Over the past few decades, numerous research studies have concluded that noise in hospitals can have a deleterious effect on patient care and recovery. āThe first step in noise reduction in hospitals is awareness about the effect that noise has on patients and providers,ā says Paul Barach, MD, Clinical Professor, Wayne State University, Detroit.
Barach cites studies that estimate average hospital noise at 70ā80 decibels, or 20ā30 db above World Health Organization recommended levels. Older hospitals have even worse acoustics. Barach also suggests that noise in general is an āabstractionā that even newer hospitals find difficult to define and mitigate.
Noise control is even more important now that the Affordable Care Act has mandated that reimbursement for hospital services be based, in part, on patient satisfaction surveys. Ā These surveys have consistently given the lowest scores to hospital environments for sleep disruption. Itās little wonder, then, that hospitals are pursuing more quietude in their plans for new buildings, renovations and expansions, as well as in their personnel training.
āAcoustics is invisible until itās a problem,ā observes James Perry, Chief Technology Officer for the New York-based acoustical and A/V consultant Cerami & Associates. He emphasizes, too, that noise āis about behavior,ā and often is generated āby activities [more] than building systems.ā
Ā
Different rooms, different noises
Noise abatement strategies need to take into account that hospitals have many rooms with different noise characteristics, says Ben Davenny, PE, INCE, LEED AP EDAC, a Senior Acoustical Consultant with Acentech. Patient floors are usually organized around bustling nursesā stations. MRI rooms are particularly sensitive to vibration through floors and walls. Operating rooms require 20 air exchanges per hour, creating their own unique din.
There are lobbies, waiting rooms, examination and emergency rooms where privacy is paramount. Many larger, regional hospitals have helipads: their chopper noise must be kept from entering the building.
Davenny points out that it is useful to consider the type of noise source. āThereās a false impression that a quieter environment is always a better one,ā he says. āThe trick is to take a different look at these noise sources and develop more efficient methods in reducing disturbance to patients.ā
Medical technology has become a new noise source that has āoverwhelmedā the hospital environment, says Joanne Solet, PhD, Assistant Clinical Professor of Medicine at Harvard Medical School. Solet was part of a team of researchers that conducted a three-day study in which the team subjected 12 healthy participants to 14 different sounds to determine which sounds were most likely to disrupt sleep.
The teamās findings, published in the Annals of Internal Medicine (June 2012), found that āelectronic soundsāĀ were more arousing than others. āIf these noises bothered a dozen healthy people, you can bet they are bothering people who are patients,ā says Solet.
Ā
Over the din, patients are heard
Noise reduction started showing up on hospitalsā radar screens in 2006, when the Centers for Medicare & Medicaid Services (CMS) implemented an ongoing national surveyāknown as the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHCPāto measure customer satisfaction with hospital care. When the Affordable Care Act became law, it included a requirement that the survey results be used as one measure to calculate payments that CMS made to acute-care hospitals.
āThe surveys let consumers weigh in, and with HCAHCP, hospitals canāt bury their issues,ā says David Sykes, Chairman of the Acoustics Research Council.
From July 1, 2013 through June 30, 2014, the latest period tracked and posted by Medicare.gov, 62% of patients surveyed said their rooms were āalways quiet at night,ā with another 29% saying their rooms were āusually quiet.ā Those scores were below patient ratings for 30 other criteria of their hospital stay, such as cleanliness and communications.
With one in three hospitals operating in the red, according to the American Hospital Association, patient satisfaction has become a make or break issue. The poorest-performing hospitals have 1% of their total annual reimbursements withheld by CMS; the highest-performing facilities get a 1% bonus. By 2017, those fines and bonuses will increase to 2%.
āHospitals need to know how much quiet a patient needs to be able to sleep because theyāre getting dinged by the government if their performance scores are low,ā says Gary Madaras, PhD, Associate AIA, ASA, INCE, an Acoustics Specialist with Rockfon, which makes acoustic ceiling products. Solet adds that the government now bases its acceptance levels for patient readmission to hospitals in part on the facilityās past performance.
Healthcare systems are addressing this problem by getting more stakeholders involved in helping them improve patient satisfaction. HGA Architects and Affinity Health solicited input from former patients, family members, and caregivers during pre-design sessions for Affinityās 25,000-sf Heart, Lung, and Vascular Center at St. Elizabeth Hospital, in Appleton, Wis. Those sessions included discussions about workflow, corridor circulation patterns, and patient privacy. The team also implemented a post-occupancy evaluation determine whether its evidence-based design principles were being achieved in areas that include noise levels.
For several years now, architects have been turning to the Facilities Guidelines Instituteās guidelines for product and design best practices that can help their clients tone down noise and vibration. āWe provide the tools to build the better mousetrap,ā says FGI CEO Douglas Erickson, FASHE, CHFM, HFDP, CHC.
Stanford Health Care, Palo Alto, Calif., is building an 824,000-sf, 368-bed hospital that is following many of the noise and vibration reduction guidelines laid out by the FGI, says George Tingwald, MD, AIA, ACHA, Director of Medical Planning, Facilities Design and Construction at Stanford Health.
Hospitals are also trying to get their employees to be more alert to the noise they produce. Bonny Slater, Senior Interior Designer-Health & Wellness in Genslerās Washington, D.C., office, sees hospitals experimenting with āquiet times,ā when corridor lights are dimmed to signal when noise volumes should be lowered.
Ā
Reactions to noise are subjective
Not everyone is convinced that design can alter staff behaviors to reduce hospital noise, especially when a lot of hospitals still donāt coordinate when clinical, food service, and cleaning staffs enter a patientās room, says Kenneth Van Wyk, President of consultant Acoustics by Design. āThere are no dashboards in hospitals,ā says Sykes. Chris Kay, ACHE, Managing Principal-National Healthcare & Science Buildings Practice at Jacobs, is even less sanguine about behavioral modification, which he calls āthe least effective method of reducing hospital noise.ā
Patient surveys have certainly given hospitals more insight into where their services and facilities are falling short or excelling. Jean R. Elrick, MD, Senior Vice President of Administration at Massachusetts General Hospital, in Boston, gets patient narratives every Wednesday. She says she can tell which buildings and departments are performing best. Mass Generalās 530,000-sf Lunder Building, which opened in 2011, was among a handful of hospital facilities that closely followed FGIās 2010 revised guidelines. Elrick says Lunderās patient scores have consistently risen, and Lunder has become the model the hospital would follow when it renovates or expands other buildings on its campus.
The 640,000-sf MaineGeneral Medical Alfond Center for Health, in Augusta, which opened in August 2013, is another replacement hospital that was built to FGIās noise and vibration guidelines. As a result, its āalways quiet at nightā score improved to 76.5% over the period December 2013 through July 2014, from 61.5% over the period January through October 2013. The portion of patients who would recommend the hospital jumped to 76.8%, from 65.2%, according to Rick Albert, MaineGeneralās Director of Plant Operations.
But patient scores donāt tell the whole story, mainly because surveys donāt identify which noises are causing the most distress. Since 2010, Rockfonās Madaras has tracked patient scores of about 50 new hospitals. He has found that most new faciliies arenāt that much better than older ones. Those findings lead Madaras to believe that reactions to hospital noises can be individual and subjective.
Solet points out that a certain portion of the population is always going to be more sensitive to their surroundings. So, says Tingwell of Stanford Health Care, a hospitalās biggest dilemma, when devising a noise-reduction strategy, might be figuring out how to assuage patientsā perceptions, real or imagined, about noise.
Related Stories
| Oct 15, 2014
Harvard launches ādesign-centricā center for green buildings and cities
The impetus behind Harvard's Center for Green Buildings and Cities is what the design schoolās dean, Mohsen Mostafavi, describes as a ārapidly urbanizing global economy,ā in which cities are building new structures āon a massive scale.āĀ
| Oct 13, 2014
Debunking the 5 myths of health data and sustainable design
The path to more extensive use of health data in green building is blocked by certain myths that have to be debunked before such data can be successfully incorporated into the project delivery process.
| Oct 12, 2014
AIA 2030 commitment: Five years on, are we any closer to net-zero?
This year marks the fifth anniversary of the American Institute of Architectsā effort to have architecture firms voluntarily pledge net-zero energy design for all their buildings by 2030.Ā
| Oct 8, 2014
Massive āhealthcare villageā in Nevada touted as worldās largest healthcare project
The $1.2 billion Union Village project is expected to create 12,000 permanent jobs when completed by 2024. Ā
| Oct 3, 2014
Designing for women's health: Helping patients survive and thrive
In their quest for total wellness, women today are more savvy healthcare consumers than ever before. They expect personalized, top-notch clinical care with seamless coordination at a reasonable cost, and in a convenient location. Is that too much to ask?Ā
| Sep 29, 2014
10 common deficiencies in aging healthcare facilities
VOA's Douglas King pinpoints the top issues that arise during healthcare facilities assessments, including missing fire/smoke dampers, out-of-place fire alarms, and poorly constructed doorways.Ā
| Sep 25, 2014
Look to history warily when gauging where the construction industry may be headed
Precedents and patterns may not tell you all that much about future spending or demand.
| Sep 24, 2014
Architecture billings see continued strength, led by institutional sector
On the heels of recording its strongest pace of growth since 2007, there continues to be an increasing level of demand for design services signaled in the latest Architecture Billings Index.
| Sep 23, 2014
Cedars-Sinai looks to streamline trauma care with first-of-its-kind OR360 simulation space
The breakthrough simulation center features moveable walls and a modular ceiling grid that allow doctors and military personnel to easily reconfigure the shape and size of the space.
| Sep 22, 2014
4 keys to effective post-occupancy evaluations
Perkins+Will's Janice Barnes covers the four steps that designers should take to create POEs that provide design direction and measure design effectiveness.