Welcome to JTEHM’s Editorial Blog! The Blog features updates and commentary on issues and research advances that are of interest to our community. Our inaugural blog is by Junior Associate Editor Avinash Konkani, who discusses noise – a little-known hazard of the ICU (a place nearly 80% of Americans will be admitted to in their lifetimes).
Today’s Intensive Care Units (ICUs) are complex and stressful environments for both patients and caregivers. In addition to the discomfort and fear they are already undergoing, patients experience the ICU itself as a noisy, overly bright, restricting, and social isolating place. Noise levels play a significant role in making the ICU a hostile, and sometimes even dangerous, environment for patients. ICUs regularly exceed World Health Organization-recommended maximum hospital noise levels of 35 A-weighted decibels [dBA] and US Environmental Protection Agency’s (EPA’s) recommended 45 dBA, with average levels of 60-70 dBA and peaks over 90 dBC.
High numbers of false alarms from medical devices and conversations are the top two reasons for noise. Other sources of noise include telephones, mobile phones, TVs, air conditioning, and day-to-day activities like closing doors, opening of packages, etc.
The negative impact of noise on patients includes sleep disturbance, variation of heart rate and blood pressure, and longer healing processes and hospital stays. ICU noise also has negative impacts on staff: noise increases mental stress and annoyance, and decreases speech intelligibility, job performance and ultimately patient safety. Therefore it is very important to decrease the noise level below 45 dBA. Practically, however, this is a very difficult task.
One of the key elements to control noise is to curtail the increasing number of false (clinically insignificant) and non-actionable alarms from the medical devices. False alarms are generally triggered by a patient’s movement or a bad sensor connection and require an action by a clinician, whereas non-actionable alarms are true alarms that do not trigger any action by clinicians. The latter are also called known alarms. For example, a known alarm will occur when a nurse is changing electrodes on a patient; the medical device beeps because the electrodes were disconnected. In April, The Joint Commission released a
>Sentinel Event Alert
on medical device alarm safety in hospitals and an info-graphic explaining the scope of the problem.
In my research at Oakland University (Rochester, MI), we are applying a behavior modification program and medical device alarm management techniques to reduce unnecessary and harmful noise from humans and medical devices.