NOISE
By Ameya Nerurkar
Mandar Samant
Chih-Pin Hsiao
“Unnecessary noise, then, is the most cruel absence of care which can be inflicted
either on sick or well.”
By Florence Nightingale, 1859
Causes Of Noise
Standards and Current Conditions
In 1995, Guidelines for Community Noise from World Health Organization
(WHO) recommends an Lmax of no more than 40 dB(A) at night measure on
the fast setting. They also suggest patient room Leq of no more than 35dB(A)
during the day and 30 dB(A) at night.
Study shows that the average day time sound levels in Johns Hopkins Hospitals
are 72 dB(A).
The typical speech level for communication between two people
is 45-50 dB(A)
Effects Of Noise
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Several adverse effects are associated with noise
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increase noradrenalin concentrations in urine, hypertension and
myocardial infarction
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Sleep disturbance
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exposure to sudden, unexpected noise raises patient heart rates
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tend to increase blood pressure levels
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In a hospital environment, where people are already ill and
psychologically stressed, unnecessary noise can be very harmful
-
Could cause staff stress and burnout
Solutions
Assessing and managing Sound Environment
Identify Sources of noise
Maintenance and replacement of Hospital equipments
Layout and acoustic treatment of patients’ rooms and corridors etc
Equipment Repair and Replacement
Scheduling regular maintenance to keep equipments in working order
padding chart holders and pneumatic tube systems, and lowering volume
levels on clinical and communication equipment
purchasing choices that are based on auditory performance
Design of Patient rooms and adjacent Areas:
Standardize on single bed private room
Solutions
Effects of Noise in ICU
Results
• Noise levels ranged between 49 and 89 dB (A) with
a mean of 65 dB (A).
• Peak noise levels were measured as high as 89 dB
(A).
• The noise levels measured at different locations in
the intensive care unit did not differ significantly.
• Noises created by other patients, those who were
admitted from emergency room and operating
room into intensive care unit, monitor alarms,
conversations among staff were the most disturbing
noise sources for patients.
Conclusions
The patients who were located in the bed which was
closer to the nurses' station were more affected by the
intensive care unit noise than other patients.
• Having a previous intensive care unit experience also
affected the patients' disturbance levels owing to noise.
• Relevance to clinical practice:
Nurses are in key positions where they can identify
physical, psychological and social stressors that affect
patients during their hospital stay. Staff education,
planned nursing activities and proper design of intensive
care unit may help combat this overlooked problem.
•
ICU Admission and Discharge Criteria
Mengdie Hu, Karsten M. Jensen, Thomas Roh
ICU Admission and Transfer/Discharge Guidelines
St. Joseph Hospital 2009
• A list of criteria for the admission to ICU
• Made to assure the appropriate utilization and resources of
the ICU
Analysis of indications for early discharge from
the intensive care unit
Bone et al. 1993
• Patients with moderately severe illness benefit more from
ICUs than patients who are severely ill or not very ill.
• A predictive model can be developed to determine the
mortality risk 24h after admission.
Consequences of discharges from intensive
care at night
Goldfred et al. 2000
• Patients who are discharged at night have a much higher
risk of dying
• Night discharges are more likely to be premature
• Insufficiency of intensive-care beds
Critically ill patients readmitted to intensive care
units--lessons to learn?
Metnitz et al. 2003
• Readmission raises the risk of dying more than four times
• Residual organ dysfunctions at time of discharge
• Optimizing organ functions in patients before discharge
Triaging patients to the ICU: a pilot study of
factors influencing admission decisions and
patient outcomes
Garrouste-Orgeas et al. 2003
• Patients triaged by a senior physician are more likely to be
refused admission
• Refusal are related to patient age, underlying diseases, selfsufficiency and number of beds available
The patient-at-risk team (PART): identifying and
managing seriously ill ward patients
Goldhill et al. 1999
• Patients admitted from hospital wards to ICU have a higher
mortality then patients admitted from other areas
• The PART protocol are a simple way of trying to identify
critically ill patients on wards
Analysis of indications for early discharge from
the intensive care unit.
Bone et. al 1993
• Measures: Mortality and Quality of Life
• Acute Physiology and Chronic Health Evaluation (APACHE)
• Objective methods for determining patient discharge from
ICU
Mortality among appropriately referred patients
refused admission to intensive-care units
Metcalfe et al. 1997
• UK - excess mortality for those too ill or too well
• 9% higher rate of mortality
• More ICU beds or better admission and discharge criteria
Guideline on Admission and Discharge for Adult
Intermediate Care Units
American College of Critical Care Medicine
of the Society of Critical Care Medicine 1998
• Admit low risk patients to intermediate care units
• List of Requirements
• Labor cost reduction
Discharge Criteria - A new trend
Chung 1995
• Discharging patients after anesthesia and surgery
• Mathematical scoring system for five different areas
• Recommends using a numerical system to determine
discharging a patient