Posted August 24, 2012

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By Vikki Choate, RN, MSN, CPHQ

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Business Pug' Holder Card Wallet Credit CH00003092 Card Azeeda 'Rolling A calm and quiet hospital environment is critical in achieving good clinical outcomes. Our patients require adequate rest in order to heal and recover faster. Because of the work we do in hospitals, such as administering medications at various hours and transferring equipment, keeping a quiet environment is challenging. Noisy hospital environments can cause sleep deprivation, increase stress levels and even decrease our patients' overall perception of their hospital stay.

We know that when our patients don't get the rest they need, it can mean a longer recovery period and even a longer stay in the hospital. It then impacts the cost of the patient's stay, not only personally, but to the hospital as well. Research shows that the combined Clean and Quiet Environment composites are among the hardest to improve.

Noise levels affect more than just how our patients rate us on the Quietness composite. When our patients cannot clearly hear us, they can miss key information about their care. As caregivers, noise levels can also interfere with the information we hear our patients telling us. This can lead to problems such as errors in medication, ineffective pain management, and miscommunications about discharge instructions. Each of these problems can then directly affect other composites including Communication of Medications, Pain Management and Discharge Instructions.

We have found that there is not one tactic that impacts the patients' perception of a quiet environment, but a combination of small changes done consistently. We've harvested some key strategies that our partners have successfully implemented to improve the “quietness” rating. Some of these best practices include:

  • Develop a quietness committee. This committee is in charge of identifying and correcting or minimizing those occurrences that cause noise at night (and really, noisy environments during the day can affect the way our patients rate us, even though the question specifically states at night).
  • Close the patient's door. Noise levels outside the patient's room can be quickly reduced by closing the door. Try using key words such as, "I'm going to close the door for your privacy and so you can rest better," to explain why you are keeping their door closed. This can also reduce noise for other patients.
  • Dim the lights. When the lights in our patient's room are dim, it encourages us to speak in softer tones.
  • Card Pug' Credit Card Azeeda Business 'Rolling Holder Wallet CH00003092 Reduce nighttime lab draws. If we are required to draw blood during nighttime hours, explain why it is necessary that it occurs at that time.
  • Eliminate overhead paging. Even if our patient's door is closed, overhead paging becomes significantly louder during nighttime hours.
  • Provide “quiet kits” upon arrival. Include headphones and/or ear plugs for our patients to use at night. Try using key words such as "We will gladly provide ear plugs for you if you’d like to help you get the rest you need so that you may heal."

At Studer Group®, we have seen a direct correlation between increased HCAHPS results in those hospital organizations that use specific tactics to assist with the “quietness” question. For instance, when Nurse Leaders round on patients or during Hourly Rounding®, we can specifically ask our patients if the noise levels were satisfactory overnight or if they had any trouble resting. Hourly Rounding® is also proven to reduce the use of call lights – another noise factor. We can also check our patient's pumps to reduce or eliminate IV alarms from going off, especially during the night.

Ultimately, we want our patients to heal quicker and be discharged as soon as possible, and adequate rest is one of the quickest ways we can assist with a faster recovery.

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