Published in The Plain Dealer (centerpiece of the Health section). Print version (PDF) PAGE 1 and PAGE 2.
Also published on Cleveland.com: http://www.cleveland.com/healthfit/index.ssf/2012/08/sssh_uh_project_tamps_down_hos.html
By Casey Capachi
CLEVELAND, Ohio — “Florence Nightingale once said that unnecessary noise is the cruelest form of punishment that we can inflict on our patients,” says Kathleen Vidal, director of nursing practice development, whose job it is to improve patient experience, as she talks to a group of nurses about to begin their first week at University Hospitals. “When you think about it, that’s pretty intense.”
Vidal takes a moment, indulging in the silence she is advocating for on the hospital’s patient floors. Then she continues: “But it’s the absolute truth. Imagine if you were sick, wouldn’t you prefer a quieter hospital environment?”
The new nurses nod solemnly in agreement.
Following the class, Vidal, a nurse for 25 years at UH, who left only to serve in the Navy, takes the elevator up to the fifth floor of Lerner Tower, one of three floors that earlier this year were part of a pilot project to reduce noise levels and increase patient satisfaction scores.
Noise, say Vidal and a growing number of researchers, affects patients’ ability to rest and recover as well as staff’s ability to function in a high-pressure environment for many consecutive hours.
Vidal stops at one of the three nurses’ stations on the fifth floor and points to the ceiling above. “Domes were made to project judge’s voices. Why are they above a nurse’s station?”
Those decorative domes and other surfaces on the fifth and seventh floors of Lerner Tower, where patients with cardiac complications are monitored, are now covered in noise reduction tiles. Other noise reduction initiatives included repairing squeaking doors and delivery carts, assuring nurses did not congregate in one area and minimizing use of overhead paging.
On the ninth floor, a pre- and post-op floor for transplant patients, noise reduction efforts consisted of adding a TV channel that plays white noise tracks.
Vidal and her staff also passed out comfort kits containing ear plugs and eye masks to help patients with the “unavoidable noise,” a practice that has since gained popularity throughout UH, says Kimberly Kotora, director of critical care.
“Here we were providing this level of care and [the patients’ surveys were] telling us they’re not feeling that care,” says Vidal, referring to the fifth floor’s ranking in the bottom 1 percent of 1,700 hospitals surveyed nationwide for noise in the HCAHPS, a standardized government survey used by patients to rate their care after a hospital stay.
The Centers for Medicare & Medicaid Services looks at hospitals’ HCAHPS survey scores as part of an equation to determine the Medicare inpatient revenue reimbursement a hospital will receive, says Adam Beach, a senior clinical data analyst at UH.
If scores did not improve, Vidal says, a hospital system as big as UH risked losing millions of dollars.
“We couldn’t afford not to do it,” says Vidal, who credits the HCAHPS survey for making patient comfort a priority and thus encouraging UH to provide more money to improve the patient environment.
Lerner Tower, like many hospitals, was built before awareness about noise levels in hospitals began to affect how facilities were built, says Vidal. The cardiac care floors have the added challenge of housing patients whose conditions require noisy machines to monitor their health.
“Whenever you have people and equipment moving it’s going to be impossible to eliminate all noise,” says Vidal. “We needed to give our patients these amenities to help with that.”
Installing the noise reduction tiles on the fifth and seventh floors cost just under $10,000. The change, says Vidal, was “night and day.”
“I expected there to be a difference, but I think I was surprised by how much of a difference,” says Vidal. “I was surprised to see how much the staff has responded and actually changed their behaviors with lowering their voices. Nurses say they don’t feel like they’re competing with the noise anymore.”
The decrease in noise was measurable after the tiles were installed, says Melissa Braskie, a safety supervisor at UH.
Braskie analyzed the noise levels on the 7th floor before and after the tiles were installed. She had a noise dosimeter placed near the main nurse’s station — considered one of the loudest areas — over a period of several work days.
“It’s going from the sound of a vacuum cleaner to somebody just talking,” says Braskie, who was asked by Vidal to monitor noise levels after conducting a similar study at UH’s Lakeside Hospital for a master’s project at the University of Toledo.
After the installation and other noise reduction efforts, 56 percent, of patients on the fifth floor — almost twice as many as before — rated the area around their room as “always” quiet at night.
The floor has shown a significant improvement in patients’ perception of noise and now ranks in the 43rd percentile in the HCAHPS survey of hospitals.
Kotora says they recognize there’s more work to do.
In a 2005 study, Dr. James West, a professor at Johns Hopkins University’s Whiting School of Engineering, and a team of acoustical engineers noted the structural challenges hospitals have in controlling noise. That study showed that, internationally, noise levels have grown steadily over the past five decades.
“A hospital is just a big bathroom, a room without absorbing materials,” says West, who believes hospitals often shy away from addressing the problem of noise because of the cost.
“You have metal clanking on metal, motors running, you have support systems for medical equipment and each one of these contributes to noise and it keeps building and building and building. Some nurses tell me if they have anything to think about that they just go to the bathroom because it’s quieter than the ward.”
Increasingly, others are proving that noise is not just a nuisance, but a risk to patients’ health.
In 2011, UMass Memorial Medical Center made headlines when, for the second time in four years, reports surfaced that a patient may have died due to what is referred to as alarm fatigue. The Massachusetts Department of Public Health cited violations by the hospital, including failure to respond to alarms “in a timely manner” in the case of a 60-year-old male patient who, according to state investigators, showed signs of potential respiratory failure and a fast heart rate before his death in August 2010.
A recent study out of the University of Illinois at Chicago showed that millions of prescription errors were made each year because of similarly sounding names of medication being confused in a noisy environment.
Another study from the University of Minnesota in 1976 found that it took patients significantly longer to recover from cataract surgery when construction noise was present.
Wendy Miano, chief nursing officer at UH Seidman Cancer Center, says because Vidal was able to improve patient satisfaction scores in a cost-effective manner, hospital committees may look to implement her initiatives campus-wide.
“She’s taking the space that we have to work with, and hopefully with some very simple interventions, is going to change the standard of practice across campus. I think it is extremely influential work,” said Miano. “Just by virtue of that leadership she is reminding staff to create a more healing space.”
Ultimately, Vidal says, she wants to see all floors in Lerner Tower ranking in the top 50 percent of hospitals surveyed nationwide when it comes to patients’ satisfaction with noise levels. The tiles, she says, can only cover so much, the culture around noise reduction must change as well.
“We can’t say, ‘It’s a hospital — of course it’s noisy,’ ” says Vidal. “Nobody would ever make noise in a library and say ‘Oh, it’s a library.'”
“We need to get to that level where everybody walks into a hospital and uses their hospital voice.”