Implementing quiet hours on a medical telemetry unit

Many hospitals are experiencing increased noise levels due to technology, alarms, equipment, and voices. Quietness at night is one determinant of patient satisfaction that influences hospital reimbursement. Today, hospital workload pressures are equally as demanding at night as they are during the day, which makes it difficult to keep the unit quiet enough for patients to sleep. The World Health Organization recommends that sound levels be kept at 30 decibels (dB) or less in patient rooms, but hospital noises have been measured as high as 67 dB in the ICU.1 Studies link sleep deprivation with delirium, which can increase mortality.2 The importance of sleep has been well documented and is necessary for clear thinking, a healthy immune system, and general health.3 Sleep deprivation is linked to decreased immunity, impaired metabolism, decreased pain tolerance, and increased falls.4 In the hospital, cortical arousal, which disturbs sleep, can be caused by pain, nursing interventions, and noise.3 According to Florence Nightingale’s seminal work, Notes on Nursing, “Unnecessary noise, then, is the most cruel absence of care which can be inflicted on the sick or well.”5 A 30-bed medical telemetry unit in a Southern California community hospital responded to the challenge of improving the unit environment for patients by reducing noise levels at night with a nurse-led evidence-based Quietness Program. The initiative, which began in April 2015, successfully raised Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores related to patients’ satisfaction with quietness on the unit and sustained these higher scores.