By Ameya Nerurkar Mandar Samant Chih-Pin Hsiao NOISE By Ameya Nerurkar Mandar Samant Chih-Pin Hsiao “Unnecessary noise, then, is the most cruel absence of care which can be inflicted either on sick or well.” However, until 2005, little work had been done to characterize and improve the acoustic condition in hospitals even though it routinely ranks among the top complaints of hospital patients, visitors and staff (Busch-Vishniac, West, Barnhill, Hunter, Orellana, & Chivukula, 2005) (Johnson & Thornhill, 2006). Busch-Vishniac et al. summarized many studies that indicate noise in hospital will contribute to stress in staff and suggest that noise could cause staff burnout. In addition, some researchers, such as Fife, Minckley, and Wysocki, also believe that noise affects the speed of wound healing according to their studies. By Florence Nightingale, 1859

Causes Of Noise Sound emanating from Equipments for example, the portable X-Ray machine Sound made by human beings House Interiors and furnishing Sound reflecting surfaces instead of sound absorbing materials speech intelligibility Rolling equipments e.g Procedure carts , Housekeeping dollies Overhead paging

Standards and Current Conditions In 1995, Guidelines for Community Noise from World Health Organization (WHO) recommends an Lmax of no more than 40 dB(A) at night measure on the fast setting. They also suggest patient room Leq of no more than 35dB(A) during the day and 30 dB(A) at night.   Study shows that the average day time sound levels in Johns Hopkins Hospitals are 72 dB(A).   So it leads to privacy problem The typical speech level for communication between two people is 45-50 dB(A) 

Busch-Vishniac et al. reviewed the data from 1960 to 2005 and found that the average sound levels gradually increased from Leq 57 dB(A) to 72 dB(A).

Effects Of Noise Several adverse effects are associated with noise increase noradrenalin concentrations in urine, hypertension and myocardial infarction Sleep disturbance exposure to sudden, unexpected noise raises patient heart rates tend to increase blood pressure levels In a hospital environment, where people are already ill and psychologically stressed, unnecessary noise can be very harmful Could cause staff stress and burnout Decreased oxygen saturation,

Solutions Assessing and managing Sound Environment Identify Sources of noise Maintenance and replacement of Hospital equipments Layout and acoustic treatment of patients’ rooms and corridors etc Equipment Repair and Replacement Scheduling regular maintenance to keep equipments in working order padding chart holders and pneumatic tube systems, and lowering volume levels on clinical and communication equipment purchasing choices that are based on auditory performance Design of Patient rooms and adjacent Areas: Standardize on single bed private room

Solutions They choose 2-inch fiber-glassed material for their experiment. Install the panels in the corridor and nurse station. The result is that the level of noise was dropped by 5 dB(A) and the reverberation time dropped by a factor over 2.

Effects of Noise in ICU Experiments Conducted: The study was conducted with 35 coronary artery bypass graft surgery patients. The intensive care unit noise level was measured by using Bruel & Kjaer 2144 Model Frequency Analyzer next to the bed of each patient

Results Noise levels ranged between 49 and 89 dB (A) with a mean of 65 dB (A). Peak noise levels were measured as high as 89 dB (A). The noise levels measured at different locations in the intensive care unit did not differ significantly. Noises created by other patients, those who were admitted from emergency room and operating room into intensive care unit, monitor alarms, conversations among staff were the most disturbing noise sources for patients.

Conclusions  The patients who were located in the bed which was closer to the nurses' station were more affected by the intensive care unit noise than other patients. Having a previous intensive care unit experience also affected the patients' disturbance levels owing to noise. Relevance to clinical practice: Nurses are in key positions where they can identify physical, psychological and social stressors that affect patients during their hospital stay. Staff education, planned nursing activities and proper design of intensive care unit may help combat this overlooked problem.

ICU Admission and Discharge Criteria Mengdie Hu, Karsten M. Jensen, Thomas Roh ICU Admission and Transfer/Discharge Guidelines St. Joseph Hospital 2009   A list of criteria for the admission to ICU Made to assure the appropriate utilization and resources of the ICU Karsten Now we will look at the papers about the ICU admission. The St. Joseph Hospital have made some guidelines to assure the appropriate utilization and resources of the ICU It states under which conditions that can get you admitted to the ICU

Analysis of indications for early discharge from the intensive care unit  Bone et al. 1993 Patients with moderately severe illness benefit more from ICUs than patients who are severely ill or not very ill. A predictive model can be developed to determine the mortality risk 24h after admission. As early as 1993 researchers found that patients with moderately severe illness benefit more from ICUs than patients who are severely ill or not very ill. They also believe a predictive model can be developed to determine the mortality risk 24h after admission.

Consequences of discharges from intensive care at night Goldfred et al Patients who are discharged at night have a much higher risk of dying Night discharges are more likely to be premature Insufficiency of intensive-care beds The observation that patients who are discharged at night have a much higher risk of dying led to the discovery that night discharges are more likely to be premature due to insufficiency of intensive-care beds.

Critically ill patients readmitted to intensive care units--lessons to learn? Metnitz et al. 2003 Readmission raises the risk of dying more than four times Residual organ dysfunctions at time of discharge Optimizing organ functions in patients before discharge Premature discharge often lead to readmission which raises the risk of dying more than four times. It's found that organ dysfunctions at the time of discharge is associated with readmission and therefore should be part of the discharge criteria.

Triaging patients to the ICU: a pilot study of factors influencing admission decisions and patient outcomes Garrouste-Orgeas et al. 2003   Patients triaged by a senior physician are more likely to be refused admission Refusal are related to patient age, underlying diseases, self-sufficiency and number of beds available Karsten

The patient-at-risk team (PART): identifying and managing seriously ill ward patients Goldhill et al. 1999   Patients admitted from hospital wards to ICU have a higher mortality then patients admitted from other areas The PART protocol are a simple way of trying to identify critically ill patients on wards Karsten

Analysis of indications for early discharge from the intensive care unit.  Bone et. al 1993  Measures: Mortality and Quality of Life Acute Physiology and Chronic Health Evaluation (APACHE) Objective methods for determining patient discharge from ICU   Thomas

Mortality among appropriately referred patients refused admission to intensive-care units  Metcalfe et al. 1997   UK - excess mortality for those too ill or too well 9% higher rate of mortality More ICU beds or better admission and discharge criteria Thomas

Guideline on Admission and Discharge for Adult Intermediate Care Units  American College of Critical Care Medicine of the Society of Critical Care Medicine 1998 Admit low risk patients to intermediate care units List of Requirements Labor cost reduction Thomas

Discharge Criteria - A new trend Chung 1995 Discharging patients after anesthesia and surgery Mathematical scoring system for five different areas Recommends using a numerical system to determine discharging a patient Thomas