Are today’s hospitals creating an environment that encourages healing and recovery?

A 2012 study from the University of Chicago found average noise levels in hospital rooms easily exceeded the recommended 30 decibels, and peak noise levels sometimes approached the decibel level of a chain saw.¹

That sure doesn’t sound therapeutic to me!

At Voalte, we believe reducing hospital noise can improve the patient experience and positively impact HCAHPS scores. Now, there’s evidence that lowering noise also affects patient outcomes. 

In another study last year, Orfeu M. Buxton, Ph.D., of Harvard Medical School found a correlation between patient health and noise levels, stating that lowering the noise level in hospitals “would decrease patient stays and improve healing, and perhaps even reduce readmission rates.”²

He also found that some noises are more disruptive than others. In particular, patient heart rates jumped consistently due to the sound of electronic alarms and ringing telephones.

This anxiety makes perfect sense to me. Imagine being a patient in an unfamiliar setting, away from home, and facing the unknown regarding your health. You might wonder:

- Why are all these alarms going off? Did someone die? Are they for me?
- Why does the nurse keep leaving my room to talk on the phone? Is she talking to my doctor? Why don’t they want me to hear?
- Why is this machine attached to me beeping? What does it mean? Am I taking a turn for the worse? 

Too often, caregivers and the communication tools they use only add to the cacophony … and the anxiety. Many nurses are given phones as their main tool to communicate with other caregivers, departments and doctors. Yet HIPAA requires they don’t discuss clinical matters in front of a patient, so every phone call causes an interruption as the nurse leaves the patient’s bedside to answer the call. If the nurse is too busy to answer, other noisy strategies such as overhead paging attempt to locate them.

Fortunately, there is a solution. Secure text messaging via smartphone can eliminate up to 70 percent of ringing telephones and nearly all overhead paging. Alarm management tools can integrate disjointed devices and assign levels so all alarms are not treated equally.

As scientific evidence supports the importance of lowering the noise level in hospitals, old attitudes are changing gradually. Maybe what will truly push the urgency of this issue will be the new policies linking hospital reimbursement to patient satisfaction.

<sub>1. Jordan C. Yoder, BSE; Paul G. Staisiunas, BA; David O. Meltzer, MD, PhD; Kristen L. Knutson, PhD; Vineet M. Arora, MD, MAPP, Arch Intern Med. 2012;172(1):68-70. doi:10.1001/archinternmed.2011.603.

2. Orfeu M. Buxton, Ph.D., assistant professor, Harvard Medical School, and associate neuroscientist, division of sleep medicine, department of medicine, Brigham and Women's Hospital, Boston; Gulshan Sharma, M.D., M.P.H., director, Medical Intensive Care Unit, University of Texas Medical Branch at Galveston; June 12, 2012, Annals of Internal Medicine.</sub>

How long does it take your nurses to respond when a patient pushes the nurse call light? Two minutes? Four minutes? Longer?

If you don’t know the answer, you should, because it influences everything from health outcomes to patient satisfaction to financial results.

Patients use the nurse call light for various reasons, but as you can see in this bar chart from the American Journal of Nursing (AJN), the top three calls are for bathroom assistance, IV problems or alarms, and accidental calls that often involve pushing the call button while turning over in bed or trying to turn the TV channel. While none of these involve life-threatening scenarios, your nurses’ response to them has a major impact.

Consider a call for bathroom assistance. If a nurse doesn’t get to the patient’s room within a couple of minutes, will the patient wait or try to get up from bed on their own? If they get out of bed, in an unfamiliar place and perhaps while taking pain medication, the danger of a fall is significant.  

At one hospital, I heard about a patient breaking her hip in a fall while trying to get to the bathroom. In addition to the suffering of the patient and her negative impression of the care she received, the hospital took a financial loss from the cost of the patient’s resulting surgery and the increased length of her stay.



The AJN study found that each patient averages 4.59 nurse calls per day. It’s simple arithmetic to multiply your number of patients by the number of calls per day to arrive at the potential for such negative consequences.

So what are you doing to make sure your nurses respond to calls in a timely manner? In a typical scenario, when a patient pushes the nurse call light, an alert goes to the unit coordinator, who responds by asking the patient what they need, then tracks down that patient’s nurse to relay the information. Depending on the communication system, that could mean using an overhead paging system, making a phone call that may or may not be answered, or using a one-way communication device. The nurse then needs to respond to the unit coordinator to find out which patient is calling and what their needs are. If the nurse is busy, the unit coordinator needs to locate another nurse or nurse technician using the same process.

With Voalte One, when a patient pushes the nurse call light, an alert goes directly to the nurse, who can proceed to the patient’s room or send a text to a technician asking him or her to go to the room to assist the patient. 

When a nurse responds to a call promptly, the patient not only receives the best possible care but also feels well cared-for.  When delays can have such a high price, a couple minutes makes a difference.


_{Source: Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety, AJN, September 2006, Vol. 106, No. 9. By Christine M. Meade, Ph.D., Amy L. Bursell, Ph.D., Lyn Ketelsen, MBA, R.N.}

What can we do to reduce noise? There are many attempts to reduce noise in hospitals. Reducing noise should improve the patient experience and improve HCAHP scores. Just as important and a bi-product of noise is patient anxiety! Patients unexpectedly find themselves in a new setting, away from home, facing the unknown in the form of a health condition, unfamiliar with their surroundings or the routine. Activity going on all around them that they do not understand:

 

What are all these alarms for? Did someone die? Are they for me?

Why does the nurse keep leaving my room to talk on the phone? Is it my doctor? Why don't they want me to hear?

They are always getting calls when they are treating me and leaving the room.

Are they understaffed? If I need assistance, will it be available?

That's a new alarm sound! What does it mean? I don't see any nurses anywhere? What is going on?

Why is this machine attached to me beeping? What does it mean? Am I taking a turn for the worst? Should I call my nurse? Where are they?

I wish my doctor would call. I asked the nurse to notify him I'm having a new pain. The nurse says they can't do anything without the doctor's approval. When will they contact him? Why hasn't he got back to them? Can't they call him again?

Why didn't the nurse answer her phone when she was in my room? Maybe it was my doctor?

 

Too often caregivers and the communication tools they are given only add to the anxiety.

Alarms all sounding the same and difficult to differentiate their urgency are heard throughout every hospital unit. Nurses go home exhausted from alarm fatigue. Patients lay in bed awakened at all hours of the day and night with anxiety at what the cacophony of alarms and other noises mean.

Nurses are provided phones as the main tool to communicate with other caregivers, departments, and doctors. Unfortunately HIPAA requires they do not talk of clinical matters in front of a patient. The phone causes numerous interruptions for nurses treating patients requiring they leave the room. If they do not answer the phone alternate strategies of overhead paging, and attempts to find them take over.

 

Today's technology offers many other solutions:

 

Alarm management tools can make sense of the numerous disjointed devices producing the cacophony of alarm noise.

Sophisticated nurse text messaging (similar to what is available on smartphones) can eliminate 78% of ringing telephone calls, almost all overhead paging and the potential for missed patient requests.

 

When looking to reduce noise, consider improving patient anxiety as well. It will more than give you justification and urgency to proceed and result in a better environment for all.

One of the many fun facets of my job as a Voalte clinical trainer is travel. Lots and lots of travel. Crosstown and cross-country. Short-term (I've spent less than 24 hours onsite before flying out again) and long-term (after a month in Houston, I had fallen in love with "The Big Heart," a nickname the city earned post-Katrina). When I'm not introducing new users to Voalte One, I'm kayaking outside the La Jolla sea caves, eating whole lobster in the North End (yep, wore the bib!), and watching sunkissed city kids dancing at the waterwall at Millenium Park…

 

On a recent long flight sans Wi-Fi and entertainment, I had time to do some thinking and I found myself in awe of how drastically working for Voalte has changed the way I perceive and experience our world. Specifically, I'm now acutely aware of our connectedness…all the different ways we choose to communicate, conduct business, and foster relationships.

 

Voalte is indisputably the industry leader in smartphone healthcare communications, but somewhere over New Mexico I considered that we're also still very much at the forefront of a broader movement towards more efficient interactions conveyed via increasingly sophisticated technologies. We're among the communication cowboys (and girls)! How fitting that I was thinking of this 29,000 feet over Santa Fe.

 

Of course, there are valid arguments against this evolution, trend, whatever you want to call it. People are concerned that we're swiftly losing the value of personal interaction and face time (the literal meaning, not the Jobs creation), and there might be something to that. Instead of exchanging a handshake when I accepted employment with Voalte, I signed and scanned a document. I emailed my enthusiasm to an office 1,248 miles away. So I get it. I empathize with a fear of the implications that pulling back from human-to-human connections might have on us. But while I waited for the flight attendant to reach my row with the beverage service, I put together an entirely different, more positive spin on technology-assisted communication.

 

The bottom line for me is this. All of that impersonal communication technology facilitated me finding and gaining employment with Voalte, and now when I return from my travels, I come back to smiles, and hugs, and long "catching up" conversations with coworkers that have quickly become friends. Technology isn't impersonalizing communication; it's expanding our world and allowing us access to people, places, and activities that weren't possible before. So I'm proud that we're connectivity pioneers. I'll keep viewing the world with excitement for the future, open to all the possibilities that new communication methods will bring. I've witnessed firsthand in hospitals all over the country what we have accomplished in healthcare; I can't wait to see what other industries will introduce…