Luke Zoontjens: Quiet please

SURVEYS of Australian hospital patients appear to overlook one of the lowest areas of satisfaction internationally — an issue which extends beyond individual dissatisfaction to impact actual health outcomes in both existing and future hospitals.

The US national Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is regarded as such an important annual benchmark in hospital patient satisfaction, that it is used to calculate the relative level of government funding between individual providers.

It includes 10 headline metrics and, since the survey started in 2007, the one which has consistently scored lowest every year in terms of patient satisfaction is “Quietness of the hospital environment”.

It is difficult to extract a direct comparison between the US program and Australian results (beyond those by Healthscope using a version of CAHPS), particularly as patient experience surveys in each Australian state and territory vary considerably in scope and detail.

Some surveys don’t rate the issue of noise at all, and instead appear aimed at meeting the National Safety and Quality Health Service Standards, which are not explicit regarding the issue of quietness.

Although quietness in hospitals is acknowledged as very important in the literature, it is not consistently addressed in current national programs affecting procurement and ongoing management.

Key issues raised by patients in Australia and internationally about noise in hospitals include (in no specific order) equipment alarms; intrusion from hallway conversations and use of mobile phones; other patient activities (snoring, cries, laughter, coughing, talking, use of televisions and the like); and sudden noises such as squeaks, clattering and knocks from the movement of carts and gurneys, office equipment, slamming cabinet doors and shutters.

Regardless of whether patients (or staff) identify noise as simply an annoyance, it remains a serious risk factor to patient health and facility outcomes.

Over the past few decades, the literature has firmly identified the benefits of good acoustic design and management, and the potential psychological and physiological effects where it is neglected.

These effects include increased sensitivity to pain; sleep disturbance and decreased rates of rehabilitation; increased risks of myocardial defects and cardiovascular disease; prolonged release of corticosteroids associated with chronic stress; as well as temporary and ongoing changes in mental health, dementia, behaviour and hypertension.

Excessive noise has also been shown to increase risks of staff fatigue, error and occupational stress.

By identifying these issues in the early design stage for new facilities, and coordinating administrative and engineering measures for existing facilities, dramatic improvements can often be achieved without major disruptions or capital investment.

For example, in inpatient wards this may include signage and enforcement of appropriate mobile phone use and public visiting hours; identifying quiet periods overnight in which staff conversations are minimised using quiet voices; low volume televisions and other audio restricted to ear phones (ie, not audible in corridors); and disabling unnecessary equipment alarms.

Further improvements might include subtlely increased background sound levels to mask intrusive noise; increased privacy; treating all doors and cupboards to avoid slamming or creaking; applying foam or soft linings to meals trolleys, drawers and bulky items such as gas bottles; decentralising nurse stations and locating high traffic and utility areas away from patient rooms; applying polymer and/or rubber-impregnated flooring over concrete; rubber-lined castors and wheels for all mobile equipment, trolleys and gurneys; smart alarms integrated with other communication systems; and silent mobile paging and voicemail systems for staff.

Research by my company SLR Consulting presented at the recent International Congress on Noise Control Engineering finds that existing hospital design guidance on new developments and refurbishments, such as the Australian Health Facility Guidelines (AHFG), does not adequately address noise issues that affect patients and cause complaints, and do not provide objective standards which can be integrated into future facilities.

For existing hospitals, workplace behaviour and staff awareness should be regularly reviewed and managed to achieve results on a daily basis.

To better address noise in hospitals, the AHFG needs to be updated (or suitable alternative guidelines developed) along with ongoing staff education and training programs at individual facilities.

In the meantime, individual health care providers can also do this by appointing experienced consultants in hospital acoustics, and/or liaising with industry advisory groups such as the online LinkedIn Hospital Acoustics group, or the not-for-profit Association of Australian Acoustical Consultants.
 

Dr Luke Zoontjens is a professional acoustics engineer at SLR Consulting (Australia) Pty Ltd and a board member of the Australian Acoustical Society. SLR is a privately owned engineering consultancy which is a member firm of the Association of Australian Acoustical Consultants, and has received payment from various government and private organisations for consultation on the design and construction of hospitals and other health care facilities.