201 Reducing Noise Pollution on a Surgical Ward

Noise pollution in surgical wards negatively influence the wellbeing of patients and healthcare professionals. In addition to disrupting sleep and impairing communication, recognised patient consequences include increased pain, increased re-admission rates and post-ICU psychosis. Ambient white-noise machines, sound-absorbing ceilings and retractable screens are purported as noise pollution reducing strategies (NPRS). These are expensive and impractical. We investigated the capacity of various low resource NPRSs. Noise was measured using “Sound Meter” app at four sites on two identical surgical wards. Ward A and B were designated as study and control ward, respectively. Measurements were taken at three time points (9am, 11am, 3pm) every day during a week. NPRSs were then implemented in ward A and data collection repeated. Prior to intervention there was no difference in noise between ward A and ward B (83dB and 87dB respectively, p > 0.05). After intervention, ward A was significantly quieter than ward B (64dB and 85dB respectively, p < 0.05). Restructuring ward environments presents several challenges. However, low resource interventions can have a positive role in reducing noise pollution. As hospitals become busier with resumption of normal services post-COVID-19, staff should be considerate of noise pollution in order to create an environment conducive to high quality patient care.

Intensive care unit delirium - does prolonged intensive care unit stay increase morbidity

<p class="abstract"><strong>Background:</strong> The term intensive care unit (ICU) delirium or ICU psychosis denotes the transient period of psychosis exhibited by the geriatric patients placed in long term ICU care. This condition can be mistaken for organic neurological deterioration and can result in improper treatment, delayed rehabilitation and longer ICU stay. The objective of the study was to analyse the outcome of early ward rehabilitation in post-surgical patients with ICU psychosis.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective case control study of 45 geriatric patients (above 60 years of age) who developed delirium or psychosis after long term ICU stay (&gt;4 days) following a major trauma and orthopaedic procedure. Of the 45 patients, 28 patients (group A) were shifted out of ICU after haemodynamic stability despite continued delirious episodes. The remaining 17 patients (group B) were those who were retained in the ICU for complete neurological recovery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Significant positive difference was noted in patients who were shifted out of ICU early (group A) compared to group B. Group A patients had faster recovery, lesser delirious episodes (2.3±0.9 compared to 13.4±2.7) and fewer days of hospital stay (4.9±1.2 compared to 12.4±2.6) when compared to group B. None of the patients had any episodes of psychosis after discharge from the hospital when followed up for duration of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> Post-operative geriatric patients diagnosed with ICU psychosis fare better with early out of ICU mobilisation. It is not essential to wait for full neurological recovery to shift these patients out of ICU though close ward monitoring may be essential in some cases.</p>

The Nature of Sleep

In April of 2004, only a few months into my fieldwork, I was struck by the level and variety of doubt expressed by the physicians at the Midwest Sleep Disorder Center (MSDC). The MSDC is a group of physicians recognized in the field as experts in many areas of sleep medicine, especially parasomnias—such as sleepwalking, sleep-related eating, and REM behavior disorder. Dr. Richards, the clinic's senior researcher and a neurologist by training, began the weekly departmental rounds. Generally, these consisted of case studies presented by the assembled clinicians and fellows, but at times rounds wandered into more philosophical discussions or ribald joking. On this day, Dr. Richards asked Dr. Pym if he had seen any patients of note. Pym was trained as a pediatrician, and his patients, at both the MSDC and the neighboring Children's Hospital, were mostly adolescents and young children. Pym had been in Nicaragua for the previous three weeks as part of a volunteer program to provide medical aid to the rural poor, and so had no cases, but he took the opportunity to make some observations on sleep disorders in Central America. He remarked that most of the places he had been to had about eleven hours of night and thirteen of daylight, and with only intermittent electrical lighting in the evening, most people went to bed at nightfall and arose with the sun. As a result, he postulated, most of the sleep disorders that physicians dealt with in the United States were not found there. He went on to blame electric lighting for many of the sleep problems in the United States—including insomnia and advanced and delayed sleep phase disorders—since it negatively affected biological impulses to sleep. Pym claimed that sleep disorders were “rare” in Nicaragua. He said most children there slept with their parents, who attended to their sleep problems as they happened, and so they did not develop into more acute pathological forms. This led into a broader conversation about light and its effects on human sleep patterns, in which some of the discussion revolved around sleeplessness in intensive care units; apparently, Richards reported, many people never entered REM sleep while in the units due to lighting disruptions, which, he said, might account for “ICU psychosis,” as people hallucinated due to sleepiness. At this point, Dr. Blake, a young pediatrician, remarked in relation to the newness of sleep medicine, “We're all flying by the seats of our pants,” to which Richards said, “We don't know anything.”