Noise, stress, and annoyance in a pediatric intensive care unit

ARTEMIS: An alarm threshold and policy mining system for the intensive care unit

BACKGROUND

Alarm fatigue is a major technology-induced hazard for patients and staff in intensive care units. Too many - mostly unnecessary - alarms cause desensitisation and lack of response in medical staff. Unsuitable alarm policies are one reason for alarm fatigue. But changing alarm policies is a delicate issue since it concerns patient safety.

OBJECTIVE

We present ARTEMIS, a novel, computer-aided clinical decision support system for policy makers that can help to considerably improve alarm policies using data from hospital information systems.

METHODS

Policy makers can use different policy components from ARTEMIS' internal library to assemble tailor-made alarm policies for their intensive care units. Alternatively, policy makers can provide even more highly customised policy components as Python functions using data the hospital information systems. This can even include machine learning models - for example for setting alarm thresholds. Finally, policy makers can evaluate their system of policies and compare the resulting alarm loads.

RESULTS

ARTEMIS reports and compares numbers of alarms caused by different alarm policies for an easily adaptable target population. ARTEMIS can compare policies side-by-side and provides grid comparisons and heat maps for parameter optimisation. For example, we found that the utility of alarm delays varies based on target population. Furthermore, policy makers can introduce virtual parameters that are not in the original data by providing a formula to compute them. Virtual parameters help measuring and alarming on the right metric, even if the patient monitors do not directly measure this metric.

CONCLUSION

ARTEMIS does not release the policy maker from assessing the policy from a medical standpoint. But as a knowledge discovery and clinical decision support system, it provides a strong quantitative foundation for medical decisions. At comparatively low cost of implementation, ARTEMIS can have a substantial impact on patients and staff alike - with organisational, economic, and clinical benefits for the implementing hospital.

Noise levels and annoyance among staff in a tertiary care hospital in North India: A cross-sectional study

Hospital noise has remained a low priority problem in India. An area of not less than 100 meters around a hospital is considered a silence zone, with guidelines restricting noise levels at 50dBA during daytime and 40dBA during the night. World Health Organization (WHO) guidelines also stipulate an average of 30dBA and a maximum of 40dbA. Annoyance is a known effect of noise exposure. However, very few studies have attempted to explore the hospital soundscape and the annoyance among staff related to it. Noise data was collected from 30 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 defined as a stress reaction to environmental noise and was measured using standardized general purpose noise reaction questionnaire (ISO-TS/15666). Data was analyzed in SPSS. The mean LAeq 24 h across all the sites was 69.5dBA (SD ±5.8dBA) for the weekdays and 66.2dBA (SD ±4.6dBA) for the weekends. Noise levels were higher during the day than during the night, and higher during the weekdays as compared to the weekends. 332(73.8%) study participants were found to be annoyed due to hospital noise. Annoyance among study participants was significantly associated with LAeq 24 h > 80 dBA during the weekdays [aOR = 5.08 (1.17-22.06)] and LAeq 24 h of 65-80 dBA during the weekends [aOR = 2.71 (1.46-5.01)]. Noise levels in the hospital far exceeded WHO and Central Pollution Control Board (CPCB) guidelines recommended for indoor hospital noise, as well as the national guidelines for sensitive zones. Almost three-fourth of the study participants were annoyed due to hospital noise. Significant association was found between annoyance among staff and higher noise levels of their workplace. Similar studies need to be conducted in hospitals across India to generate evidence on the current situtation and identify solutions.

Amidst the clamor: Effects of emergency department noise on Physicians' health and attention

OBJECTIVE

This study aims to assess effects of noise on physicians' stress levels and attention capacities within an emergency department.

METHODS

In this prospective cross-sectional study, 15 physicians from a state hospital emergency department with 300,000 annual visits provided demographics, work factors, and physiologic data. Attention was evaluated through smartphone-based Stroop tests, while noise and heart rates were monitored via smartwatches.

RESULTS

Median physician age was 26, with 16 months' emergency department experience. Average sound intensity was 68.80 dB. Despite noise, physicians in green/yellow areas showed increased Stroop scores (p = 0.002). Heart rate responses correlated with noise changes. End-of-shift surveys highlighted physicians' adaptability and resilience to high noise levels.

CONCLUSION

Noisy emergency departments pose health risks to physicians, but noise-related stress did not significantly affect attention, beneficial for patient care.

AI-based soundscape analysis: Jointly identifying sound sources and predicting annoyancea)

Soundscape studies typically attempt to capture the perception and understanding of sonic environments by surveying users. However, for long-term monitoring or assessing interventions, sound-signal-based approaches are required. To this end, most previous research focused on psycho-acoustic quantities or automatic sound recognition. Few attempts were made to include appraisal (e.g., in circumplex frameworks). This paper proposes an artificial intelligence (AI)-based dual-branch convolutional neural network with cross-attention-based fusion (DCNN-CaF) to analyze automatic soundscape characterization, including sound recognition and appraisal. Using the DeLTA dataset containing human-annotated sound source labels and perceived annoyance, the DCNN-CaF is proposed to perform sound source classification (SSC) and human-perceived annoyance rating prediction (ARP). Experimental findings indicate that (1) the proposed DCNN-CaF using loudness and Mel features outperforms the DCNN-CaF using only one of them. (2) The proposed DCNN-CaF with cross-attention fusion outperforms other typical AI-based models and soundscape-related traditional machine learning methods on the SSC and ARP tasks. (3) Correlation analysis reveals that the relationship between sound sources and annoyance is similar for humans and the proposed AI-based DCNN-CaF model. (4) Generalization tests show that the proposed model's ARP in the presence of model-unknown sound sources is consistent with expert expectations and can explain previous findings from the literature on soundscape augmentation.

Preventing Excessive Noise Exposure in Infants, Children, and Adolescents

Noise exposure is a major cause of hearing loss in adults. Yet, noise affects people of all ages, and noise-induced hearing loss is also a problem for young people. Sensorineural hearing loss caused by noise and other toxic exposures is usually irreversible. Environmental noise, such as traffic noise, can affect learning, physiologic parameters, and quality of life. Children and adolescents have unique vulnerabilities to noise. Children may be exposed beginning in NICUs and well-baby nurseries, at home, at school, in their neighborhoods, and in recreational settings. Personal listening devices are increasingly used, even by small children. Infants and young children cannot remove themselves from noisy situations and must rely on adults to do so, children may not recognize hazardous noise exposures, and teenagers generally do not understand the consequences of high exposure to music from personal listening devices or attending concerts and dances. Environmental noise exposure has disproportionate effects on underserved communities. In this report and the accompanying policy statement, common sources of noise and effects on hearing at different life stages are reviewed. Noise-abatement interventions in various settings are discussed. Because noise exposure often starts in infancy and its effects result mainly from cumulative exposure to loud noise over long periods of time, more attention is needed to its presence in everyday activities starting early in life. Listening to music and attending dances, concerts, and celebratory and other events are sources of joy, pleasure, and relaxation for many people. These situations, however, often result in potentially harmful noise exposures. Pediatricians can potentially lessen exposures, including promotion of safer listening, by raising awareness in parents, children, and teenagers. Noise exposure is underrecognized as a serious public health issue in the United States, with exposure limits enforceable only in workplaces and not for the general public, including children and adolescents. Greater awareness of noise hazards is needed at a societal level.

Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study

Background

Exposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting.

Methods

In this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical-surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds.

Results

The mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently.

Conclusion

Our study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, identifying these sound sources can have a meaningful impact on patients and staff by identifying targets for future interventions, thus leading to a healthier environment.

Promoting Functional Recovery in Critically Ill Children

Over two-thirds of pediatric critical illness survivors will experience functional impairments that persist after discharge, that is, post-intensive care syndrome in pediatrics (PICS-p). Risk factors include child and family characteristics, invasive procedures, and social determinants of health. Approaches to remediate PICS-p include early rehabilitation, minimizing sedation, psychosocial resources for caregivers, delivery of family-centered care, and longitudinal screening for PICS-p. Challenges include feasible and validated approaches to screening, and resources and coordination for multidisciplinary care. Next steps should include resources to identify and address adverse social determinants of health and examination of treatment efficacy and implementation equity.

Noise exposure in pediatric otolaryngology clinic: A sound survey of a single-institution tertiary care facility

BACKGROUND

The Occupational Safety and Health Administration (OSHA) considers acoustic exposure of 90 decibels (dB) an occupational risk for noise-induced hearing loss. Pediatric healthcare clinicians are exposed to considerable noise especially during invasive procedures, predisposing them to noise-induced hearing loss, increased work-related stress, and increased complications associated with intense noise exposure. While there has been extensive research in noise exposure in dentistry, to date there has been no research on noise exposure in the pediatric otolaryngology clinic setting. The objective of this study is to quantify the degree of noise exposure that pediatric otolaryngologists encounter in the clinical setting.

METHODS

A sound survey was performed of 420 pediatric otolaryngology clinic visits within a single-institution tertiary care facility from January 2022 to March 2022, with a total of 409 visits included. At each visit, noise was measured using a calibrated National Institute for Occupational Safety and Health (NIOSH) Sound Meter application, an iPad, and a microphone. The Equivalent Continuous Sound Pressure Level (LAeq), peak sound pressure level (SPL), C-weighted peak noise level (LCpeak), and the 8-hour time-weighted average (TWA) sound level were recorded.

RESULTS

The average LAeq was 61.1 dB, the median LAeq was 60.3 dB, and the average peak SPL was 80.5 dB. Only 0.5 % of visits reached an LAeq above 80 dB, however, 51 % were above 60 dB and 99 % were above 45 dB. No clinicians were exposed to noise exceeding established limits of safety. Patients younger than ten years old (p < 0.001) and those who underwent procedures such as cerumen removal (p < 0.001) elicited higher ranges of elevated noise. Multivariate analysis confirmed that increased age decreased acoustic exposure while procedures increased acoustic exposure.

CONCLUSIONS

The results of this study suggest that pediatric otolaryngology clinicians do not exceed hazardous noise limit exposure. However, they are exposed to levels above those which have been linked to stress, poor productivity, and stress-related disorders. This analysis also reports that patients who are younger and those that undergo procedures, specifically cerumen removal, tend to expose their providers to the highest levels of noise. This is the first study examining noise exposure in pediatric otolaryngology, and further research should evaluate the risks of noise exposure in this environment.

Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study

OBJECTIVES

In this preliminary, longitudinal study, our objective was to assess changes in sleep quality during an inpatient stay in a rehabilitation setting in the United States and to relate changes to patients' demographic and clinical characteristics (i.e., age, gender, BMI, ethnicity, reason for hospitalization, pre-hospital living setting, prior diagnosis of sleep disorders, and mental health status).

METHODS

A total of 35 patients participated in this preliminary study (age = 61 ± 16 years old, 50% <65; BMI = 30 ± 7 kg/m²; 51% female; 51% Caucasian). The average length of hospitalization was 18 ± 8 days. Reasons for hospitalization included orthopedic-related issues (28%), spinal cord injury (28%), stroke (20%), and other (23%). In this sample, 23% had prior sleep disorders (mostly sleep apnea), and 60% came from an acute care unit. Patients' sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) at admission and before discharge. Demographic and medical data were collected. Patients' mental health status was also assessed at the same intervals. Nighttime sound levels and the average number of sleep disturbances were also collected throughout the study (6 months).

RESULTS

Our data revealed that most patients had poor sleep (PSQI > 5) at admission (86%) and discharge (80%). Using a repeated ANOVA, a significant interaction was obtained between sleep quality and the presence of a diagnosed sleep disorder [F (1, 33) = 12.861, p = 0.001, η²_p = 0.280]. The sleep quality of patients with sleep disorders improved over their stay, while the sleep of patients without such disorders did not. The mean nighttime sound collection level averages and peaks were 62.3 ± 5.1 dB and 86.1 ± 4.9 dB, respectively, and the average number of sleep disturbances was 2.6 ± 1.1.

CONCLUSION

The improved sleep observed in patients with vs. without sleep disorders might be related to the care received for treating such disorders over the stay. Our findings call for the better detection and management of poor sleep in acute inpatient rehabilitation settings. Furthermore, if our findings are replicated in the future, studies on the implementation of quiet times for medical staff, patients, and family should be performed to improve sleep quality in the inpatient rehabilitation setting.

The Effectiveness of the Interventions to Reduce Sound Levels in the ICU: A Systematic Review

Excessive noise is ubiquitous in the ICU, and there is growing evidence of the negative impact on work performance of caregivers. This study aims to determine the effectiveness of interventions to reduce noise in the ICU.

DATA SOURCES

Databases of PubMed, EMBASE, PsychINFO, CINAHL, and Web of Science were systematically searched from inception to September 14, 2022.

STUDY SELECTION

Two independent reviewers assessed titles and abstracts against study eligibility criteria. Noise mitigating ICU studies were included when having at least one quantitative acoustic outcome measure expressed in A-weighted sound pressure level with an experimental, quasi-experimental, or observational design. Discrepancies were resolved by consensus, and a third independent reviewer adjudicated as necessary.

DATA EXTRACTION

After title, abstract, and full-text selection, two reviewers independently assessed the quality of each study using the Cochrane's Risk Of Bias In Nonrandomized Studies of Interventions tool. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and interventions were summarized.

DATA SYNTHESIS

After screening 12,652 articles, 25 articles were included, comprising either a mixed group of healthcare professionals (n = 17) or only nurses (n = 8) from adult or PICU settings. Overall, the methodological quality of the studies was low. Noise reduction interventions were categorized into education (n = 4), warning devices (n = 3), multicomponent programs (n = 15), and architectural redesign (n = 3). Education, a noise warning device, and an architectural redesign significantly decreased the sound pressure levels.

CONCLUSIONS

Staff education and visual alert systems seem promising interventions to reduce noise with a short-term effect. The evidence of the studied multicomponent intervention studies, which may lead to the best results, is still low. Therefore, high-quality studies with a low risk of bias and a long-term follow-up are warranted. Embedding noise shielding within the ICU-redesign is supportive to reduce sound pressure levels.

Perceived sounds and their reported level of disturbance in intensive care units: A multinational survey among healthcare professionals

PURPOSE

The noise levels in intensive care units have been repeatedly reported to exceed the recommended guidelines and yield negative health outcomes among healthcare professionals. However, it is unclear which sound sources within this environment are perceived as disturbing. Therefore, this study aimed to evaluate how healthcare professionals in Germany, Switzerland, and Austria perceive the sound levels and the associated sound sources within their work environment and explore sound reduction strategies.

MATERIAL AND METHODS

An online survey was conducted among 350 healthcare professionals working in intensive care units. The survey consisted of items on demographic and hospital data and questions about the perception of the sound levels [1 (strongly disagree) to 5 (strongly agree)], disturbance from sound sources [1 (not disturbing at all) to 5 (very disturbing)], and implementation potential, feasibility, and motivation to reduce sound reduction measures [1 (not high at all) to 5 (very high)].

RESULTS

Approximately 69.3% of the healthcare professionals perceived the sound levels in the ICUs as too high. Short-lasting human sounds (e.g. moans or laughs) [mean (M) ± standard deviation (SD) = 3.30 ± 0.81], devices and alarms (M ± SD = 2.67 ± 0.59), and short-lasting object sounds (M ± SD = 2.55 ± 0.68) were perceived as the most disturbing sounds. Reducing medical equipment alarms was considered to have greater implementation potential [M ± SD = 3.62 ± 0.92, t(334) = -7.30, p < 0.001], feasibility [M ± SD = 3.19 ± 0.93, t(334) = -11.02, p < 0.001], and motivation [M ± SD = 3.85 ± 0.89, t(334) = -10.10, p < 0.001] for reducing the sound levels.

CONCLUSION

This study showed that healthcare professionals perceive short-lasting human sounds as most disturbing and rated reducing medical equipment alarms as the best approach to reduce the sound levels in terms of potential, feasibility, and motivation for implementation.

Noise in ICUs: Review and Detailed Analysis of Long-Term SPL Monitoring in ICUs in Northern Spain

Intensive care units (ICUs) are busy and noisy areas where patients and professional staff can be exposed to acoustic noise for long periods of time. In many cases, noise levels significantly exceed the levels recommended by the official health organisations. This situation can affect not only patient recovery but also professional staff, making ICUs unhealthy work and treatment environments. To introduce the measures and reduce the acoustic noise in the ICU, acoustic noise levels should first be measured and then appropriately analysed. However, in most studies dealing with this problem, measurements have been performed manually over short periods, leading to limited data being collected. They are usually followed by insufficient analysis, which in turn results in inadequate measures and noise reduction. This paper reviews recent works dealing with the problem of excessively high noise levels in ICUs and proposes a more thorough analysis of measured data both in the time and frequency domains. Applied frequency domain analysis identifies the cyclic behaviour of the measured sound pressure levels (SPLs) and detects the dominant frequency components in the SPL time series. Moreover, statistical analyses are produced to depict the patterns and SPLs to which patients in ICUs are typically exposed during their stay in the ICU. It has been shown that the acoustic environment is very similar every night, while it can vary significantly during the day or evening periods. However, during most of the observed time, recorded SPLs were significantly above the prescribed values, indicating an urgent need for their control and reduction. To effectively tackle this problem, more detailed information about the nature of noise during each of the analysed periods of the day is needed. This issue will be addressed in the continuation of this project.

A Bayesian network model to predict the role of hospital noise, annoyance, and sensitivity in quality of patient care

Background

Hospital noise can adversely impact nurses’ health, their cognitive function and emotion and in turn, influence the quality of patient care and patient safety. Thus, the aim of this study was to predict the contributing roles of exposure to hospital noise, staff noise-sensitivity and annoyance, on the quality of patient care.

Methods

This descriptive and cross-sectional study was carried out among nurses in an Iranian hospital. To determine nurses’ noise exposure level, the noise was measured in 1510 locations across the hospital in accordance with ISO 9612 standards using KIMO DB 300/2 sound level meter and analyzer. An online survey was used to collect nurses’ individual data. Study questionnaires included demographics, Weinstein noise sensitivity scale, noise annoyance scale, and quality of patient care scale. Finally, to analyze the data, Bayesian Networks (BNs), as probabilistic and graphical models, were used.

Results

For the high noise exposure state, high noise sensitivity, and high annoyance, with the probability of 100%, the probability of delivering a desirable quality of patient care decreased by 21, 14, and 23%, respectively. Moreover, at the concurrently high noise exposure and high noise sensitivity with the probability of 100%, the desirable quality of patient care decreased by 26%. The Bayesian most influence value was related to the association of noise exposure and annoyance (0.636). Moreover, annoyance had the highest association with the physical aspect of quality of care (0.400) and sensitivity had the greatest association with the communication aspect (0.283).

Conclusion

Annoyance induced from environmental noise and personal sensitivity affected the quality of patient care adversely. Moreover, noise and sensitivity had a separate direct adverse effect upon the quality of patient care, and their co-occurrence reduced the potential for delivering quality patient care.

Methods for Measuring and Identifying Sounds in the Intensive Care Unit

Background

Despite many studies in the field examining excessive noise in the intensive care unit, this issue remains an ongoing problem. A limiting factor in the progress of the field is the inability to draw conclusions across studies due to the different and poorly reported approaches used. Therefore, the first goal is to present a method for the general measurement of sound pressure levels and sound sources, with precise details and reasoning, such that future studies can use these procedures as a guideline. The two procedures used in the general method will outline how to record sound pressure levels and sound sources, using sound level meters and observers, respectively. The second goal is to present the data collected using the applied method to show the feasibility of the general method and provide results for future reference.

Methods

The general method proposes the use of two different procedures for measuring sound pressure levels and sound sources in the intensive care unit. The applied method uses the general method to collect data recorded over 24-h, examining two beds in a four-bed room, via four sound level meters and four observers each working one at a time.

Results

The interrater reliability of the different categories was found to have an estimate of >0.75 representing good and excellent estimates, for 19 and 16 of the 24 categories, for the two beds examined. The equivalent sound pressure levels (L_Aeq) for the day, evening, and night shift, as an average of the sound level meters in the patient room, were 54.12, 53.37, and 49.05 dBA. In the 24-h measurement period, talking and human generated sounds occurred for a total of 495 (39.29% of the time) and 470 min (37.30% of the time), at the two beds of interest, respectively.

Conclusion

A general method was described detailing two independent procedures for measuring sound pressure levels and sound sources in the ICU. In a continuous data recording over 24 h, the feasibility of the proposed general method was confirmed. Moreover, good and excellent interrater reliability was achieved in most categories, making them suitable for future studies.

Intelligibility of medically related sentences in quiet, speech-shaped noise, and hospital noise

Noise in healthcare settings, such as hospitals, often exceeds levels recommended by health organizations. Although researchers and medical professionals have raised concerns about the effect of these noise levels on spoken communication, objective measures of behavioral intelligibility in hospital noise are lacking. Further, no studies of intelligibility in hospital noise used medically relevant terminology, which may differentially impact intelligibility compared to standard terminology in speech perception research and is essential for ensuring ecological validity. Here, intelligibility was measured using online testing for 69 young adult listeners in three listening conditions (i.e., quiet, speech-shaped noise, and hospital noise: 23 listeners per condition) for four sentence types. Three sentence types included medical terminology with varied lexical frequency and familiarity characteristics. A final sentence set included non-medically related sentences. Results showed that intelligibility was negatively impacted by both noise types with no significant difference between the hospital and speech-shaped noise. Medically related sentences were not less intelligible overall, but word recognition accuracy was significantly positively correlated with both lexical frequency and familiarity. These results support the need for continued research on how noise levels in healthcare settings in concert with less familiar medical terminology impact communications and ultimately health outcomes.

A contrastive learning approach for ICU false arrhythmia alarm reduction

The high rate of false arrhythmia alarms in Intensive Care Units (ICUs) can lead to disruption of care, negatively impacting patients’ health through noise disturbances, and slow staff response time due to alarm fatigue. Prior false-alarm reduction approaches are often rule-based and require hand-crafted features from physiological waveforms as inputs to machine learning classifiers. Despite considerable prior efforts to address the problem, false alarms are a continuing problem in the ICUs. In this work, we present a deep learning framework to automatically learn feature representations of physiological waveforms using convolutional neural networks (CNNs) to discriminate between true vs. false arrhythmia alarms. We use Contrastive Learning to simultaneously minimize a binary cross entropy classification loss and a proposed similarity loss from pair-wise comparisons of waveform segments over time as a discriminative constraint. Furthermore, we augment our deep models with learned embeddings from a rule-based method to leverage prior domain knowledge for each alarm type. We evaluate our method using the dataset from the 2015 PhysioNet Computing in Cardiology Challenge. Ablation analysis demonstrates that Contrastive Learning significantly improves the performance of a combined deep learning and rule-based-embedding approach. Our results indicate that the final proposed deep learning framework achieves superior performance in comparison to the winning entries of the Challenge.

Music Is Served: How Acoustic Interventions in Hospital Dining Environments Can Improve Patient Mealtime Wellbeing

Eating-related challenges and discomforts arising from moderately acquired brain injuries (ABI)—including physiological and cognitive difficulties—can interfere with patients’ eating experience and impede the recovery process. At the same time, external environmental factors have been proven to be influential in our mealtime experience. This experimental pilot study investigates whether redesigning the sonic environment in hospital dining areas can positively influence ABI patients’ (n = 17) nutritional state and mealtime experience. Using a three-phase between-subjects interventional design, we investigate the effects of installing sound proofing materials and playing music during the lunch meals at a specialised ABI hospital unit. Comprising both quantitative and qualitative research approaches and data acquisition methods, this project provides multidisciplinary and holistic insights into the importance of attending to sound in hospital surroundings. Our results demonstrate that improved acoustics and music playback during lunch meals might improve the mealtime atmosphere, the patient well-being, and social interaction, which potentially supports patient food intake and nutritional state. The results are discussed in terms of potential future implications for the healthcare sector.

Decaying amplitude envelopes reduce alarm annoyance: Exploring new approaches to improving auditory interfaces

Auditory alarms offer great potential for facilitating human-computer interactions in complex, rapidly changing environments. They are particularly useful in medical settings, where in theory they should afford communication in emergency rooms, operating theatres, and hospitals around the world. Unfortunately, the sounds typically used in these devices are problematic, and researchers have documented numerous shortcomings. Their ubiquity means that even incremental improvements can have significant benefits for patient care. However, solutions have proven challenging for multiple reasons-including issues of backward compatibility inherent in changing any standard. Here we present a series of three experiments showing that manipulations to one specific, understudied property can significantly lower alarm annoyance without harming learning or memory-while preserving an alarm's melodic and rhythmic structure. These results suggest promising new directions for improving the hospital's soundscape, where evidence of problems related to sound are increasingly recognized as affecting medical outcomes as well as physician well-being.

Sounds in nursing homes and their effect on health in dementia: a systematic review

OBJECTIVES

Nursing home residents with dementia are sensitive to detrimental auditory environments. This paper presents the first literature review of empirical research investigating (1) the (perceived) intensity and sources of sounds in nursing homes, and (2) the influence of sounds on health of residents with dementia and staff.

DESIGN

A systematic review was conducted in PubMed, Web of Science and Scopus. Study quality was assessed with the Mixed Methods Appraisal Tool. We used a narrative approach to present the results.

RESULTS

We included 35 studies. Nine studies investigated sound intensity and reported high noise intensity with an average of 55-68 dB(A) (during daytime). In four studies about sound sources, human voices and electronic devices were the most dominant sources. Five cross-sectional studies focused on music interventions and reported positives effects on agitated behaviors. Four randomized controlled trials tested noise reduction as part of an intervention. In two studies, high-intensity sounds were associated with decreased nighttime sleep and increased agitation. The third study found an association between music and less agitation compared to other stimuli. The fourth study did not find an effect of noise on agitation. Two studies reported that a noisy environment had negative effects on staff.

CONCLUSIONS

The need for appropriate auditory environments that are responsive to residents' cognitive abilities and functioning is not yet recognized widely. Future research needs to place greater emphasis on intervention-based and longitudinal study design.

"Noise Factory": A qualitative study exploring healthcare providers' perceptions of noise in the intensive care unit

OBJECTIVES

This study aimed to explore healthcare providers' perceptions of noise in the intensive care unit.

DESIGN

A qualitative exploratory study was conducted using group interviews.

SETTING

The setting comprised a total of 15 participants (five physicians and ten registered nurses) working in an 18-bed medical surgical intensive care unit at a teaching hospital in Istanbul, Turkey. Semi-structured questions were formulated and used in focus group interviews, after which the recorded interviews were transcribed by the researchers. Thematic analysis was used to identify significant statements and initial codes.

FINDINGS

Four themes were identified: the meaning of noise, sources of noise, effects of noise and prevention and management of noise. It was found that noise was an inevitable feature of the intensive care unit. The most common sources of noise were human-induced. It was also determined that device-induced noise, such as alarms, did not produce a lot of noise; however, when staff were late in responding, the sound transformed into noise. Furthermore, it was observed that efforts to decrease noise levels taken by staff had only a momentary effect, changing nothing in the long term because the entire team failed to implement any initiatives consistently. The majority of nurses stated that they were now becoming insensitive to the noise due to the constant exposure to device-induced noise.

CONCLUSION

The data obtained from this study showed that especially human-induced noise threatened healthcare providers' cognitive task functions, concentration and job performance, impaired communication and negatively affected patient safety. In addition, it was determined that any precautions taken to reduce noise were not fully effective. A team approach should be used in managing noise in intensive care units with better awareness.

Noise pollution in hospitals - A study of public perception

Introduction:

Hospitals are categorized under silent zone, but noise pollution in this setup is inevitable. The noise in hospitals may have adverse effects on the patients, caregivers and professionals working in hospitals.

Aim:

The aim of the study was to determine awareness of public regarding noise pollution in hospitals, its health effects and mitigation measures.

Method:

The present study was an internet-based questionnaire survey. The questionnaire consisted of a common Section-I for all participants and an additional Section-II for participants of the study who were Audiologists. Descriptive statistical analysis was done on the acquired data.

Results:

174 completed questionnaires were received and analysed, out of which 108 were general public and 66 were Audiologists. The data analysis revealed that the public is aware of the presence of noise in hospitals, some of its overt health effects and measures that can be taken to control the noise pollution in hospitals. Only 22.7% Audiologists who participated in the study were aware of the more technical aspects like permissible noise level in hospitals and their response was similar to that of the general public.

Conclusion:

Though the public is aware of some of the basic facts related to noise in hospitals, there is a need to create public awareness and to train Audiologists regarding hearing conservation program in hospital setups.

Re-Sounding Alarms: Designing Ergonomic Auditory Interfaces by Embracing Musical Insights

Auditory alarms are an important component of human–computer interfaces, used in mission-critical industries such as aviation, nuclear power plants, and hospital settings. Unfortunately, problems with recognition, detection, and annoyance continue to hamper their effectiveness. Historically, they appear designed more in response to engineering constraints than principles of hearing science. Here we argue that auditory perception in general and music perception in particular hold valuable lessons for alarm designers. We also discuss ongoing research suggesting that the temporal complexity of musical tones offers promising insight into new ways of addressing widely recognized shortcomings of current alarms.

Cardiorespiratory and Pulse Oximetry Monitoring in Hospitalized Children: A Delphi Process

OBJECTIVES

Cardiorespiratory and pulse oximetry monitoring in children who are hospitalized should balance benefits of detecting deterioration with potential harms of alarm fatigue. We developed recommendations for monitoring outside the ICU on the basis of available evidence and expert opinion.

METHODS

We conducted a comprehensive literature search for studies addressing the utility of cardiorespiratory and pulse oximetry monitoring in common pediatric conditions and drafted candidate monitoring recommendations based on our findings. We convened a panel of nominees from national professional organizations with diverse expertise: nursing, medicine, respiratory therapy, biomedical engineering, and family advocacy. Using the RAND/University of California, Los Angeles Appropriateness Method, panelists rated recommendations for appropriateness and necessity in 3 sequential rating sessions and a moderated meeting.

RESULTS

The panel evaluated 56 recommendations for intermittent and continuous monitoring for children hospitalized outside the ICU with 7 common conditions (eg, asthma, croup) and/or receiving common therapies (eg, supplemental oxygen, intravenous opioids). The panel reached agreement on the appropriateness of monitoring recommendations for 55 of 56 indications and on necessity of monitoring for 52. For mild or moderate asthma, croup, pneumonia, and bronchiolitis, the panel recommended intermittent vital sign or oximetry measurement only. The panel recommended continuous monitoring for severe disease in each respiratory condition as well as for a new or increased dose of intravenous opiate or benzodiazepine.

CONCLUSIONS

Expert panel members agreed that intermittent vital sign assessment, rather than continuous monitoring, is appropriate management for a set of specific conditions of mild or moderate severity that require hospitalization.

Effects of intensive care unit ambient sounds on healthcare professionals: results of an online survey and noise exposure in an experimental setting

BACKGROUND

Noise levels on intensive care units (ICUs) are typically elevated. While many studies reported negative effects of ICU ambient sounds on patients, only few investigated noise as a factor to influence well-being or performance in healthcare professionals.

METHODS

An online survey in the German-speaking part of Switzerland was conducted to assess how ICU soundscapes are subjectively perceived by healthcare professionals. The questionnaire was answered by 348 participants. Additionally, effects of noise on working memory performance were evaluated in an experimental noise exposure setting. Twenty-six healthcare professionals and 27 healthy controls performed a 2-back object-location task while being exposed to either ICU or pink noise.

RESULTS

Survey results demonstrate that a majority of participants was aware of heightened noise levels. Participants reported that mostly well-being, performance, and attention could be reduced, along with subjective annoyance and fatigue by ICU ambient sounds. Although no significant effects of noise exposure on working memory performance was observed, self-assessments revealed significantly higher stress levels, increased annoyance and distraction ratings as well as decreased confidence in performance after ICU-noise exposure.

CONCLUSION

Subjective assessments indicate that heightened noise levels on ICUs induce annoyance, with heightened stress levels, impaired well-being, and reduced performance being potential consequences. Empirical evidence with objective and physiological measures is warranted.

Contribution of alarm noise to average sound pressure levels in the ICU: An observational cross-sectional study

OBJECTIVES

To explore sound levels, alarm frequencies and the association between alarms and sound levels.

DESIGN

A single center observational cross-sectional study.

SETTING

Four intensive care units.

MAIN OUTCOME MEASURES

Contribution of alarms: red (life threatening), yellow (indicate excess of limits) and blue (technical) to sound pressure levels dB(A) at nursing stations.

RESULTS

Mean sound pressure levels differed significantly between day (56.1 ± 5.5), evening (55.1 ± 5.7) and night periods 53.6 ± 5.6; p < 0.01. 175,996 alarms were recorded of which 149,764 (85%) were yellow, 18,080 (10%) were red and 8,152 (5%) were blue. The mean sound levels without alarms (background) is 56.8 dB(A), with only red: 56.0 dB(A), only yellow: 55.6 dB(A), only blue: 56.0 dB(A) and mixed alarms: 56.3 dB(A). Yellow alarms (b = -0.93; 95% CI: -1.26 to -0.6; p < 0.001) were weakly but significantly associated with mean sound levels and lead to a slight decrease in noise level (1 dB), Red alarms (b = -0.3; 95% CI: -1.237 to 0.63; p = 0.52). The R Square of the model with all alarms was 0.01 (standard error of estimate, 6.9; p < 0.001).

CONCLUSIONS

Sound levels were high during all day-periods. Alarms exceeding limits occurred most frequently. However, the contribution of alarms to sound levels measured at the nursing station is clinically limited.

Hospital flooring safety and health: knowledge gaps and suggestions

Fall incidents are a leading safety concern in the hospital industry. Whereas roughening the floor surface can reduce fall risks, there remains unanswered controversies between achieving and maintaining hygienic cleaning efficiencies and adequately addressing conditions of flooring safety. Thus, the current study critically overviews the status of research and accepted practices on hospital flooring safety and healthy controls. Salient literature was identified by searching keywords and phrases within the databases of PubMed, Web of Science, MEDLINE, Scopus and ScienceDirect to find answers for the major questions on hospital floorings. A comprehensive review analysis identified that underlying causes of hospital fall incidents and flooring-attributable infectious illnesses mainly comprised floor types and materials, cleaning chemicals, materials and methods, maintenance and slip-resistance properties. Findings from this study suggest several major actions to advance hospital flooring safety and health research and practice.

Assessment Of Ambient-Noise Exposure Among Female Nurses In Surgical Cardiac Intensive Care Unit

PURPOSE

To measure noise levels in the Saud Albabtain Cardiac Center cardiac surgical intensive-care unit (CSICU) at different locations to find out the prevalence of noise-induced hearing loss among female nurses.

METHODS

Ambient CSICU noise was measured using a sound-level meter and personal noise dosimeter during morning and night shifts (12 hours each) for 30 days. An audiometry test and questionnaire were used to test nursing responses to noise levels.

RESULTS

Mean 12-hour average noise levels at the station during night shift were 60.3±7.1 dB(A) and inside rooms 62.48±8.02 dB(A). However, during morning shift 64.1±8.4 dB(A) in the rooms was recorded, while 68.8±8.2 dB(A) was recorded at the station, with a significant difference between the shifts (p<0.0001). ICU monitors recorded the highest noise-source levels of 82.7±5.3 dB(A). The lowest significant source was the suction machines, with an average of 67.1±12.5 dB(A). A significant correlation between decibel loss and nurse experience was observed.

CONCLUSION

Noise levels in the CSICU at Saud Albabtain Cardiac Center were higher than World Health Organization standards. CSICU nurses are exposed to noise levels that can affect their hearing capacity. Further research isneeded for effective medical device-alarm management.

Floor finish selection in health-care facilities: a systematic literature review

Purpose

The purpose of this paper is to identify, analyze and discuss floor finishes used in health-care facilities and their selection criteria in the form of advantages and disadvantages. The authors also identify the top three health-care floor finishes and selection criteria based on the literature review results. Although flooring materials have a considerable impact on the life-cycle cost and indoor environment of health-care facilities, what criteria may be used for such flooring choices is not thoroughly studied.

Design/methodology/approach

The authors performed a systematic review of the literature on certain flooring systems currently used in health-care facilities and the criteria applied for their selection. Peer-reviewed studies and articles published after Year 2000 consistent with the research design were included.

Findings

Sixteen different selection criteria that influence the choice of floor finishes in health-care facilities were determined and discussed. The results show that the top three-floor finish materials preferred in health-care facilities are sheet vinyl, rubber and carpet, and the top three selection criteria for floor finishes are indoor air quality, patient safety and infection control.

Originality/value

The results of this study will assist building owners, architects and interior designers with implementing an informed design decision-making process, particularly in relation to floor finish selection. The findings will also provide guidance to floor finish manufacturers to improve their products based on facility managers’ preferences.

Safer health care environments by design

Health care environments can and are being designed to prevent injury, minimize human error, and actually promote improved health and safety. This article shows risk managers how evidence-based design is reducing medication error, staff injury, infection rates, patient falls, and more. Research knowledge can contribute to effective design solutions by simply clarifying a safety problem so solutions can be sought; it can inform the design process with potential solutions; or it can be part of a structured process where new research knowledge is created. This article shares specific examples of the types of research that can inform designing for a safer physical environment. A case study shows how one project in two phases benefited from engaging initially in a general way and later, in a highly structured process, to integrate the evidence to improve design for safety.

Effects of strategic early-morning caffeine gum administration on association between salivary alpha-amylase and neurobehavioural performance during 50 h of sleep deprivation

Self-assessment is the most common method for monitoring performance and safety in the workplace. However, discrepancies between subjective and objective measures have increased interest in physiological assessment of performance. In a double-blind placebo-controlled study, 23 healthy adults were randomly assigned to either a placebo (n = 11; 5 F, 6 M) or caffeine condition (n = 12; 4 F, 8 M) while undergoing 50 h (i.e. two days) of total sleep deprivation. In previous work, higher salivary alpha-amylase (sAA) levels were associated with improved psychomotor vigilance and simulated driving performance in the placebo condition. In this follow-up article, the effects of strategic caffeine administration on the previously reported diurnal profiles of sAA and performance, and the association between sAA and neurobehavioural performance were investigated. Participants were given a 10 h baseline sleep opportunity (monitored via standard polysomnography techniques) prior to undergoing sleep deprivation (total sleep time: placebo = 8.83 ± 0.48 h; caffeine = 9.01 ± 0.48 h). During sleep deprivation, caffeine gum (200 mg) was administered at 01:00 h, 03:00 h, 05:00 h, and 07:00 h to participants in the caffeine condition (n = 12). This strategic administration of caffeine gum (200 mg) has been shown to be effective at maintaining cognitive performance during extended wakefulness. Saliva samples were collected, and psychomotor vigilance and simulated driving performance assessed at three-hour intervals throughout wakefulness. Caffeine effects on diurnal variability were compared with previously reported findings in the placebo condition (n = 11). The impact of caffeine on the circadian profile of sAA coincided with changes in neurobehavioural performance. Higher sAA levels were associated with improved performance on the psychomotor vigilance test during the first 24 h of wakefulness in the caffeine condition. However, only the association between sAA and response speed (i.e. reciprocal-transform of mean reaction time) was consistent across both days of sleep deprivation. The association between sAA and driving performance was not consistent across both days of sleep deprivation. Results show that the relationship between sAA and reciprocal-transform of mean reaction time on the psychomotor vigilance test persisted in the presence of caffeine, however the association was relatively weaker as compared with the placebo condition.

Environmental Noise around Hospital Areas: A Case Study

Due to the particular characteristics of hospitals, these buildings are highly sensitive to environmental noise. However, they are usually located close or within urban agglomerations. Hence, hospitals are, in many cases, exposed to high levels of environmental noise. A study of one of the main hospitals in the Extremadura region (Spain) is presented here to allow a global assessment of the acoustic impact of outdoor sound sources. Both long- and short-term measurements were carried out, and a software model was developed. The measured values exceed the World Health Organisation reference value of 50 dBA for daytime and evening, and are even higher than the 55 dBA limit at which severe annoyance is generated. Taking into account the results obtained, the noise impact on this hospital is primarily influenced by three sound sources: road traffic, cooling towers of the hospital and the emergency helicopter. Their relative importance depends on the facade under consideration. It can therefore be concluded that the overall situation of the hospital needs to be improved. Thus, a series of solutions are proposed for a possible action plan based on interventions regarding the main sound sources and the location of the most sensitive areas to environmental noise.

Noise levels in general pediatric facilities: A health risk for the staff?

This study was initiated to investigate noise levels in general pediatric facilities. Although occupational noise limits of 85dBA for L_Aeq,8h (daily noise exposure) and 140dBC for L_Cpeak (peak sound level) have proven to prevent hearing loss, even low levels of continuous noise (45dBA and above) can cause adverse health effects (ISO = International Organization for Standardization, A = Austrian VOLV). The sound level measurements of L_Aeq (equivalent sound level) and L_Cpeak were conducted with a decibel meter in the examination rooms (EXR) and waiting rooms (WR) of 10 general pediatric practices and outpatient clinics in the city of Vienna, Austria. L_Aeq,8h was calculated from L_Aeq, and independent variables with a potential influence on noise levels were also examined. In EXR, the random sample consisted of 5 to 11 measuring periods per facility (mean: 7.1 ± 1.9) with a total duration between 43.85 and 98.45 min. (total: 10:19:04). With L_Aeq ranging from 67.2 to 80.2dBA, specific recommended limits were exceeded considerably (ISO: 45dBA; A: 50dBA). In WR, the random sample comprised 5 to 18 measurements per facility (mean: 13.7 ± 5.0) with a total duration ranging from 25 to 90 min. (total: 11:25:00). The values for L_Aeq were between 60.6dBA and 67.0dBA. All of these significantly exceeded recommended limits of 55dBA (ISO) and 5 out of 10 exceeded 65dBA (A). L_Cpeak reached 116.1dBC in WR and 114.1dBC in EXR. The highest calculated daily noise exposure of pediatricians (L_Aeq,8h) was 79dBA. Although no significantly increased risk for hearing loss can be concluded from our findings, it must be assumed that noise levels in general pediatrics have the potential to cause stress and associated health issues. Further research is necessary to foster the recognition of noise-related health impairments of pediatric staff as occupational diseases.

Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms

Objective

This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs.

Materials and methods

A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts.

Results

Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001).

Discussion and conclusion

Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms.

Prospective cohort study on noise levels in a pediatric cardiac intensive care unit

PURPOSE

To describe noise levels in a pediatric cardiac intensive care unit, and to determine the relationship between sound levels and patient sedation requirements.

MATERIALS AND METHODS

Prospective observational study at a pediatric cardiac intensive care unit (PCICU). Sound levels were measured continuously in slow A weighted decibels dB(A) with a sound level meter SoundEarPro® during a 4-week period. Sedation requirement was assessed using the number of intermittent (PRNs) doses given per hour. Analysis was conducted with autoregressive moving average models and the Granger test for causality.

RESULTS

39 children were included in the study. The average (SD) sound level in the open area was 59.4 (2.5) dB(A) with a statistically significant but clinically unimportant difference between day/night hours (60.1 vs. 58.6; p-value < 0.001). There was no significant difference between sound levels in the open area/single room (59.4 vs. 60.8, p-value = 0.108). Peak noise levels were > 90 dB. There was a significant association between average (p-value = 0.030) and peak sound levels (p-value = 0.006), and number of sedation PRNs.

CONCLUSION

Sound levels were above the recommended values with no differences between day/night or open area/single room. High sound levels were significantly associated with sedation requirements.

The Importance of Specific Workplace Environment Characteristics for Maximum Health and Performance: Healthcare Workers' Perspective

OBJECTIVE

To examine the importance of specific workplace environment characteristics for maximum health and performance, assigned by healthcare employees, and how they relate to the nature of their work.

METHODS

A cross-sectional mixed-method study was conducted with content analysis and robust regression models to examine the relationship between workplace environment characteristics and perceived importance in promoting health and performance.

RESULTS

Our findings suggest that perceptions of key environment characteristics that safeguard health and performance in healthcare workplaces may vary by employee sex, setting, and nature of healthcare work involved. Theme and model descriptions of the influence of these factors on participant perceptions are provided.

CONCLUSIONS

Employee feedback on workplace characteristics that impact health and performance could be instrumental in determining the priorities of workplace design.

Stress, Fatigue, and Workload in Intensive Care Nursing: A Scoping Literature Review

Stress and fatigue are being interchangeably used in the nursing literature resulting in operationalization and measurement issues. A scoping review was conducted to identify different definitions and operationalization of these constructs. Findings can be used to develop tools to measure stress and fatigue as different constructs to aid nursing administrators to gain a new perspective into nursing schedule, workload, morale and well-being of nurses. The findings show that there is a research gap in measurement of acute stress in nursing, physiological measures are currently not used for continuous assessment of stress or fatigue for nurses, and lack of stress and fatigue definitions in terms of physiological measures for assessment purposes. Continuous monitoring and physiological measures such as heart rate can be used to measure and differentiate between the constructs of stress and fatigue

Quality Improvement Initiative to Reduce Pediatric Intensive Care Unit Noise Pollution With the Use of a Pediatric Delirium Bundle

OBJECTIVES:

Noise pollution in pediatric intensive care units (PICU) contributes to poor sleep and may increase risk of developing delirium. The Environmental Protection Agency (EPA) recommends <45 decibels (dB) in hospital environments. The objectives are to assess the degree of PICU noise pollution, to develop a delirium bundle targeted at reducing noise, and to assess the effect of the bundle on nocturnal noise pollution.

METHODS:

This is a QI initiative at an academic PICU. Thirty-five sound sensors were installed in patient bed spaces, hallways, and common areas. The pediatric delirium bundle was implemented in 8 pilot patients (40 patient ICU days) while 108 non-pilot patients received usual care over a 28-day period.

RESULTS:

A total of 20,609 hourly dB readings were collected. Hourly minimum, average, and maximum dB of all occupied bed spaces demonstrated medians [interquartile range] of 48.0 [39.0-53.0], 52.8 [48.1-56.2] and 67.0 [63.5-70.5] dB, respectively. Bed spaces were louder during the day (10AM to 4PM) than at night (11PM to 5AM) (53.5 [49.0-56.8] vs. 51.3 [46.0-55.3] dB, P < 0.01). Pilot patient rooms were significantly quieter than non-pilot patient rooms at night (n=210, 45.3 [39.7-55.9]) vs. n=1841, 51.2 [46.9-54.8] dB, P < 0.01). The pilot rooms compliant with the bundle had the lowest hourly nighttime average dB (44.1 [38.5-55.5]).

CONCLUSIONS:

Substantial noise pollution exists in our PICU, and utilizing the pediatric delirium bundle led to a significant noise reduction that can be perceived as half the loudness with hourly nighttime average dB meeting the EPA standards when compliant with the bundle.

Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study

PURPOSE

Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment.

METHODS

Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar.

RESULTS

Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff.

CONCLUSIONS

Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.

Factors Affecting Acoustics and Speech Intelligibility in the Operating Room: Size Matters

Supplemental Digital Content is available in the text.

INTRODUCTION:

Noise in health care settings has increased since 1960 and represents a significant source of dissatisfaction among staff and patients and risk to patient safety. Operating rooms (ORs) in which effective communication is crucial are particularly noisy. Speech intelligibility is impacted by noise, room architecture, and acoustics. For example, sound reverberation time (RT₆₀) increases with room size, which can negatively impact intelligibility, while room objects are hypothesized to have the opposite effect. We explored these relationships by investigating room construction and acoustics of the surgical suites at our institution.

METHODS:

We studied our ORs during times of nonuse. Room dimensions were measured to calculate room volumes (V_R). Room content was assessed by estimating size and assigning items into 5 volume categories to arrive at an adjusted room content volume (V_C) metric. Psychoacoustic analyses were performed by playing sweep tones from a speaker and recording the impulse responses (ie, resulting sound fields) from 3 locations in each room. The recordings were used to calculate 6 psychoacoustic indices of intelligibility. Multiple linear regression was performed using V_R and V_C as predictor variables and each intelligibility index as an outcome variable.

RESULTS:

A total of 40 ORs were studied. The surgical suites were characterized by a large degree of construction and surface finish heterogeneity and varied in size from 71.2 to 196.4 m³ (average V_R = 131.1 [34.2] m³). An insignificant correlation was observed between V_R and V_C (Pearson correlation = 0.223, P = .166). Multiple linear regression model fits and β coefficients for V_R were highly significant for each of the intelligibility indices and were best for RT₆₀ (R² = 0.666, F(2, 37) = 39.9, P < .0001). For D_max (maximum distance where there is <15% loss of consonant articulation), both V_R and V_C β coefficients were significant. For RT₆₀ and D_max, after controlling for V_C, partial correlations were 0.825 (P < .0001) and 0.718 (P < .0001), respectively, while after controlling for V_R, partial correlations were −0.322 (P = .169) and 0.381 (P < .05), respectively.

CONCLUSIONS:

Our results suggest that the size and contents of an OR can predict a range of psychoacoustic indices of speech intelligibility. Specifically, increasing OR size correlated with worse speech intelligibility, while increasing amounts of OR contents correlated with improved speech intelligibility. This study provides valuable descriptive data and a predictive method for identifying existing ORs that may benefit from acoustic modifiers (eg, sound absorption panels). Additionally, it suggests that room dimensions and projected clinical use should be considered during the design phase of OR suites to optimize acoustic performance.

Effect of environmental noise and music on dexmedetomidine-induced sedation in dogs

Background

Previous studies in human patients suggest depth of sedation may be affected by environmental noise or music; however, related data in domestic animals is limited. The objective of the current study was to investigate the effect of noise and music on dexmedetomidine-induced (DM- 10 µg/kg, IM) sedation in 10 dogs.

Methods

In a crossover design, post-DM injection dogs were immediately subjected to recorded human voices at either 55–60 decibel (dB) (Noise 1) or 80–85 dB (Noise 2); classical music at 45–50 dB (Music); or background noise of 40–45 dB (Control+). Control− included IM saline injection and exposure to 40–45 dB background noise. Sedation was assessed via monitoring spontaneous behavior and accelerometry (delta-g) throughout three 20-min evaluation periods: baseline, noise exposure, and post-treatment. Sedation was further assessed during two restraint tests at 30 min (R1) and 40 min (R2) post-injection. A mixed model for crossover design was used to determine the effect of noise exposure and time on either spontaneous behavior scores or delta-g. The restraint scores were analyzed using a two-way repeated measures ANOVA.

Results

Spontaneous behavior scores indicated less sedation during Noise 2 compared to Control+ (P = 0.05). R2 restraint scores for all DM treatments except Noise 2 indicated significantly higher sedation than Control− [C+ (P = 0.003), M (P = 0.014) and N1 (P = 0.044)].

Discussion

Results suggest that the quality of sedation is negatively impacted by high-intensity noise conditions (80–85 dB), but exposure to music did not improve sedation in this population of research dogs.

Noise peaks influence communication in the operating room. An observational study

Noise peaks are powerful distractors. This study focuses on the impact of noise peaks on surgical teams' communication during 109 long abdominal surgeries. We related measured noise peaks during 5-min intervals to the amount of observed communication during the same interval. Results show that noise peaks are associated with less case-relevant communication; this effect is moderated by the level of surgical experience; case-relevant communications decrease under high noise peak conditions among junior, but not among senior surgeons. However, case-irrelevant communication did not decrease under high noise level conditions, rather there was a trend to more case-irrelevant communication under high noise peaks. The results support the hypothesis that noise peaks impair communication because they draw on attentional resources rather than impairing understanding of communication. As case-relevant communication is important for surgical performance, exposure to high noise peaks in the OR should be minimised especially for less experienced surgeons. Practitioner Summary: This study investigated whether noise during surgeries influenced the communication within surgical teams. During abdominal surgeries, noise levels were measured and communication was observed. Results showed that high noise peaks reduced the frequency of patient-related communication, but did not reduce patient-irrelevant communication. Noise may negatively affect team coordination in surgeries.

Development and Application of a Clinical Microsystem Simulation Methodology for Human Factors-Based Research of Alarm Fatigue

OBJECTIVES

(1) To develop a clinical microsystem simulation methodology for alarm fatigue research with a human factors engineering (HFE) assessment framework and (2) to explore its application to the comparative examination of different approaches to patient monitoring and provider notification.

BACKGROUND

Problems with the design, implementation, and real-world use of patient monitoring systems result in alarm fatigue. A multidisciplinary team is developing an open-source tool kit to promote bedside informatics research and mitigate alarm fatigue.

METHOD

Simulation, HFE, and computer science experts created a novel simulation methodology to study alarm fatigue. Featuring multiple interconnected simulated patient scenarios with scripted timeline, "distractor" patient care tasks, and triggered true and false alarms, the methodology incorporated objective metrics to assess provider and system performance. Developed materials were implemented during institutional review board-approved study sessions that assessed and compared an experimental multiparametric alerting system with a standard monitor telemetry system for subject response, use characteristics, and end-user feedback.

RESULTS

A four-patient simulation setup featuring objective metrics for participant task-related performance and response to alarms was developed along with accompanying structured HFE assessment (questionnaire and interview) for monitor systems use testing. Two pilot and four study sessions with individual nurse subjects elicited true alarm and false alarm responses (including diversion from assigned tasks) as well as nonresponses to true alarms. In-simulation observation and subject questionnaires were used to test the experimental system's approach to suppressing false alarms and alerting providers.

CONCLUSIONS

A novel investigative methodology applied simulation and HFE techniques to replicate and study alarm fatigue in controlled settings for systems assessment and experimental research purposes.

Assessment of noise pollution in and around a sensitive zone in North India and its non-auditory impacts

Noise pollution in hospitals is recognized as a serious health hazard. Considering this, the current study aimed to map the noise pollution levels and to explore the self reported non-auditory effects of noise in a tertiary medical institute. The study was conducted in an 1800-bedded tertiary hospital where 27 sites (outdoor, indoor, road side and residential areas) were monitored for exposure to noise using Sound Level Meter for 24h. A detailed noise survey was also conducted around the sampling sites using a structured questionnaire to understand the opinion of the public regarding the impact of noise on their daily lives. The equivalent sound pressure level (Leq) was found higher than the permissible limits at all the sites both during daytime and night. The maximum equivalent sound pressure level (Lmax) during the day was observed higher (>80dB) at the emergency and around the main entrance of the hospital campus. Almost all the respondents (97%) regarded traffic as the major source of noise. About three-fourths (74%) reported irritation with loud noise whereas 40% of respondents reported headache due to noise. Less than one-third of respondents (29%) reported loss of sleep due to noise and 8% reported hypertension, which could be related to the disturbance caused due to noise. Noise levels in and around the hospital was well above the permissible standards. The recent Global Burden of Disease highlights the increasing risk of non communicable diseases. The non-auditory effects studied in the current work add to the risk factors associated with non communicable diseases. Hence, there is need to address the issue of noise pollution and associated health risks specially for vulnerable population.