In a hospital room, many sounds can disturb the peace and quiet that are conducive to a patient’s healing. Sometimes, a beeping monitor or a roommate’s TV conspire to prevent sleep. Often, the 24/7 activity typical in hospitals — maintenance, deliveries or even hallway conversations — can interrupt rest.
That noise can irritate patients or make them plain miserable, said Sven Gierlinger, vice president and chief experience officer at Northwell Health. He remembers how uncomfortable he was when he couldn’t sleep during a hospital stay of his own at another health system.
“Noise in the hospital environment is one area where quality and patient experience come together,” he said. “It affects outcomes, and it affects overall experience.” In fact, the sound levels in hospitals can be high enough to raise a patient’s blood pressure, increase the use of pain medication and slow healing, according to numerous studies.
The health system’s patient experience team is collaborating with Northwell’s nursing and support services to launch Creating a Healing Environment/Quiet at Night system-wide.
The effort began last year as Mr. Gierlinger’s team looked at how to improve Northwell’s performance in the US Centers for Medicare and Medicaid Services’ (CMS) Hospital Star Ratings Program. “We made a heat map of the data,” he said. “At almost every site, noise was the worst-scoring patient-experience factor. And we said, ‘That’s just not OK.’”
At the same time, Northwell’s nursing leaders had also identified noise as a key target for improvement, said Amy Loeb, RN, DNP, vice president and chief nursing officer at Peconic Bay Medical Center, who is leading the initiative on behalf of nursing.
“There’s a lot we need to do for our patients when they’re in the hospital, so some disruption is unavoidable,” Dr. Loeb said. “But we know that sleep and rest are as important as eating and drinking when you’re trying to get well. So we had to find the right balance.”
Over the past few months, Healing Environment piloted a number of changes at units in 11 Northwell hospitals. One of the most successful: “quiet hours,” which typically run between about 9:30 p.m. to 6 a.m. An announcement on the public address system reminds visitors that patients may be trying to sleep. Staff members also dim the lights, lower their voices and bundle care when possible.
The initiative also emphasizes maintaining individual bedtime rituals. When a patient enters a unit, a nurse will ask about habits that make sleep easier. Lights on or off? TV dark or providing soothing background noise? Nurses provide amenities such as earphones and eye masks for patient comfort and as a courtesy between roommates, Dr. Loeb said. And nursing staff ask in advance for the preferred way to wake up — a tap on the shoulder or a persistent shake — if a patient must receive, for example, a dose of medication.
“These protocols require a new way of thinking, but they allow patients to sleep better,” Dr. Loeb said. “When patients get the rest they need, they heal faster. And we are all here for the patients.”New councils, including frontline workers who know the night shift first-hand, have identified sound issues from “wheels and heels.” As a result, units are de-squeaking equipment and rescheduling deliveries that used to happen in the middle of the night. In addition, facility renovations and construction will incorporate noise reduction where possible. Elements can include decentralized nursing stations to keep gatherings small and conversations quieter, sound-absorbing flooring materials and acoustic ceiling tiles. Numerous Northwell inpatient units have already installed special noise-abating carpeting.
Press Ganey patient satisfaction data is already showing a substantial impact from the initiative.
“We’re making strides,” Mr. Gierlinger said. “It’s good to see such as strong response.” The initiative is rolling out throughout the rest of the health system by the end of this year.
“This is a culture shift,” Dr. Loeb said. “When you walk into a library or a house of worship, you automatically get quiet. I don’t know that our hospitals will ever feel like a library or church, but in the future they will feel more restful. That will make for a better place to work, and a better place to heal.”