Far from the idyllic image of a quiet space in which to heal, hospitals are noisy, disruptive and chaotic environments. One study in the May 2007 issue of Building Services Engineering Research and Technology discovered 86 different sources of noise: from patients and staff; overhead paging, alarms and medical systems; radios and television.
While the World Health Organization recommends that noise levels not exceed 30 decibels for patient rooms, researchers at the University of Chicago Medical Center found that peak noise levels approached that of a chainsaw — more than 80 decibels. Some hospitals have installed noise-absorbing ceiling tiles and ambient white-noise machines; others have tried to lower voices and even pass out headsets to patients, according to Laura Landro in a June 10, 2013, article in The Wall Street Journal.
New findings on the negative effects of noise on patient recovery and satisfaction led Inspira Health Network to reduce noise at the source. Inspira is a charitable nonprofit health care organization with three hospitals, 728 beds and more than 1,100 physicians in southern New Jersey. Leaders at Inspira realized that high noise levels from alarms, alerts and overhead pages were eroding its post-discharge patient satisfaction scores and fatiguing caregivers.
The health system launched a "quiet hospital" initiative to silence noisy wards, using technology to enable more direct communication between caregivers and, as a result, to eliminate many sources of noise.
Reducing Overhead Paging
According to a recent benchmarking study the Beryl Institute, hospital administrators ranked noise reduction as a priority for improving scores on patient experience surveys. Noise is not just annoying; it can disturb sleep, cause spikes in blood pressure, interfere with pain management and impede the ability to heal. But patients are not the only ones affected. Noise makes it difficult for caregivers to concentrate, causes stress and fatigue, and can affect workplace satisfaction and quality of care.
Inspira leaders wanted to reduce the number of overhead pages to lower noise levels, a consistent complaint among patients. Medical staff were frustrated with long hold times on an automated phone system, so they were skipping this process and going directly to the operator, increasing the number of overhead pages.
The health system replaced its broadcast system with direct communications between physician and physician, and between physician and patient. The system has improved the timely communication among health care team members: Doctors can be reached by their preferred method, such as on their mobile device, as well as customize messages and alter dates and times to accommodate their changing schedules.
The program has led to another success: Inspira reduced its average callback time from 20 minutes to a matter of seconds in most cases. The organization achieved the goals of the quiet campaign while also improving both patient and provider satisfaction.
After succeeding in reducing overhead paging and response time, Inspira leaders looked at other ways direct communications could streamline operations while reducing noise levels. They chose to set up automated appointment reminders in several departments to decrease manual calls and follow-ups — in turn, leading to a quieter environment for the patient.
Timely, relevant information in the user's preferred format — phone, text or email — engages patients without annoying or disrupting them. Departments can create a template for each modality or procedure type, and then determine the form of the message, its content, frequency and escalation process. Patients no longer face alert fatigue and easily can confirm or reschedule an appointment.
Direct reminders and notifications enabled Inspira to reduce its number of no-shows for a significant return on investment in just four months. In radiology alone, the department projects an increase in revenue by more than $150,000 a year.
Inspira is now determining how it will use direct communications in the future. It is looking to expand its use to include automated alerts and secure texting.
Using system features such as "calendar awareness" on-call scheduling, notifications such as stat order and consult requests can be automated and sent to the right person at the right time. Stat requests can be sent to the covering doctor, regardless of time of day, and no-stat requests can be sent to the clinician covering the next day at the start of business.
Inspira is planning a transition into the bring-your-own-device era by integrating direct communications with a HIPAA-compliant texting application. The app will allow clinicians to send and receive protected health information either by computer or personal devices.
In addition, nurses will be able to create active alerts to reach a clinician with secure text messaging rather than pagers. Caregivers have found pagers to be unreliable in certain parts of the hospital, and pagers add to the noise in the environment. Moreover, pagers display incomplete information and make it difficult for clinicians to determine urgency. Inspira hopes that secure text messaging will reduce noise levels even further, boost physician response time and improve care through the delivery of more complete, accurate information.
By implementing enterprise communications technology, Inspira has been able to mitigate noise levels and streamline the flow of communications. The health system has improved patient and provider satisfaction through better care coordination and communication, ensuring the dissemination of the right information at the right time to the right person.
Gregory Herman, M.D., is the chief medical information officer at Inspira Health Network, Woodbury, N.J. Brian Biddulph-Krentar is the chief technology officer at HIT Application Solutions, Exton, Pa.