Despite hospitals’ attempts to calm patients with music, relaxing imagery and even virtual reality, research continues to support the fact that excess noise in the doctor’s office increases patients’ anxiety levels, worsening healthcare outcomes and degrading a provider's quality of care. Hospital noise expert Susan E. Mazer, PhD, weighed in on the decades-old issue in the Journal of Radiology Nursing this fall.
The sound problem isn’t new, Mazer, CEO of Healing HealthCare Systems and a fellow at the Center for Innovation at Fielding Graduate University in Santa Barbara, California, said in the journal. In fact, it stretches back as far at the nineteenth century, when Florence Nightingale called unnecessary noise in the medical environment “the cruelest absence of care.”
“Although the hospital or clinic is most commonly thought to be about beds, walls, windows, floors, ceilings and technology, it is also about people, clutter and noise,” Mazer wrote. “The sounds of suffering and trauma, of machines and technology, that are overheard through thin walls and curtains become the context in which patients and their families undergo their own healthcare experiences."
Previous studies have solidified the fact that patients often present to the hospital with high levels of anxiety, and that stress is only compounded by erratic sounds like buzzers, slamming doors, squeaky carts and intimidating medical machinery. Mazer said anxiety is directly tied to how long a patient’s procedure might take as well as how much medication they’ll require—an important note when considering that, two decades ago, a patient satisfaction survey found noise to be more of an irritant to patients than any other factor within a hospital.
At the heart of this issue, Mazer wrote, are radiology departments’ cultural norms, which vary from institution to institution. She said every radiology lab has its own sound, whether loud or quiet, and simply accepting and adapting to those noises can perpetuate discomfort for patients. For example, if someone noticed a loose wheel on a cart, they should report the disturbance rather than continue to live with it.
Mazer said this is helpful because while nurses, physicians and ancillary staff may not be bothered by something like a wobbly cart, an anxious patient might be.
Fixes typically aren’t limited to physical shortcomings, either, she said. The onus for keeping patients safe, calm and assured is on radiology staff themselves, and internal regulations regarding nurse call systems, phones and public conversations can help drive that behavioral standard.
“The solutions to the hospital noise issues reside in the culture, exactly where they are birthed,” Mazer said. “Yes, mechanical fixes can help, as can acoustic improvements. However, what we are then left with are people—people making noise, people causing annoyance and patients who have little control over their own circumstances.”
Mazer said it’s also worth investing the time to assess a department’s sound environment at all hours of the day and from different geographic locations within the department. Nurses can help implement the practice, she wrote, since they’re constantly performing duties that require them to move throughout the hospital.
“Establishing a priority to create calm within the anxiety can and should be driven by nursing and may draw in representation from the facility management staff,” she said. “This effectively spreads the accountability for the sound environment to include all those who have direct contact with patients. Physicians should also be included.”
Mazer wrote that balancing a sound environment is tricky, since it can be both too loud and too quiet for comfort, but said unnecessary sounds within a radiology department are, “at the least, uncaring and without regard for the patient whose suffering and discomfort are worsened.”
“Aim for more than auditory neutrality because neither silence nor chaos ‘do no harm’ when it comes to noise and distraction,” she said. “What is heard should reflect the same values and standards as the clinical care you provide.”