Impacts of noise in hospitals on patients and staff

Transcription

1 Sound Competence Center -- Struer Evidence-based healthcare design research: Impacts of noise in hospitals on patients and staff Roger Ulrich, PhD Aalborg University Department of Architecture, Design, and Media Technology and Chalmers University of Technology Center for Healthcare Building Research State of Evidence-Based Design Research Quality research (more than 2,500 studies) links the physical environment to outcomes in following areas: Patient safety (infection, falls, errors) Other patient outcomes (such as pain, length of stay) Overall care quality Costs of healthcare Staff outcomes(such as safety, work satisfaction, effectiveness) (Only about 10% of studies focus on staff) Hospital noise levels internationally are far higher than recommended values Surfaces are sound reflecting, creating poor acoustics Noise sources are numerous and loud Many noise sources are unnecessary Daytime db(a) levels in hospitals by year (Busch-Vishniac, West et al. 2005) WHO daytime continuous max 35 db 3300 times above recommended pressure level

2 NIGHT db(a) levels in hospitals by year (Busch-Vishniac, West et al. 2005) (1000 times too high) 30 db WHO night continuous max Reverberation time (RT) >1.0 sec Noise worsens patient outcomes Blood pressure Heart rate Respiration rate Arrhythmia Oxygen saturation Pain Anxiety May slow wound healing Noise worsens patient sleep Sleep disruption linked to: Stress Falls Delirium Altered glucose metabolism Impaired immune function Inflammation 2

3 Noise worsens patient satisfaction Data from different countries shows widespread strong patient dissatisfaction with noise In U.S., 50% patients are dissatisfied with noise in and around their room, the lowest rating for any quality indicator Countries such as England and U.S. have adopted payment policies that take into account satisfaction, which has strengthened the business/economic case for quiet hospitals Noise: negative impacts on STAFF Increased stress, job strain, fatigue Annoyance/irritation Reduced work satisfaction Headaches Hearing loss Linked to burnout Reduced speech clarity, communication More difficult monitoring of patient s vital signs Reduced working memory and job performance Measures for creating quiet hospitals Are staff education and culture change programs effective in reducing noise? (Such as lowering voices, turning down phones and pagers, closing doors) Generally no. Much research shows such programs have little or no impact. What measures are effective for quieting healthcare buildings? Single-bed patient rooms Sound-absorbing environmental surfaces (such as ceilings) Reduce noise sources (provide personal communication devices, not overhead paging, etc.) 3

4 What measures are effective for quieting healthcare buildings? But sound masking can pose safety risks and usually is not appropriate Quieting measures should improve speech recognition and patient privacy, and mustenable staff to hear alarms and other vital sounds "Influences of Noise on Patient and Staff Outcomes in Coronary Critical Care" (Blomkvist, Theorell, Ulrich, Eriksen, Hagerman & Rasmanis, 2005) CCU Floor Plan (Sound Reflecting Ceiling Tiles) CCU Floor Plan (Sound Absorbing Ceiling Tiles) 88 db pulse Reverberation time:.8 sec 70 db 88 db pulse Reverberation time:.4 sec 64 db Reduction of 6 db(a) 4

5 STUDY (Hagerman, Rasmanis, Blomkvist, Ulrich, Eriksen, and Theorell, International Journal of Cardiology) Patients:adults (94) diagnosed with acute myocardial infarction in a coronary critical care unit in a Stockholm hospital Intervention: Acoustics were improved by periodically changing ceiling tiles from sound-reflecting to sound-absorbing tiles Findings:During good acoustics patients slept better, had less physiological stress and a lower incidence of re-hospitalization STUDY (Blomkvist, Eriksen, Theorell, Ulrich and Rasmanis, Occupational and Environmental Medicine) Staff:nurses (36) who were specialists in cardiology and worked regularly in the coronary critical care unit Findings: During good acoustics staff: experienced lessened work demands increased workplace social support improved quality of patient care better speech intelligibility American Women in Labor &Delivery Units Rate Room Noise From Gesell and Malone (2002) Press Ganey Associates Based on data from 152,399 female patients in 566 hospitals across 46 states January through December,

6 Satisfaction Satisfaction with Room Noise (from Gesell and Malone, 2002) Had roommate 14.6% Single room Research: Exposure to NATURE Sights + Sounds Improve Outcomes Nature distraction reduces stress Naturedistraction produces clinically important pain reduction Lessens anger/aggression Increases satisfaction 60 Research: Viewing nature pictures reduces stress 6

7 Distraction Theory for Pain Reduction Pain absorbs conscious attention As more attention is devoted to pain, pain intensity increases But if a patient becomes engrossed in a pleasant distraction, less attention is devoted to pain, so pain decreases The more engrossing the pleasant distraction, the greater the pain relief Distraction with NatureSights and Sounds Reduces Pain During Bronchoscopy (Diette et al., 2003) Patients: 80 adult patients undergoing flexible bronchoscopy with conscious sedation Results: Patients randomly assigned nature distraction experienced significantly less pain Patient at Prince of Wales Hospital, Hong Kong, wearing VR glasses to view nature movie during diagnostic procedure (Lee, Chan et al., 2003) 7