This paper presents a nursing research utilization project proposal focused on reducing excessive noise levels in a hospital coronary care unit. Drawing on national survey data from the HCAHPS instrument and peer-reviewed clinical literature, the proposal identifies noise as a significant threat to patient healing, particularly for cardiac patients recovering from surgery or acute cardiac events. The paper outlines a structured noise reduction protocol encompassing staff education, equipment modifications, sound-masking technology, and architectural adjustments such as decentralized nursing stations. An evaluation plan using patient surveys is described, along with guidance on grant funding, feedback mechanisms, and decision-making criteria for revising unsuccessful interventions.
The Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) partnered together to develop a comprehensive survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The purpose of the survey is to collect patients' reports and perspectives developed during their hospital stay. The public is encouraged to express their feelings and concerns about hospitals and to rate their hospital experience. One of the specific questions on the survey addresses noise. National healthcare quality surveys have found that noise in hospitals is an urgent concern. Noise level is among the physical environment factors that influence the "healing environment" of any healthcare setting (Reiling, Hughes, & Murphy, 2008).
Not all patients have trouble with the level of noise involved in their hospital stay, but enough patients struggle with it to indicate that it is a significant problem for a meaningful percentage of the population. More than one survey has shown a correlation between quieter hospital stays and faster healing. That finding merits serious attention, since it is far better for a patient to have a hospital stay that is as brief and comfortable as possible. If the level of noise in a hospital affects recovery speed — so that patients in quieter environments heal faster and are discharged sooner — then hospitals, patients, and even insurance companies have strong incentives to find ways to provide quieter environments across all types of hospital settings.
Each hospital has a different way of handling patient complaints about noise and other concerns. For a hospital that genuinely wants to address noise and ensure that its patients are comfortable during their stay, there are numerous options. Conducting patient surveys is one of the best ways for any hospital to obtain accurate, actionable information about areas requiring improvement. That process benefits patients directly while also helping the hospital ensure it is performing as well as possible.
Even hospitals that are understandably focused on financial sustainability should care deeply about the patients who come through their doors. When a hospital centers its attention on people rather than profit, positive outcomes tend to follow. That can only happen, however, if the hospital takes the time to listen to its patients' needs.
This paper explores the problem of excessive noise in a hospital setting, most specifically in a cardiac care unit. By examining the noise level and determining whether it is detrimental to patients, the hospital can decide what changes to make and how to improve patient outcomes. Not all patients are equally bothered by noise, but it remains an issue for a significant number of hospitalized individuals.
This study focuses on a single hospital unit as a case example. The Coronary Care Unit of the study hospital in Manhasset, New York is a 12-bed unit that has experienced a 20% increase in patient complaints about noise level over the last three quarters of the year. This is clearly a worsening problem relative to historical norms. Using the baseline number of complaints typically received in the unit, the rise in complaints — and any subsequent drop once noise-reduction measures are implemented — can be measured systematically. Lowering the number of complaints will be necessary to keep patients comfortable and to potentially improve their health outcomes.
The Coronary Care Unit will implement a noise reduction protocol that includes the following evidence-based (EB) elements: (a) a reduction of equipment and machinery noise, (b) a reduction in the volume of staff conversations, (c) a reduction of construction, trash pickup, traffic, and other exterior noises, and (d) a reduction of overall hospital sounds such as food carts, other patients, and any extraneous noise not covered by the preceding categories. It is necessary to measure the noise levels in each of these specific areas before the intervention and again afterward to provide solid feedback about whether the noise reduction plans have been adequate or whether further changes are still needed.
Evidence from past studies confirms that there are several distinct sources of noise that can be reduced in a hospital (Xie, Kang, & Mills, 2009). This is important because it gives a hospital multiple areas on which to focus. Not all hospitals have noise problems in every category, but even a hospital with a single area of concern has a clear target for improvement. When these noise sources are reduced or eliminated as much as possible, patients heal faster, feel better, complain less, and are generally discharged earlier than patients who must contend with constant noise and disruption (Xie, Kang, & Mills, 2009).
To give patients the best chance of recovery, hospital noise levels should be kept to a minimum — and that is especially true in cardiac units, where patients are often recovering from surgery or serious cardiac events (Xie, Kang, & Mills, 2009). Excessive noise can slow healing and elevate heart rate and blood pressure, both of which are particularly dangerous outcomes in cardiac patients. If noise is a contributing factor to these problems, the hospital must act to reduce it.
The Coronary Care Unit has launched a project to reduce its noise level, with success defined as at least a 20% reduction in noise-related complaints on patient surveys by July 1, 2013. This target is designed to compensate for the 20% increase seen on past surveys and to return the unit to its complaint baseline. From that point, the hospital can work toward reducing complaints even further. All changes implemented will be tracked through patient surveys so that the value of each intervention can be assessed. If the plans do not succeed, alternate strategies will need to be identified and tested.
Staff education and new-employee orientation will mandate awareness of noise management, including the use of personal phones, general noise levels, and IV pump alarms. Sound control must be treated as a matter of accountability in maintaining an appropriate care environment (Mazer, 2006). Reducing staff conversation and overhead voice paging — by introducing electronic documentation, email-based collaboration, electronic messaging, and electronic orders — will improve noise levels throughout the unit and enhance patient comfort (Solet, Buxton, Ellenbogen, Wang, & Carballiera, 2010).
Exterior noise from outside the hospital building (such as road traffic) will be mitigated by the installation of window treatments that provide soundproofing and insulation around window frames. Research has found that exterior noises are generally the least annoying stimuli for patients; other sources — towel dispensers, closing doors, toilet flushes, and ice machines — tend to be more disruptive to recovering patients (Solet, Buxton, Ellenbogen, Wang, & Carballiera, 2010).
Addressing these noise sources gives the staff meaningful control over the acoustic environment. Installation of sound-masking generators near the nursing station and in patient rooms will further reduce noise for those recovering from serious surgery or cardiac events. Sound masking appears to be the most effective technique for improving sleep, decreasing noise levels, and promoting healing (Xie, Kang, & Mills, 2009). Creating small nursing stations at both ends of the corridors will also help decongest the main nursing station. A separate physicians' station situated away from the main traffic flow allows doctors to work quietly while reviewing patient charts. This proposed solution is consistent with current research, making it a well-supported choice for the unit.
"Literature linking noise to sleep, delirium, and cardiac risk"
"Survey methodology and baseline comparison approach"
"Contingency planning, feedback, and policy enforcement"
8. Did you find the noise level aggravating or upsetting? Yes / No
9. Did the noise level make you angry? Yes / No
10. Did you tell a nurse or other healthcare professional about the level of noise?
11. If yes, was anything done about your complaint or comment?
12. Do you feel the level of noise took away from your ability to heal properly? Yes / No
13. Do you feel the hospital should make changes to the level of noise in the cardiac care unit?
14. What do you feel would be beneficial in lowering the noise level in the hospital?
15. Please share any additional thoughts you have as they relate specifically to noise levels during your hospital stay.
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