5 Strategies to Minimize Noise in Hospital Settings

Quiet environments are conducive to patient healing and recovery. That’s why the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) included in Centers for Medicare and Medicaid Services quality measurement programs includes a “quiet at night” metric.

At the same time, the requirements of delivering hospital-level care — including physiologic monitors, moving large pieces of equipment and responding to emergencies — pose unique challenges for maintaining a quiet environment. Environmental noise inside hospitals can range from 37-88.6 A-weighted decibels (dB(A)) during the day and 38.7-68.8 dB(A) at night, according to a 2021 systematic review.

Quieter hospital environments can also benefit staff. Studies have shown that high noise levels can annoy and distract health care workers, interfere with communication and worsen alarm fatigue, according to Health Facilities Management (HFM).

To optimize the healing environment and minimize stress, distraction, annoyance and sleep disturbance, hospitals can take steps to reduce avoidable noise. For health care leaders looking to improve both patient and employee experiences, these strategies can help lower the volume.

1 | Establishing Quiet Hours

New Hyde Park, New York-based Northwell Health improved its “quiet at night” metric in part by designating quiet hours for each department, typically from 11 p.m. to 5 a.m., according to a study published in the Journal of Patient Experience. Through hospital-based “Night Councils” led by frontline team members, interdisciplinary teams within Northwell also promoted peer accountability (e.g., using code words to indicate that noise levels had risen in patient care areas). Between 2017 and 2020, Northwell improved its overall HCAHPS “quiet at night” top box performance (meaning patients selected “always”) by 30 percentile rank points compared to the national Press Ganey database.

2 | Developing Sleep Protocols

Henry Ford Health in Detroit also increased patient satisfaction scores by designating quiet hours from 11 p.m. to 5 a.m. and implementing sleep protocols for various departments, including nurses; certified nursing assistants (CNAs); transport; clerks and VIP nurses; and lab, radiologic technology and imaging. For example, the protocol for nurses includes turning off hallway lights, keeping voices down and turning off lights in patients’ rooms if patients agree, among other quieting measures. As a result of the sleep protocols, the share of surveyed patients who reported being “very satisfied” with their sleep quality while in the hospital rose from 16.67% to 37%.

3 | Factoring Noise Control into Construction and Renovation Plans

Hospital design can have a significant impact on noise levels. Subsequently, plans for new construction and renovations should include noise control strategies, such as turning corridors and storage rooms into acoustic buffers and distancing high-activity areas from rooms for patient care and observation, according to HFM. Additionally, health systems and hospitals should select materials and equipment that minimize noise, such as acoustic ceiling tiles that dampen noise.

4 | Educating and Engaging Frontline Workers

Northwell educated and engaged frontline team members about efforts to sustain quiet hours through unit-based huddles. Additionally, the health system supported noise reduction through ongoing awareness activities, daily leadership rounding, data monitoring and compliance monitoring. The system has also celebrated improvements in HCAHPS performance and recognized staff members who support a quiet environment for healing.

5 | Identifying Issues During Night Rounds

ChristianaCare in Wilmington, Delaware, has worked to minimize noise between 9 p.m. and 6 a.m. with a “Quiet at Night” initiative. The system’s noise reduction efforts have included having members of a multidisciplinary committee conduct night rounds to pinpoint potential sources of acoustic annoyance, such as loud linen cart lids and rattling medication carts.

Ultimately, some hubbub is unavoidable in hospital settings, but more peaceful nights and better experiences for patients and staff are possible with sustained strategic effort.

“Engaging interdisciplinary care teams, adopting evidence-based interventions, designing for optimal experience and instilling sustainment activities may lead to improved system and hospital performance outcomes,” the Northwell researchers wrote in the Journal of Patient Experience. “Change does not happen immediately, it requires patience, diligence and a spirt of continuous improvement.”