Making Noise in the Modern Hospital

This Element examines the problem of hospital noise, a problem that has repeatedly been discovered anew, with each new era bringing its own efforts to control and abate unwanted sound in healthcare settings. Why, then, has hospital noise never been resolved? This question is at the heart of Making Noise in the Modern Hospital, which brings together histories of the senses, space, technology, society, medicine and architecture to understand the changing cacophony of the late twentieth-century British hospital. This Element is fundamentally interdisciplinary – despite being historical, it comes up to the present day and brings in scholarship on space, place, atmosphere and the senses that will have relevance to scholars working outside of historical research. The intersection between medical and sensory histories also puts interdisciplinary research at the Element's core.

A novel corpus developed to evaluate the impact of hospital noise on speech intelligibility

Hospital noise often exceeds recommended sound levels set by health organizations leading to reductions in speech intelligibility and communication breakdowns between doctors and patients. However, quantifying the impact of hospital noise on intelligibility has been limited by stimuli employed in prior studies, which did not include medically related terminology. To address this gap, a corpus of medically related sentences was developed. Word frequency, word familiarity, and sentence predictability, factors known to impact intelligibility of speech, were quantified. Nearly 700 words were selected from the Merriam-Webster Medical Dictionary. Word frequency was taken from Lexique, a 51-million-word corpus of American subtitles (Brysbaert & New, 2009). Word familiarity was rated by 41 monolingual listeners. The words were then used to construct 200 sentences. To determine sentence predictability, the sentences were presented to 48 participants with one word missing; their task was to fill in the missing word. Three 40 item sentence sets with different familiarity / frequency types (low/low, high/low, high/high) were selected, all with low predictability levels. These sentences and 40 standard speech perception sentences were recorded by two male and two female talkers. This corpus can be used to assess how hospital noise impacts intelligibility across listener populations. Brysbaert, M., & New, B. (2009). Moving beyond Kučera and Francis: A critical evaluation of current word frequency norms and the introduction of a new and improved word frequency measure for American English. Behavior Research Methods, 41, 977-990. doi:10.3758/BRM.41.4.977.

Spatiotemporal Assessment Of The Effect of Indoor Noise On Annoyance, Health And Comfort In Hospital Wards And Intensive Care Unit

Hospital-noise levels can induce physiological responses, and affects sleep quality, which could contribute to cardiovascular-related health problems. Till date, high resolution hospital noise exposure assessment studies have not received much attention in Oman. This study aims at assessing sound pressure levels across hospital wards and intensive care unit (ICU) rooms to determine annoyance, and potential health effects based on perception and risk estimates. An indoor exposure assessment using high precision noise sensors was conducted in a female medical ward (FMW), isolated ward (SLW), emergency ward (EMW), and intensive care Unit (ICU) in a public hospital in Muscat city, Oman. Self–administered questionnaire was randomly distributed among respondents using both online and field survey approach to ascertain annoyance, health effects, and potential risks associated with exposure. The study found that 24–hr noise levels (LAeq) ranged from 55.2–61.7 dB(A) in the hospital wards and ICU rooms, which exceeded WHO’s hospital indoor rooms critical limit of 35 dB(A) by 58% – 76%. A total of 150 participants took part in the survey. Among the respondents, 53% reported moderate annoyance at the hospital wards while 56% felt sensitivity to the noise levels. Noise annoyance was reported by the majority of the patients across the various wards and emergency rooms as causing slight annoyance (50%) and intermittent sleep disturbances (49%). The majority (73%) of the medical staff have complained that the current noise levels affect overall work performance (p = 0.004), while 70% of them have further complained of it as a cause of workplace distraction (p = 0.011). Quantitative risk estimates showed that both the % of highly annoyed (HA) persons (16%), and highly sleep–disturbed (HSD) persons (9%) were very high in FMW, while ICU was found to have the lowest risk. However, the greater number of the respondents (87%) believed there are possibilities of mitigating (p <0.001) the current noise levels.

Patient Satisfaction With Noise

Practice Problem: Noise on hospital units can interfere with patient rest, timely recovery, and statisfacton with care. Improvements in the reduction of hospital noise levels lead to improved patient satisfaction and improved rest. Patients were surveyed on their satisfaction with noise during the day and at night. PICOT: In Acute Care Patients (P), does the implementation of a noise reduction program (I) compared to no noise reduction program (C), affect patient satisfaction with noise (O) over a six-week period (T)? Evidence: Studies show that many hospitals have noise levels that exceed the World Health Organization’s recommended standards for noise levels. Evidence showed that implementing a noise reduction program that included quiet times and sleep menus produced an increase in patient satisfaction with noise. Intervention: Implementation of a noise reduction program and establishing a two-hour quiet time during the day. The program also established a sleep menu to identify and support patient bedtime rituals. Outcome: The implementation of a noise reduction program showed a statistical decrease in measurable noise levels. The project produced a clinically significant increase in patient satisfaction during the day and a clinically significant improvement in patient satisfaction with sleep quality and quantity. Conclusion: The goal of the noise reduction project was to improve the patients’ overall satisfaction with hospital noise during the day and overnight. This project showed that a noise reduction program could decrease noise levels and improve patient satisfaction with noise.

Annoyance among Staff and Noise Level in a Tertiary Care Hospital in New Delhi, India: A Pilot Study

Introduction: In India, an area of not less than 100 metres around a hospital is considered a silence zone, with guidelines restricting noise levels at 50dBA during daytime and 40dBA during the night. Annoyance is a known effect of noise exposure. Objectives: To determine the feasibility of an extensive study on noise in the hospital, annoyance in staff due to hospital noise and its associated factors. Methods: Noise data was collected from 3 sites, using a Digital Integrating Sound Level Meter, LutronSL-4035SD(ISO-9001,CE,IEC1010) meeting IEC61672 standards. Stratified random sampling of staff was done on basis of noise exposure. A pre-designed, semi-structured questionnaire collected information on sociodemographic and work profile. Annoyance was measured using standardized general purpose noise reaction questionnaire (ISO-TS/ 15666). Data was analysed in SPSS. Result: Laeq ranged from 56dB in nephrology ward to 89.2dB at OPD atrium. Maximum noise level was 98.6dB in OPD atrium and 86.1dB in nephrology ward. Levels at night in ward were higher than during day time. 24 (53.3%) of the staff said their workplace is noisy, while 26(57.8%) were annoyed by workplace noise. Annoyance due to hospital noise was associated with age (p=0.003), duration of work in hospital per week (p=0.04), duration of work in current department (p=0.007), noise level (p=0.04) and workplace distance from arterial road (p=0.02). Conclusion: Hospital noise levels are higher than recommended levels for sensitive zones as per national guidelines and exceed levels inside wards as stipulated by WHO. More than half the study population were annoyed by workplace noise indicating need for interventions. A study throughout the hospital to study noise levels and annoyance among staff following similar methodology is feasible and necessary.

Research: Replacing Overhead Paging with Smartphones to Reduce Hospital Noise

Hospital noise is associated with adverse effects on patients and staff. Communication through overhead paging is a major contributor to hospital noise. Replacing overhead paging with smartphones through a clinical mobility platform has the potential to reduce transitory noises in the hospital setting, though this result has not been described. The current study evaluated the impact of replacing overhead paging with a smartphone-based clinical mobility platform on transitory noise levels in a labor and delivery unit. Transitory noises were defined as sound levels greater than 10 dB above baseline, as recorded by a sound level meter. Prior to smartphone implementation, 77% of all sound levels at or above 60 dB were generated by overhead paging. Overhead pages occurred at an average rate of 3.17 per hour. Following smartphone implementation, overhead pages were eliminated and transitory noises decreased by two-thirds (P &lt; 0.001). The highest recorded sound level decreased from 76.54 to 57.34 dB following implementation. The percent of sounds that exceeded the thresholds recommended by the Environmental Protection Agency and International Noise Council decreased from 31.2% to 0.2% following implementation (P &lt; 0.001). Replacement of overhead paging with a clinical mobility platform that utilized smartphones was associated with a significant reduction in transitory noise. Clinical mobility implementation, as part of a noise reduction strategy, may be effective in other inpatient settings.

Examining the Utility of Perceptual Noise Categorization in Pediatric and Neonatal Hospital Units

Medical and nursing staff working in hospitals often experience exposure to extreme sound environments, and there is growing evidence of the negative impacts. Previous research highlighted various complexities regarding noise sources in hospitals; however, identifications of intrinsic noise categories that can reveal the complex mixture of existing hospital noise is still limited. The objective of this work was to identify intrinsic categories of the noise sources based on staff perceived annoyance and explore clear associations of these categorized noise sources with psychological perceptions. The staff perceptual responses regarding hospital noise were assessed by conducting surveys at the three pediatric and neonatal care units in two hospitals. Using principle component analysis (PCA), the psychological annoyance responses of 94 participants were used to derive the inherent structural patterns of the existing noise sources. The derived PCA categorization was validated on mixed-model analysis of variances, and employed on regression models to explore potential associations between the categorized noise factors and the staff’s psychological perceptions. The results highlighted three intrinsic noise categories and their negative impacts on staff’s psychological perceptions including work/rest disturbance and noisiness. Taken as a whole, the findings better reveal problematic noise source categories and establish a framework for hospital noise control that is less source-specific and more broadly generalizable.