CS72 - Do your Best Quietly!
Primary Author: Ariam Gebrehiwot
Co-Author(s):
Institution: Washington Hospital Center, Washington, DC
Contact Email: ariam.gebrehiwot@medstar.net
   
Purpose: In May of 2007, through analysis of the Patient Satisfaction survey on 4D the dedicated Heart Failure Unit, it was identified that an opportunity existed to address the noise level on the unit. Additionally, during rounds conducted by the Department Head the patients would state “I cannot get any sleep on this unit”. Physicians and other clinical staff commented on the high level of ambient noise and “chatter” that resulted in an environment that was not conducive to healing.
Description: An interdisciplinary team met where the Department Head shared the “burning platform”. This involved the case for change based upon patient satisfaction data and patient safety information focusing on creating a healthy work environment that minimized distractions. The team then brainstormed ideas to reduce the noise level. The first item implemented was to actually measure the decibels of noise on the unit. A “noise traffic light” was installed near the nursing station. This traffic light provided a visual in which a green light meant <90 decibels, yellow was 90-110 decibels and red was >110. Data from the traffic light could be downloaded and provides a graphic display of decibels over time. Another strategy consisted of turning off the telemetry station audible alarm located in the nursing station. Satellite STAT phones were installed throughout the unit, in which the Centralized Telemetry staff would call if a lethal state existed. All phones ring simultaneously and all nursing staff are required to answer immediately. This was a change from dedicated phones near the nursing station. Other strategies included “siesta time” daily between 2 PM-4 PM. During this time the lights are dimmed and quietness is encouraged.
Evaluation/Outcomes: Traffic Light baseline data from a random 48 hour period show 1 episode of >110 decibels, 52 episodes of 90-110 decibels and all other recorded noise level was < 90 decibels. After telemetry alarms were silenced noise level recorded decreased. During a 48 hour period there were no recorded episodes of >110 decibels, 30 episodes of 90-110 decibels and all other time, noise level was <90 decibels. The unit’s Press Ganey Score for “Noise level in and around room” before implementation was at Mean Score of 64.8 which is 4% ranking. After implementation Mean Score improved to 88.6 which is 99% ranking. There have been no patient safety issues related to reliance on centralized telemetry rather than unit alarms.
   
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