by mechanical adjustments, such as changing wheels, applying padding, repairing or replacing door bumpers, using thicker carpeting, and installing effective acoustic ceiling tiles.

Purchasing new equipment based not only on function and price but also on auditory impact is another possible approach. Biomedical engineering departments that evaluate all patient care equipment prior to its use should be testing for its auditory impact, as well as for safety and operation.

Optimise the use and functionality of equipment

For patients who need them, checking and adjusting monitors to avoid unnecessary alarms reduces noise exposure and distraction. Judiciously using barriers, such as doors and curtains, to provide both visual and auditory protection begins the process of controlling sounds that resonate from one area to another.

Re-design for sound control

Since many of the building components in hospital environments that contribute to noise (such as flooring, ceilings, walls, and door placement and function) cannot be fundamentally changed, consider re-designing areas to provide quiet spaces.