1
|
Tronstad O, Zangerl B, Patterson S, Flaws D, Yerkovich S, Szollosi I, White N, Garcia-Hansen V, Leonard FR, Weger BD, Gachon F, Brain D, Lavana J, Hodgson C, Fraser JF. The effect of an improved ICU physical environment on outcomes and post-ICU recovery-a protocol. Trials 2024; 25:376. [PMID: 38863018 DOI: 10.1186/s13063-024-08222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Intensive care medicine continues to improve, with advances in technology and care provision leading to improved patient survival. However, this has not been matched by similar advances in ICU bedspace design. Environmental factors including excessive noise, suboptimal lighting, and lack of natural lights and views can adversely impact staff wellbeing and short- and long-term patient outcomes. The personal, social, and economic costs associated with this are potentially large. The ICU of the Future project was conceived to address these issues. This is a mixed-method project, aiming to improve the ICU bedspace environment and assess impact on patient outcomes. Two innovative and adaptive ICU bedspaces capable of being individualised to patients' personal and changing needs were co-designed and implemented. The aim of this study is to evaluate the effect of an improved ICU bedspace environment on patient outcomes and operational impact. METHODS This is a prospective multi-component, mixed methods study including a randomised controlled trial. Over a 2-year study period, the two upgraded bedspaces will serve as intervention beds, while the remaining 25 bedspaces in the study ICU function as control beds. Study components encompass (1) an objective environmental assessment; (2) a qualitative investigation of the ICU environment and its impact from the perspective of patients, families, and staff; (3) sleep investigations; (4) circadian rhythm investigations; (5) delirium measurements; (6) assessment of medium-term patient outcomes; and (7) a health economic evaluation. DISCUSSION Despite growing evidence of the negative impact the ICU environment can have on patient recovery, this is an area of critical care medicine that is understudied and commonly not considered when ICUs are being designed. This study will provide new information on how an improved ICU environment impact holistic patient recovery and outcomes, potentially influencing ICU design worldwide. TRIAL REGISTRATION ACTRN12623000541606. Registered on May 22, 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385845&isReview=true .
Collapse
Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Irene Szollosi
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Nicole White
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Veronica Garcia-Hansen
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Francisca Rodriguez Leonard
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Benjamin D Weger
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Frédéric Gachon
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - David Brain
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Jayshree Lavana
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Division of Clinical Trial and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Physiotherapy Department, Alfred Hospital, Melbourne, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
2
|
Lilly CM, Kirk D, Pessach IM, Lotun G, Chen O, Lipsky A, Lieder I, Celniker G, Cucchi EW, Blum JM. Application of Machine Learning Models to Biomedical and Information System Signals From Critically Ill Adults. Chest 2024; 165:1139-1148. [PMID: 37923292 DOI: 10.1016/j.chest.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Machine learning (ML)-derived notifications for impending episodes of hemodynamic instability and respiratory failure events are interesting because they can alert physicians in time to intervene before these complications occur. RESEARCH QUESTION Do ML alerts, telemedicine system (TS)-generated alerts, or biomedical monitors (BMs) have superior performance for predicting episodes of intubation or administration of vasopressors? STUDY DESIGN AND METHODS An ML algorithm was trained to predict intubation and vasopressor initiation events among critically ill adults. Its performance was compared with BM alarms and TS alerts. RESULTS ML notifications were substantially more accurate and precise, with 50-fold lower alarm burden than TS alerts for predicting vasopressor initiation and intubation events. ML notifications of internal validation cohorts demonstrated similar performance for independent academic medical center external validation and COVID-19 cohorts. Characteristics were also measured for a control group of recent patients that validated event detection methods and compared TS alert and BM alarm performance. The TS test characteristics were substantially better, with 10-fold less alarm burden than BM alarms. The accuracy of ML alerts (0.87-0.94) was in the range of other clinically actionable tests; the accuracy of TS (0.28-0.53) and BM (0.019-0.028) alerts were not. Overall test performance (F scores) for ML notifications were more than fivefold higher than for TS alerts, which were higher than those of BM alarms. INTERPRETATION ML-derived notifications for clinically actioned hemodynamic instability and respiratory failure events represent an advance because the magnitude of the differences of accuracy, precision, misclassification rate, and pre-event lead time is large enough to allow more proactive care and has markedly lower frequency and interruption of bedside physician work flows.
Collapse
Affiliation(s)
- Craig M Lilly
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA; UMass Memorial Health, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology and Surgery, University of Massachusetts, Worcester, MA; University of Massachusetts Chan Medical School, University of Massachusetts, Worcester, MA; Clinical and Population Health Research Program, University of Massachusetts, Worcester, MA; Graduate School of Biomedical Sciences, University of Massachusetts, Worcester, MA.
| | - David Kirk
- WakeMed Health & Hospitals, Raleigh/Cary, NC
| | - Itai M Pessach
- The Chaim Sheba Medical Center and Tel-Aviv University, Tel Hashomer, Israel; Clew Medical, Netanya, Israel
| | - Gurudev Lotun
- UMass Memorial Health, UMass Memorial Medical Center, Worcester, MA
| | | | - Ari Lipsky
- The Chaim Sheba Medical Center and Tel-Aviv University, Tel Hashomer, Israel; Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Eric W Cucchi
- UMass Memorial Health, UMass Memorial Medical Center, Worcester, MA
| | - James M Blum
- Department of Anesthesiology, University of Iowa, Iowa City, IA
| |
Collapse
|
3
|
Imbriaco G, Capitano M, Rocchi M, Suhan A, Tacci A, Monesi A, Sebastiani S, Samolsky Dekel BG. Relationship between noise levels and intensive care patients' clinical complexity: An observational simulation study. Nurs Crit Care 2024; 29:555-563. [PMID: 37265028 DOI: 10.1111/nicc.12934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Noise pollution in intensive care units is a relevant problem, associated with psychological and physiological consequences for patients and healthcare staff. Sources of noise pollution include medical equipment, alarms, communication tools, staff activities, and conversations. AIMS To explore the cumulative effects of noise caused by an increasing number and type of medical devices in an intensive care setting on simulated patients with increasing clinical complexity. Secondly, to measure medical device alarms and nursing activities' sound levels, evaluating their role as potentially disruptive noises. STUDY DESIGN Observational simulation study (reported according to the STROBE checklist). Using an electronic sound meter, the sound levels of an intensive care room in seven simulated clinical scenarios were measured on a single day (09 March 2022), each featuring increasing numbers of devices, hypothetically corresponding to augmented patients' clinical complexity. Secondly, noise levels of medical device alarms and specific nursing activities performed at a distance of three meters from the sound meter were analysed. RESULTS The empty room's mean baseline noise level was 37.8 (±0.7) dBA; among the simulated scenarios, noise ranged between 45.3 (±1.0) and 53.5 (±1.5) dBA. Alarms ranged between 76.4 and 81.3 dBA, while nursing tasks (closing a drawer, opening a saline bag overwrap, or sterile packages) and speaking were all over 80 dBA. The noisiest activity was opening a sterile package (98 dBA). CONCLUSION An increased number of medical devices, an expression of patients' higher clinical complexity, is not a significant cause of increased noise. Some specific nursing activities and conversations produce higher noise levels than medical devices and alarms. This study's findings suggest further research to assess the relationships between these factors and to encourage adequate noise reduction strategies. RELEVANCE TO CLINICAL PRACTICE Excessive noise level in the intensive care unit is a clinical issue that negatively affects patients' and healthcare providers' well-being. The increase in baseline room noise from medical devices is generally limited. Typical nursing tasks and conversations produce higher noise levels than medical devices and alarms. These findings could be helpful to raise awareness among healthcare professionals to recognize noise sources. The noisiest components of the environment can be modified by staff behaviour, promoting noise reduction strategies and improving the critical care environment.
Collapse
Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est, Prehospital Emergency Dispatch Center, Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Martina Capitano
- Emergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Margherita Rocchi
- Intensive Care Unit, Nuovo San Giovanni di Dio hospital, AUSL Toscana Centro, Florence, Italy
| | - Aglaia Suhan
- Medical Department (COVID-19), Madre Teresa di Calcutta hospital, Padova, Italy
| | - Alice Tacci
- Neonatal Intensive Care Unit, Maggiore Hospital, AOU Parma, Parma, Italy
| | - Alessandro Monesi
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- Intensive Care Unit, Maggiore hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Stefano Sebastiani
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Boaz Gedaliahu Samolsky Dekel
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
Tronstad O, Patterson S, Zangerl B, Flaws D, Holdsworth R, Irvine L, Yerkovich S, Pearse I, Fraser JF. The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients. Aust Crit Care 2024:S1036-7314(24)00053-5. [PMID: 38604917 DOI: 10.1016/j.aucc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff. OBJECTIVE The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU. METHODS This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration. RESULTS Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep. CONCLUSION The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.
Collapse
Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; School of Dentistry, University of Queensland, Brisbane, Australia
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Lacey Irvine
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Qld University of Technology, Brisbane, Australia
| | - India Pearse
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Australia
| |
Collapse
|
5
|
Jonescu EE, Farrel B, Ramanayaka CE, White C, Costanzo G, Delaney L, Hahn R, Ferrier J, Litton E. Mitigating Intensive Care Unit Noise: Design-Led Modeling Solutions, Calculated Acoustic Outcomes, and Cost Implications. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241237501. [PMID: 38512990 DOI: 10.1177/19375867241237501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVES, PURPOSE, OR AIM The study aimed to decrease noise levels in the ICU, anticipated to have adverse effects on both patients and staff, by implementing enhancements in acoustic design. BACKGROUND Recognizing ICU noise as a significant disruptor of sleep and a potential hindrance to patient recovery, this study was conducted at a 40-bed ICU in Fiona Stanley Hospital in Perth, Australia. METHODS A comprehensive mixed-methods approach was employed, encompassing surveys, site analysis, and acoustic measurements. Survey data highlighted the importance of patient sleep quality, emphasizing the negative impact of noise on work performance, patient connection, and job satisfaction. Room acoustics analysis revealed noise levels ranging from 60 to 90 dB(A) in the presence of patients, surpassing sleep disruption criteria. RESULTS Utilizing an iterative 3D design modeling process, the study simulated significant acoustic treatment upgrades. The design integrated effective acoustic treatments within patient rooms, aiming to reduce noise levels and minimize transmission to adjacent areas. Rigorous evaluation using industry-standard acoustic software highlights the design's efficacy in reducing noise transmission in particular. Additionally, cost implications were examined, comparing standard ICU construction with acoustically treated options for new construction and refurbishment projects. CONCLUSIONS This study provides valuable insights into design-based solutions for addressing noise-related challenges in the ICU. While the focus is on improving the acoustic environment by reducing noise levels and minimizing transmission to adjacent areas. It is important to clarify that direct measurements of patient outcomes were not conducted. The potential impact of these solutions on health outcomes, particularly sleep quality, remains a crucial aspect for consideration.
Collapse
Affiliation(s)
- Emil E Jonescu
- Hames Sharley, Perth, Western Australia, Australia
- School of Arts and Humanities, Edith Cowan University, Perth, Western Australia, Australia
| | - Benjamin Farrel
- Gabriels Hearn Farrell Pty Ltd, South Perth, Western Australia, Australia
| | - Chamil Erik Ramanayaka
- Central Queensland University, School of Engineering and Technology, Brisbane, Queensland, Australia
| | | | | | - Lori Delaney
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Queensland, Australia
- College of Medicine and Health Sciences, Australian National University, Acton, Canberra, Australia
| | - Rebecca Hahn
- Heart and Lung Research Institute of WA, Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Health and Medical Science, Surgery, University of Western Australia, Crawley, Western Australia, Australia
- Cardiothoracic and Transplant Surgery Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Janet Ferrier
- Intensive Care Unit, St. John of God Hospital, Subiaco, Western Australia, Australia
- ANZSCTS National Cardiac Surgery Data Base, St John of God Hospital, Perth Western Australia
| | - Edward Litton
- Intensive Care Unit, St. John of God Hospital, Subiaco, Western Australia, Australia
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
6
|
Schön I, Witek S, Merz N, Ziegler S, Feuchtinger J. [Sounds in intensive care units: Perspectives of patients and parents. A qualitative study]. Pflege 2024. [PMID: 38197292 DOI: 10.1024/1012-5302/a000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Sounds in intensive care units: Perspectives of patients and parents. A qualitative study Abstract: Background: Sound levels in intensive care units exceed internationally recommended limits. This can have negative effects on patients, relatives, and staff. There is a lack of evidence on noise-reducing measures. Aim: The aim of the study was the implementation and evaluation of ward-specific noise management in intensive care units. In the present article, the question of the noise and stress experience of intensive care patients and parents of neonatal intensive care patients was explored. Methods: 33 semi-structured interviews with intensive care patients and parents of neonatal intensive care patients in three intensive care units were conducted and analysed. Results: Sounds in intensive care units can be stressful (especially alarms) but also be interpreted as meaningful. This is not only related to the context of the ICU, but also to individual experiences and the social aspects of the sounds. In order to avoid or reduce stress, participants apply individual noise (stress) management. In contrast, ward-related noise management had no specific effect on the participants. Conclusions: The findings offer indications for suitable measures to reduce the noise exposure of intensive care patients and parents of neonatal intensive care patients. Research about measures such as concepts for supporting the attribution and differentiation of sounds could follow.
Collapse
Affiliation(s)
- Isabel Schön
- AGP Sozialforschung im FIVE - Forschungs- und Innovationsverbundes an der Ev. Hochschule Freiburg e.V., Deutschland
| | - Sandra Witek
- Pflegedirektion, Pflegepraxiszentrum, Universitätsklinikum Freiburg, Deutschland
| | - Nicola Merz
- AGP Sozialforschung im FIVE - Forschungs- und Innovationsverbundes an der Ev. Hochschule Freiburg e.V., Deutschland
| | - Sven Ziegler
- Pflegedirektion, Pflegepraxiszentrum, Universitätsklinikum Freiburg, Deutschland
| | - Johanna Feuchtinger
- Pflegedirektion, Pflegepraxiszentrum, Universitätsklinikum Freiburg, Deutschland
| |
Collapse
|
7
|
Shorofi SA, Dadashian P, Arbon P, Moosazadeh M. The efficacy of earplugs and eye masks for delirium severity and sleep quality in patients undergoing coronary artery bypass grafting in cardiac intensive care units: A single-blind, randomised controlled trial. Aust Crit Care 2024; 37:74-83. [PMID: 37802695 DOI: 10.1016/j.aucc.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Delirium is a neuropsychiatric syndrome with a wide range of possible causes and multiple complications in patients admitted to intensive care units. It is, therefore, necessary to seek appropriate and safe strategies to prevent and manage delirium. This study is intended to examine the efficacy of eye masks and earplugs for delirium severity and sleep quality in patients with coronary artery bypass grafting in a cardiac intensive care unit. MATERIALS AND METHODS This single-blind, randomised controlled trial was conducted on 114 patients who were consecutively enrolled and randomly assigned to either the experimental group or the control group. The experimental group received routine care plus eye masks and earplugs, and the control group received only routine care. The delirium severity and sleep quality were measured with the Neelon and Champagne confusion scale and the Verran and Snyder-Halpern sleep scale. RESULTS The mean delirium severity score differed significantly between the two groups on the second, third, and fourth postoperative days (p < 0.001). Although the trend of changes in the mean delirium severity score from the first postoperative day (before the intervention) to the second, third, and fourth postoperative days was downward in the two groups (trending towards higher delirium severity), the control group experienced greater changes than the experimental group. An intragroup analysis of delirium severity detected a statistically significant difference in both the experimental and control groups (p < 0.001). The sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) showed a statistically significant difference between the two groups across the three intervention days (p < 0.001). CONCLUSION The overnight use of eye masks and earplugs were found to have positive effects on sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) and delirium severity in coronary artery bypass grafting patients admitted to the cardiac intensive care unit for several days. It was also found that a significant interaction effect between the sleep disturbance subscale and delirium severity exists. CLINICAL TRIAL REGISTRATION NUMBER (https://en.irct.ir): IRCT20210523051370N2.
Collapse
Affiliation(s)
- Seyed Afshin Shorofi
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran; Adjunct Research Fellow, Flinders University, Adelaide, Australia.
| | - Pooneh Dadashian
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Paul Arbon
- Torrens Resilience Institute, Flinders University, Adelaide, Australia
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
8
|
Liu Y, Wang J, Huo J, Zhang S, Han L, Lei Y, Wang Y. Application Effect of Comprehensive Noise Reduction Technology in Outpatients with Vitiligo: A Retrospective Study. Noise Health 2024; 26:37-43. [PMID: 38570309 PMCID: PMC11141697 DOI: 10.4103/nah.nah_60_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Noise is a kind of perceived public nuisance that is closely related to people's subjective feelings and lives. This study explores the clinical application effect of comprehensive noise reduction technology in outpatients with vitiligo. METHODS A total of 76 patients with vitiligo were selected in the Department of Dermatology at Baoding No. 2 Central Hospital from January 2020 to January 2021, as the control group (CG), receiving 5S management mode, and 80 patients with vitiligo from February 2021 to October 2022 were selected as the study group (SG), receiving comprehensive noise reduction technology combined with the 5S management mode for this retrospective study. The effects of different management modes on these patients were observed. RESULTS SG had higher nursing quality scores in service attitude, service initiative, communication skills, environmental management and item management and overtly a lower noise level than CG (all P < 0.001). The Hamilton Anxiety Scale (HAMA) scores of the two groups at the end of treatment were significantly lower than those on admission (P < 0.05), with SG showing a lower score than CG (P < 0.001). Correlation analysis showed that noise levels and HAMA scores had a positive correlation (r = 0.423, P < 0.001). Patients with negative feelings about medical treatment caused by various noise sources in SG were obviously less than those in CG (P < 0.05). Both the groups had a statistical difference in overall satisfaction (P < 0.05). CONCLUSION The investigation and data analysis demonstrated that comprehensive noise reduction in outpatients with vitiligo had a considerable effect. This technology can standardise the behaviour of medical staff, enhance nursing quality, reduce noise levels and alleviate patients' anxiety and improve their satisfaction. It has great benefits for the outpatient environment and patients.
Collapse
Affiliation(s)
- Yong Liu
- Dermatology Venereal Disease Department, Baoding NO. 2 Central Hospital, Zhuozhou, Hebei, China
| | - Jingjing Wang
- Dermatology Venereal Disease Department, Baoding NO. 2 Central Hospital, Zhuozhou, Hebei, China
| | - Jianli Huo
- Dermatology Venereal Disease Department, Baoding NO. 2 Central Hospital, Zhuozhou, Hebei, China
| | - Shaoguang Zhang
- Dermatology Venereal Disease Department, Baoding NO. 2 Central Hospital, Zhuozhou, Hebei, China
| | - Li Han
- Dermatology Venereal Disease Department, Baoding NO. 2 Central Hospital, Zhuozhou, Hebei, China
| | - Yong Lei
- Dermatology Venereal Disease Department, Baoding NO. 2 Central Hospital, Zhuozhou, Hebei, China
| | - Ya’nan Wang
- Department of Neurology, Baoding NO. 2 Central Hospital, Zhuozhou, Hebei, China
| |
Collapse
|
9
|
Armbruster C, Walzer S, Witek S, Ziegler S, Farin-Glattacker E. Noise exposure among staff in intensive care units and the effects of unit-based noise management: a monocentric prospective longitudinal study. BMC Nurs 2023; 22:460. [PMID: 38057790 DOI: 10.1186/s12912-023-01611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Intensive care units (ICUs) are often too noisy, exceeding 70-80 dBA, which can have negative effects on staff. The corresponding recommendation of the World Health Organization (average sound pressure level below 35 dBA) is often not achieved. To date there is a lack of intervention studies examining the extent to which unit-based noise management in ICUs contributes to a reduction in noise exposure for the staff. The study therefore aims to provide answers to 1) how unit-based noise management sustainably reduces the subjective noise exposure among staff, and 2) how this intervention affects other noise-related topics. METHODS We performed a monocentric prospective longitudinal study with three measurement points in a German university hospital in three ICUs. We collected data from different healthcare professionals and other professional groups between October 2021 and August 2022 using an online questionnaire. Data were analyzed using descriptive and inference statistics. RESULTS A total of n = 179 participants took part in the surveys. The majority of participants were nurses or pediatric nurses. Most participants worked more than 75% full-time equivalent. Staff on the three ICUs reported high levels of noise exposure. No significant changes in noise exposure over time were observed. Participants were already aware of the topic and believed that a behavior change could positively influence the noise environment. CONCLUSIONS This study provides an initial insight into how a unit-based noise management could contribute to a reduction in the subjective noise exposure among staff in ICUs. The results of this study highlight the importance of this topic. Future studies should aim to research aspects of adherence and their facilitators or barriers, which promote the sustained implementation of noise-reducing measures by staff. TRIAL REGISTRATION German Clinical Trials Register (DRKS): DRKS00025835; Date of registration: 12.08.2021.
Collapse
Affiliation(s)
- Christoph Armbruster
- Institute of Medical Biometry and Statistics (IMBI), Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany.
| | - Stefan Walzer
- Faculty of Health, Safety and Society, Care and Technology Lab, Furtwangen University, 78120, Furtwangen, Germany
| | - Sandra Witek
- Center of Implementing Nursing Care Innovations Freiburg, Medical Center - University of Freiburg, 79106, Freiburg, Germany
| | - Sven Ziegler
- Center of Implementing Nursing Care Innovations Freiburg, Medical Center - University of Freiburg, 79106, Freiburg, Germany
| | - Erik Farin-Glattacker
- Institute of Medical Biometry and Statistics (IMBI), Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany
| |
Collapse
|
10
|
Tronstad O, Flaws D, Patterson S, Holdsworth R, Garcia-Hansen V, Rodriguez Leonard F, Ong R, Yerkovich S, Fraser JF. Evaluation of the sensory environment in a large tertiary ICU. Crit Care 2023; 27:461. [PMID: 38012768 PMCID: PMC10683296 DOI: 10.1186/s13054-023-04744-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND ICU survival is improving. However, many patients leave ICU with ongoing cognitive, physical, and/or psychological impairments and reduced quality of life. Many of the reasons for these ongoing problems are unmodifiable; however, some are linked with the ICU environment. Suboptimal lighting and excessive noise contribute to a loss of circadian rhythms and sleep disruptions, leading to increased mortality and morbidity. Despite long-standing awareness of these problems, meaningful ICU redesign is yet to be realised, and the 'ideal' ICU design is likely to be unique to local context and patient cohorts. To inform the co-design of an improved ICU environment, this study completed a detailed evaluation of the ICU environment, focussing on acoustics, sound, and light. METHODS This was an observational study of the lighting and acoustic environment using sensors and formal evaluations. Selected bedspaces, chosen to represent different types of bedspaces in the ICU, were monitored during prolonged study periods. Data were analysed descriptively using Microsoft Excel. RESULTS Two of the three monitored bedspaces showed a limited difference in lighting levels across the day, with average daytime light intensity not exceeding 300 Lux. In bedspaces with a window, the spectral power distribution (but not intensity) of the light was similar to natural light when all ceiling lights were off. However, when the ceiling lights were on, the spectral power distribution was similar between bedspaces with and without windows. Average sound levels in the study bedspaces were 63.75, 56.80, and 59.71 dBA, with the single room being noisier than the two open-plan bedspaces. There were multiple occasions of peak sound levels > 80 dBA recorded, with the maximum sound level recorded being > 105 dBA. We recorded one new monitor or ventilator alarm commencing every 69 s in each bedspace, with only 5% of alarms actioned. Acoustic testing showed poor sound absorption and blocking. CONCLUSIONS This study corroborates other studies confirming that the lighting and acoustic environments in the study ICU were suboptimal, potentially contributing to adverse patient outcomes. This manuscript discusses potential solutions to identified problems. Future studies are required to evaluate whether an optimised ICU environment positively impacts patient outcomes.
Collapse
Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Dylan Flaws
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Sue Patterson
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Robert Holdsworth
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
| | - Veronica Garcia-Hansen
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Francisca Rodriguez Leonard
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Ruth Ong
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
11
|
Tronstad O, Flaws D, Patterson S, Holdsworth R, Fraser JF. Creating the ICU of the future: patient-centred design to optimise recovery. Crit Care 2023; 27:402. [PMID: 37865760 PMCID: PMC10589962 DOI: 10.1186/s13054-023-04685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Intensive Care survival continues to improve, and the number of ICU services is increasing globally. However, there is a growing awareness of the detrimental impact of the ICU environment on patients, families, and staff. Excessive noise and suboptimal lighting especially have been shown to adversely impact physical and mental recovery during and after an ICU admission. Current ICU designs have not kept up with advances in medical technology and models of care, and there is no current 'gold-standard' ICU design. Improvements in ICU designs are needed to optimise care delivery and patient outcomes. METHODS This manuscript describes a mixed-methods, multi-staged participatory design project aimed at redesigning and implementing two innovative ICU bedspaces. Guided by the action effect method and the consolidated framework for implementation research, the manuscript describes the processes taken to ensure the patient-centred problems were properly understood, the steps taken to develop and integrate solutions to identified problems, and the process of implementation planning and rebuilding in a live ICU. RESULTS Two innovative ICU bedspaces were rebuilt and implemented. They feature solutions to address all identified problems, including noise reduction, optimisation of lighting, access to nature via digital solutions, and patient connectivity and engagement, with solutions developed from various specialty fields, including IT improvements, technological innovations, and design and architectural solutions. Early evaluation demonstrates an improved lighting and acoustic environment. CONCLUSIONS Optimising the ICU bedspace environment and improving the lighting and acoustic environment is possible. The impact on patient outcomes needs to be evaluated.
Collapse
Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
12
|
Sangari A, Bingham MA, Cummins M, Sood A, Tong A, Purcell P, Schlesinger JJ. A Spatiotemporal and Multisensory Approach to Designing Wearable Clinical ICU Alarms. J Med Syst 2023; 47:105. [PMID: 37847469 DOI: 10.1007/s10916-023-01997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023]
Abstract
In health care, auditory alarms are an important aspect of an informatics system that monitors patients and alerts clinicians attending to multiple concurrent tasks. However, the volume, design, and pervasiveness of existing Intensive Care Unit (ICU) alarms can make it difficult to quickly distinguish their meaning and importance. In this study, we evaluated the effectiveness of two design approaches not yet explored in a smartwatch-based alarm system designed for ICU use: (1) using audiovisual spatial colocalization and (2) adding haptic (i.e., touch) information. We compared the performance of 30 study participants using ICU smartwatch alarms containing auditory icons in two implementations of the audio modality: colocalized with the visual cue on the smartwatch's low-quality speaker versus delivered from a higher quality speaker located two feet away from participants (like a stationary alarm bay situated near patients in the ICU). Additionally, we compared participant performance using alarms with two sensory modalities (visual and audio) against alarms with three sensory modalities (adding haptic cues). Participants were 10.1% (0.24s) faster at responding to alarms when auditory information was delivered from the smartwatch instead of the higher quality external speaker. Meanwhile, adding haptic information to alarms improved response times to alarms by 12.2% (0.23s) and response times on their primary task by 10.3% (0.08s). Participants rated learnability and ease of use higher for alarms with haptic information. These small but statistically significant improvements demonstrate that audiovisual colocalization and multisensory alarm design can improve user response times.
Collapse
Affiliation(s)
- Ayush Sangari
- Renaissance School of Medicine, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11790, USA.
| | - Molly A Bingham
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Mabel Cummins
- Department of Neuroscience, Vanderbilt University, Nashville, TN, USA
| | - Aditya Sood
- Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Anqy Tong
- Department of Neuroscience, Vanderbilt University, Nashville, TN, USA
| | | | - Joseph J Schlesinger
- Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
13
|
Naef AC, Knobel SEJ, Ruettgers N, Rossier M, Jeitziner MM, Zante B, Müri RM, Schefold JC, Nef T, Gerber SM. Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study. Front Med (Lausanne) 2023; 10:1219257. [PMID: 37521352 PMCID: PMC10382019 DOI: 10.3389/fmed.2023.1219257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
Background Exposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting. Methods In this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical-surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds. Results The mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently. Conclusion Our study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, identifying these sound sources can have a meaningful impact on patients and staff by identifying targets for future interventions, thus leading to a healthier environment.
Collapse
Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Marilyne Rossier
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse, Basel, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - René M. Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| |
Collapse
|
14
|
Showler L, Ali Abdelhamid Y, Goldin J, Deane AM. Sleep during and following critical illness: A narrative review. World J Crit Care Med 2023; 12:92-115. [PMID: 37397589 PMCID: PMC10308338 DOI: 10.5492/wjccm.v12.i3.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 06/08/2023] Open
Abstract
Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.
Collapse
Affiliation(s)
- Laurie Showler
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Jeremy Goldin
- Sleep and Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Adam M Deane
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| |
Collapse
|
15
|
Rios D, Katzman N, Burdick KJ, Gellert M, Klein J, Bitan Y, Schlesinger JJ. Multisensory alarm to benefit alarm identification and decrease workload: a feasibility study. J Clin Monit Comput 2023:10.1007/s10877-023-01014-4. [PMID: 37133627 PMCID: PMC10154742 DOI: 10.1007/s10877-023-01014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/05/2023] [Indexed: 05/04/2023]
Abstract
The poor design of conventional auditory medical alarms has contributed to alarm desensitization, and eventually, alarm fatigue in medical personnel. This study tested a novel multisensory alarm system which aims to help medical personnel better interpret and respond to alarm annunciation during periods of high cognitive load such as those found within intensive care units. We tested a multisensory alarm that combined auditory and vibrotactile cues to convey alarm type, alarm priority, and patient identity. Testing was done in three phases: control (conventional auditory), Half (limited multisensory alarm), and Full (complete multisensory alarm). Participants (N = 19, undergraduates) identified alarm type, priority, and patient identity (patient 1 or 2) using conventional and multisensory alarms, while simultaneously completing a cognitively demanding task. Performance was based on reaction time (RT) and identification accuracy of alarm type and priority. Participants also reported their perceived workload. RT was significantly faster for the Control phase (p < 0.05). Participant performance in identifying alarm type, priority, and patient did not differ significantly between the three phase conditions (p = 0.87, 0.37, and 0.14 respectively). The Half multisensory phase produced the lowest mental demand, temporal demand, and overall perceived workload score. These data suggest that implementation of a multisensory alarm with alarm and patient information may decrease perceived workload without significant changes in alarm identification performance. Additionally, a ceiling effect may exist for multisensory stimuli, with only part of an alarm benefitting from multisensory integration.
Collapse
Affiliation(s)
- Derek Rios
- Department of Neuroscience Nashville, Vanderbilt University, Nashville, TN, 37235, USA
| | - Nuphar Katzman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Be'er Sheva, Beersheba, Israel
| | | | - May Gellert
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Be'er Sheva, Beersheba, Israel
| | - Jessica Klein
- Vanderbilt University School of Medicine, 1161 21st Ave South, Nashville, TN, 37232, USA
| | - Yuval Bitan
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Joseph J Schlesinger
- Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37209, USA.
| |
Collapse
|
16
|
Cash EK, Giambra BK. Audiovisual Recording in the Inpatient Setting: A Method for Studying Parent-Nurse Communication. JOURNAL OF FAMILY NURSING 2023; 29:192-201. [PMID: 37133301 DOI: 10.1177/10748407231162131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Audiovisual recordings are under-utilized for capturing interactions in inpatient settings. Standardized procedures and methods improve observation and conclusion validity drawn from audiovisual data. This article provides specific approaches for collecting, standardizing, and maintaining audiovisual data based on a study of parent-nurse communication and child and family outcomes. Data were collected using audio and video recorders at defined time points simplifying its collection. Data were downloaded, edited for size and privacy, and securely stored, then transcribed, and subsequently reviewed to ensure accuracy. Positive working relationships with families and nurses facilitated successful study recruitment, data collection, and transcript cleaning. Barriers to recruitment and data collection, such as privacy concerns and technical issues, were successfully overcome. When carefully coordinated and obtained, audiovisual recordings are a rich source of research data. Thoughtful protocol design for the successful capture, storage, and use of recordings enables researchers to take quick action to preserve data integrity when unexpected situations arise.
Collapse
Affiliation(s)
- Erin K Cash
- Cincinnati Children's Hospital Medical Center, OH, USA
| | - Barbara K Giambra
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Nursing, OH, USA
| |
Collapse
|
17
|
Knauert MP, Ayas NT, Bosma KJ, Drouot X, Heavner MS, Owens RL, Watson PL, Wilcox ME, Anderson BJ, Cordoza ML, Devlin JW, Elliott R, Gehlbach BK, Girard TD, Kamdar BB, Korwin AS, Lusczek ER, Parthasarathy S, Spies C, Sunderram J, Telias I, Weinhouse GL, Zee PC. Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e49-e68. [PMID: 36999950 PMCID: PMC10111990 DOI: 10.1164/rccm.202301-0184st] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Background: Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods: We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results: We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions: ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.
Collapse
|
18
|
Dallı ÖE, Yıldırım Y, Aykar FŞ, Kahveci F. The effect of music on delirium, pain, sedation and anxiety in patients receiving mechanical ventilation in the intensive care unit. Intensive Crit Care Nurs 2023; 75:103348. [PMID: 36470699 DOI: 10.1016/j.iccn.2022.103348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To examine the effects of music for patients under mechanical ventilation support in the intensive care unit on their delirium, pain, sedation, and anxiety. RESEARCH METHODOLOGY/DESIGN A single-blind, randomized, controlled trial. SETTING The study was conducted with delirium positive patients between August 2020 and September 2021 in the medical/surgical intensive care unit of a university hospital in Turkey. METHODS The study sample was selected through a simple and stratified randomization method; patients who met the inclusion criteria were assigned to the music, noise reduction or control group. The data were collected by using a Confusion Assessment Method for the ICU (CAM-ICU), CAM-ICU-7, Critical Care Pain Observation Tool (CPOT), Richmond Agitation-Sedation Scale (RASS), Facial Anxiety Scale (FAS), PRE-DELIRIC model, and Glasgow Coma Scale (GCS). The interventions were repeated twice a day for five days. RESULTS A total of 36 patients were included, with 12 patients in each group. Significant decreases were found in the severity of delirium and pain and the level of sedation and anxiety in the music compared to the other groups (p < 0.05). The number of patients with delirium and the number of days with mechanical ventilation was found to be significantly lower in the music group compared to the other groups (p < 0.05). CONCLUSION Music intervention may be used as a nursing intervention to control delirium, pain, need for sedation and anxiety in intensive care unit patients. However, additional studies with larger sample is needed to validate findings.
Collapse
Affiliation(s)
- Öznur Erbay Dallı
- Bursa Uludag University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Nilüfer, Bursa 16059, Turkey.
| | - Yasemin Yıldırım
- Ege University Faculty of Nursing, Department of Internal Medicine Nursing, Bornova, Izmir 35100, Turkey.
| | - Fisun Şenuzun Aykar
- Izmir Tınaztepe University, Faculty of Health Sciences, Department of Nursing Buca, Izmir 35100, Turkey.
| | - Ferda Kahveci
- Bursa Uludag University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Division of Intensive Care, Nilüfer, Bursa 16059, Turkey.
| |
Collapse
|
19
|
Vreman J, Lemson J, Lanting C, van der Hoeven J, van den Boogaard M. The Effectiveness of the Interventions to Reduce Sound Levels in the ICU: A Systematic Review. Crit Care Explor 2023; 5:e0885. [PMID: 36998528 PMCID: PMC10047617 DOI: 10.1097/cce.0000000000000885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Excessive noise is ubiquitous in the ICU, and there is growing evidence of the negative impact on work performance of caregivers. This study aims to determine the effectiveness of interventions to reduce noise in the ICU. DATA SOURCES Databases of PubMed, EMBASE, PsychINFO, CINAHL, and Web of Science were systematically searched from inception to September 14, 2022. STUDY SELECTION Two independent reviewers assessed titles and abstracts against study eligibility criteria. Noise mitigating ICU studies were included when having at least one quantitative acoustic outcome measure expressed in A-weighted sound pressure level with an experimental, quasi-experimental, or observational design. Discrepancies were resolved by consensus, and a third independent reviewer adjudicated as necessary. DATA EXTRACTION After title, abstract, and full-text selection, two reviewers independently assessed the quality of each study using the Cochrane's Risk Of Bias In Nonrandomized Studies of Interventions tool. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and interventions were summarized. DATA SYNTHESIS After screening 12,652 articles, 25 articles were included, comprising either a mixed group of healthcare professionals (n = 17) or only nurses (n = 8) from adult or PICU settings. Overall, the methodological quality of the studies was low. Noise reduction interventions were categorized into education (n = 4), warning devices (n = 3), multicomponent programs (n = 15), and architectural redesign (n = 3). Education, a noise warning device, and an architectural redesign significantly decreased the sound pressure levels. CONCLUSIONS Staff education and visual alert systems seem promising interventions to reduce noise with a short-term effect. The evidence of the studied multicomponent intervention studies, which may lead to the best results, is still low. Therefore, high-quality studies with a low risk of bias and a long-term follow-up are warranted. Embedding noise shielding within the ICU-redesign is supportive to reduce sound pressure levels.
Collapse
|
20
|
Krüger L, Mannebach T, Zittermann A, Wefer F, von Dossow V, Rojas Hernandez S, Gummert J, Langer G. Patientinnen- und patientenbezogene Auswirkungen von prozessverantwortlicher Pflege. Med Klin Intensivmed Notfmed 2023; 118:257-262. [PMID: 36971803 PMCID: PMC10160145 DOI: 10.1007/s00063-023-00998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/08/2023] [Indexed: 03/29/2023]
Abstract
Abstract
Background
Since January 2022, a primary nursing system called process-responsible nursing (PP) has substituted the standard room care system in an intensive care unit (ICU) at our institution. The process of the development and implementation of PP is already being evaluated in a separate study as an actual analysis prior to implementation, as well as after 6 and 12 months.
Aim
This pilot randomized controlled trial (RCT) aims to test the feasibility of an RCT. For this purpose, the duration of delirium, among other things, will be compared in the project ICU with the results of standard care in another ICU at the university hospital. As secondary aims, the incidence of delirium, anxiety, the satisfaction of relatives, and the effects of PP on nurses will be assessed.
Methods
It is planned to recruit about 400–500 patients over a period of one year. They will be allocated to PP or standard care. Delirium will be assessed using the Confusion Assessment Method for Intensive Care Units by specifically trained nurses three times a day. Anxiety in patients, the satisfaction of relatives, and the effects of PP on nurses will be evaluated using the numeric rating scale, a standardized questionnaire, and a focus group interview, respectively.
Expected results
The primary hypothesis is that compared to usual care PP reduces the duration of delirium by at least 8 h. Additional hypotheses are that PP reduces anxiety in patients and increases the satisfaction of relatives.
Collapse
Affiliation(s)
- Lars Krüger
- Project and Knowledge Management/Care Development intensive care, Care Directorate, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Thomas Mannebach
- Surgical Intensive Care Unit E 0.1, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Franziska Wefer
- Care Development, Care Directorate, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
- Institute for Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Straße 176–178, 50935 Cologne, Germany
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Sebastian Rojas Hernandez
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32345 Bad Oeynhausen, Germany
| | - Gero Langer
- Institute of Health and Nursing Sciences, German Center for Evidence-based Nursing, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| |
Collapse
|
21
|
Fadiga e sono em trabalhadores de enfermagem intensivistas na pandemia COVID-19. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ar000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
22
|
Fadiga e sono em trabalhadores de enfermagem intensivistas na pandemia COVID-19. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
23
|
Ruettgers N, Naef AC, Rossier M, Knobel SEJ, Jeitziner MM, Grosse Holtforth M, Zante B, Schefold JC, Nef T, Gerber SM. Perceived sounds and their reported level of disturbance in intensive care units: A multinational survey among healthcare professionals. PLoS One 2022; 17:e0279603. [PMID: 36584079 PMCID: PMC9803129 DOI: 10.1371/journal.pone.0279603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The noise levels in intensive care units have been repeatedly reported to exceed the recommended guidelines and yield negative health outcomes among healthcare professionals. However, it is unclear which sound sources within this environment are perceived as disturbing. Therefore, this study aimed to evaluate how healthcare professionals in Germany, Switzerland, and Austria perceive the sound levels and the associated sound sources within their work environment and explore sound reduction strategies. MATERIAL AND METHODS An online survey was conducted among 350 healthcare professionals working in intensive care units. The survey consisted of items on demographic and hospital data and questions about the perception of the sound levels [1 (strongly disagree) to 5 (strongly agree)], disturbance from sound sources [1 (not disturbing at all) to 5 (very disturbing)], and implementation potential, feasibility, and motivation to reduce sound reduction measures [1 (not high at all) to 5 (very high)]. RESULTS Approximately 69.3% of the healthcare professionals perceived the sound levels in the ICUs as too high. Short-lasting human sounds (e.g. moans or laughs) [mean (M) ± standard deviation (SD) = 3.30 ± 0.81], devices and alarms (M ± SD = 2.67 ± 0.59), and short-lasting object sounds (M ± SD = 2.55 ± 0.68) were perceived as the most disturbing sounds. Reducing medical equipment alarms was considered to have greater implementation potential [M ± SD = 3.62 ± 0.92, t(334) = -7.30, p < 0.001], feasibility [M ± SD = 3.19 ± 0.93, t(334) = -11.02, p < 0.001], and motivation [M ± SD = 3.85 ± 0.89, t(334) = -10.10, p < 0.001] for reducing the sound levels. CONCLUSION This study showed that healthcare professionals perceive short-lasting human sounds as most disturbing and rated reducing medical equipment alarms as the best approach to reduce the sound levels in terms of potential, feasibility, and motivation for implementation.
Collapse
Affiliation(s)
- Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marilyne Rossier
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin Grosse Holtforth
- Psychosomatic Medicine, Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- * E-mail:
| |
Collapse
|
24
|
Latour JM, Kentish-Barnes N, Jacques T, Wysocki M, Azoulay E, Metaxa V. Improving the intensive care experience from the perspectives of different stakeholders. Crit Care 2022; 26:218. [PMID: 35850700 PMCID: PMC9289931 DOI: 10.1186/s13054-022-04094-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 01/02/2023] Open
Abstract
The intensive care unit (ICU) is a complex environment where patients, family members and healthcare professionals have their own personal experiences. Improving ICU experiences necessitates the involvement of all stakeholders. This holistic approach will invariably improve the care of ICU survivors, increase family satisfaction and staff wellbeing, and contribute to dignified end-of-life care. Inclusive and transparent participation of the industry can be a significant addition to develop tools and strategies for delivering this holistic care. We present a report, which follows a round table on ICU experience at the annual congress of the European Society of Intensive Care Medicine. The aim is to discuss the current evidence on patient, family and healthcare professional experience in ICU is provided, together with the panel’s suggestions on potential improvements. Combined with industry, the perspectives of all stakeholders suggest that ongoing improvement of ICU experience is warranted.
Collapse
|
25
|
Darbyshire JL, Duncan Young J. Variability of environmental sound levels: An observational study from a general adult intensive care unit in the UK. J Intensive Care Soc 2022; 23:389-397. [PMID: 36751355 PMCID: PMC9679913 DOI: 10.1177/17511437211022127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Intensive care units are significantly louder than WHO guidelines recommend. Patients are disturbed by activities around them and frequently report disrupted sleep. This can lead to slower recovery and long-term health problems. Environmental sound levels are usually reported as LAeq24, a single daily value that reflects mean sound levels over the previous 24-h period. This may not be the most appropriate measure for intensive care units (ICUs) and other similar areas. Humans experience sound in context, and disturbance will vary according to both the individual and acoustic features of the ambient sounds. Loudness is one of a number of measures that approximate the human perception of sound, taking into account tone, duration, and frequency, as well as volume. Typically sounds with higher frequencies, such as alarms, are perceived as louder and more disturbing. Methods Sound level data were collected from a single NHS Trust hospital general adult intensive care unit between October 2016 and May 2018. Summary data (mean sound levels (LAeq) and corresponding Zwicker calculated loudness values) were subsequently analysed by minute, hour, and day. Results The overall mean LAeq24 across the study duration was 47.4 dBA. This varied by microphone location. We identified a clear pattern to sound level fluctuations across the 24-h period. Weekends were significantly quieter than weekdays in statistical terms but this reduction of 0.2 dB is not detectable by human hearing. Peak loudness values over 90 dB were recorded every hour. Conclusions Perception of sound is sensitive to the environment and individual characteristics and sound levels in the ICU are location specific. This has implications for routine environmental monitoring practices. Peak loudness values are consistently between 90 and 100 dB. These may be driven by alarms and other sudden high-frequency sounds, leading to more disturbance than LAeq24 sound levels suggest. Addressing sounds with high loudness values may improve the ICU environment more than an overall reduction in the 24-h mean decibel value.
Collapse
Affiliation(s)
- Julie L Darbyshire
- Julie L Darbyshire, Nuffield
Department of Clinical Neurosciences, University of Oxford, Oxford UK.
| | | |
Collapse
|
26
|
Song Z, Lee PJ, Hampton T. Acoustic environments of intensive care units during the COVID-19 pandemic. APPLIED ACOUSTICS. ACOUSTIQUE APPLIQUE. ANGEWANDTE AKUSTIK 2022; 199:109037. [PMID: 36158734 PMCID: PMC9482849 DOI: 10.1016/j.apacoust.2022.109037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
This study aims to investigate the typical noise levels and noise sources in an intensive care unit (ICU) during the COVID-19 pandemic. Acoustic experiments were conducted over 24 hrs in patient wards and at nurse stations in four Chinese hospitals. From the measurements, noise levels and sources were analysed in terms of the A-weighted equivalent sound pressure levels (L Aeq) and A-weighted maximum Fast time-weighted sound pressure levels (L AFmax) over three different time periods during the day (i.e. day, evening and night). Overall, noise levels (L Aeq) for 24 hrs in all hospitals exceeded the World Health Organisation's (WHO) guide levels, varying from 51.1 to 60.3 dBA. The highest maximum noise level reached 104.2 dBA. The single-bedded wards (side rooms) were quieter than multi-bedded wards, and night time noise levels were quieter than daytime and evening across all hospitals. It was observed that the most dominant noise sources were talking/voices, door-closing, footsteps, and general activities (e.g. noise from cleaning equipment and cutlery sound). Footsteps became an unexpected dominant noise source during the pandemic because of the staff's disposable shoe covers which made footsteps noisier. Patient alarms and coughing varied significantly between patients. Talking/voices produced the highest maximum median values of the sound exposure level (SEL) and the maximum noise level at all sites. Noise levels in all the patient rooms were more than the WHO guidelines. The pandemic control guidelines had little impact on the noise levels in the ICUs.
Collapse
Affiliation(s)
- Ziwei Song
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, United Kingdom
| | - Pyoung-Jik Lee
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, United Kingdom
| | - Thomas Hampton
- ENT Department, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
27
|
Abbasi M, Yazdanirad S, Zokaei M, Falahati M, Eyvazzadeh N. A Bayesian network model to predict the role of hospital noise, annoyance, and sensitivity in quality of patient care. BMC Nurs 2022; 21:243. [PMID: 36050728 PMCID: PMC9435418 DOI: 10.1186/s12912-022-00948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Hospital noise can adversely impact nurses’ health, their cognitive function and emotion and in turn, influence the quality of patient care and patient safety. Thus, the aim of this study was to predict the contributing roles of exposure to hospital noise, staff noise-sensitivity and annoyance, on the quality of patient care. Methods This descriptive and cross-sectional study was carried out among nurses in an Iranian hospital. To determine nurses’ noise exposure level, the noise was measured in 1510 locations across the hospital in accordance with ISO 9612 standards using KIMO DB 300/2 sound level meter and analyzer. An online survey was used to collect nurses’ individual data. Study questionnaires included demographics, Weinstein noise sensitivity scale, noise annoyance scale, and quality of patient care scale. Finally, to analyze the data, Bayesian Networks (BNs), as probabilistic and graphical models, were used. Results For the high noise exposure state, high noise sensitivity, and high annoyance, with the probability of 100%, the probability of delivering a desirable quality of patient care decreased by 21, 14, and 23%, respectively. Moreover, at the concurrently high noise exposure and high noise sensitivity with the probability of 100%, the desirable quality of patient care decreased by 26%. The Bayesian most influence value was related to the association of noise exposure and annoyance (0.636). Moreover, annoyance had the highest association with the physical aspect of quality of care (0.400) and sensitivity had the greatest association with the communication aspect (0.283). Conclusion Annoyance induced from environmental noise and personal sensitivity affected the quality of patient care adversely. Moreover, noise and sensitivity had a separate direct adverse effect upon the quality of patient care, and their co-occurrence reduced the potential for delivering quality patient care.
Collapse
Affiliation(s)
- Milad Abbasi
- Faculty of Paramedicine, AJA University of Medical Sciences, Tehran, Iran.,Occupational Health and Safety Engineering, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Saied Yazdanirad
- School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mojtaba Zokaei
- Occupational Health and Safety Engineering, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mohsen Falahati
- Occupational Health and Safety Engineering, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Nazila Eyvazzadeh
- Radiation Sciences Research Center, Faculty of Paramedicine, AJA University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
28
|
Grigg-Damberger MM, Hussein O, Kulik T. Sleep Spindles and K-Complexes Are Favorable Prognostic Biomarkers in Critically Ill Patients. J Clin Neurophysiol 2022; 39:372-382. [PMID: 35239561 DOI: 10.1097/wnp.0000000000000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY In this narrative review, we summarize recent research on the prognostic significance of biomarkers of sleep in continuous EEG and polysomnographic recordings in intensive care unit patients. Recent studies show the EEG biosignatures of non-rapid eye movement 2 sleep (sleep spindles and K-complexes) on continuous EEG in critically ill patients better predict functional outcomes and mortality than the ictal-interictal continuum patterns. Emergence of more complex and better organized sleep architecture has been shown to parallel neurocognitive recovery and correlate with functional outcomes in traumatic brain injury and strokes. Particularly interesting are studies which suggest intravenous dexmedetomidine may induce a more biomimetic non-rapid eye movement sleep state than intravenous propofol, potentially providing more restorative sleep and lessening delirium. Protocols to improve intensive care unit sleep and neurophysiological studies evaluating the effect of these on sleep and sleep architecture are here reviewed.
Collapse
|
29
|
Naef AC, Knobel SEJ, Ruettgers N, Jeitziner MM, Holtforth MG, Zante B, Schefold JC, Nef T, Gerber SM. Methods for Measuring and Identifying Sounds in the Intensive Care Unit. Front Med (Lausanne) 2022; 9:836203. [PMID: 35733869 PMCID: PMC9207602 DOI: 10.3389/fmed.2022.836203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite many studies in the field examining excessive noise in the intensive care unit, this issue remains an ongoing problem. A limiting factor in the progress of the field is the inability to draw conclusions across studies due to the different and poorly reported approaches used. Therefore, the first goal is to present a method for the general measurement of sound pressure levels and sound sources, with precise details and reasoning, such that future studies can use these procedures as a guideline. The two procedures used in the general method will outline how to record sound pressure levels and sound sources, using sound level meters and observers, respectively. The second goal is to present the data collected using the applied method to show the feasibility of the general method and provide results for future reference. Methods The general method proposes the use of two different procedures for measuring sound pressure levels and sound sources in the intensive care unit. The applied method uses the general method to collect data recorded over 24-h, examining two beds in a four-bed room, via four sound level meters and four observers each working one at a time. Results The interrater reliability of the different categories was found to have an estimate of >0.75 representing good and excellent estimates, for 19 and 16 of the 24 categories, for the two beds examined. The equivalent sound pressure levels (LAeq) for the day, evening, and night shift, as an average of the sound level meters in the patient room, were 54.12, 53.37, and 49.05 dBA. In the 24-h measurement period, talking and human generated sounds occurred for a total of 495 (39.29% of the time) and 470 min (37.30% of the time), at the two beds of interest, respectively. Conclusion A general method was described detailing two independent procedures for measuring sound pressure levels and sound sources in the ICU. In a continuous data recording over 24 h, the feasibility of the proposed general method was confirmed. Moreover, good and excellent interrater reliability was achieved in most categories, making them suitable for future studies.
Collapse
Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- *Correspondence: Stephan M. Gerber
| |
Collapse
|
30
|
Mansour W, Knauert M. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Clin Chest Med 2022; 43:287-303. [PMID: 35659026 PMCID: PMC9177053 DOI: 10.1016/j.ccm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.
Collapse
Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
| |
Collapse
|
31
|
Krüger L, Bolte C, Fröhlich M, Heide K, Schumacher J, Oldag A, Wolter B, Lauenroth H, Wefer F. [Delirium prevention and management: Development and implementation of a non-pharmacological catalog of measures in the acute setting]. Pflege 2022; 35:302-311. [PMID: 35333108 DOI: 10.1024/1012-5302/a000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Delirium prevention and management: Development and implementation of a non-pharmacological catalog of measures in the acute setting Abstract. Background: In October 2018, a new delirium management concept was developed in a university hospital for cardiovascular diseases. As part of a multi-professional approach, the previously established "Evidence-based Nursing working group (AK EBN)", consisting of academically qualified nurses from the hospital, was involved in the implementation process. Aim: The AK EBN aimed to identify effective non-pharmacological interventions to prevent and treat delirium and to establish how these interventions could influence delirium rates in hospital patients. Methods: The EbN method was employed to address the study question applying the PICO framework (Behrens & Langer, 2016) as the bases for systematic searches in different databases. Relevant studies were identified, data were extracted, displayed in tables and discussed within the AK using established critical appraisal tools for quality assessment. Results: Despite a heterogeneous study sample, results showed that there is meaningful evidence for the effectiveness of intervention bundles on the reduction of delirium rates. Bundles include for example, aspects of orientation and noise reduction. As a result, a catalogue of non-pharmacological interventions, communication aids, and a guide for involving caregivers in the prevention and treatment of delirium were developed. Additionally, continuing training events held by the participants of AK EBN were organized. Conclusions: To promote the successful implementation of projects in practice, the involvement of all stakeholders is important. As part of a skill-grade-mix, nurses made an important contribution in this multi-professional project.
Collapse
Affiliation(s)
- Lars Krüger
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Christina Bolte
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Mandy Fröhlich
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Kristina Heide
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Jana Schumacher
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Anne Oldag
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Björn Wolter
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Hanni Lauenroth
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| | - Franziska Wefer
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen
| |
Collapse
|
32
|
Amoatey P, Al-Harthy I, Al-Mushaifari MA, Al-Jabri K, Al-Mamun A. Effect of ambient noise on indoor environments in a health care facility in Oman. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15081-15097. [PMID: 34625898 DOI: 10.1007/s11356-021-16875-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
Hospital-noise levels can induce physiological responses and affect sleep quality, which could contribute to cardiovascular-related health problems. Till date, high-resolution hospital noise exposure assessment studies have not received much attention in Oman. This study aims at assessing sound pressure levels across hospital wards and intensive care unit (ICU) rooms to determine annoyance and potential health effects based on perception and risk estimates. An indoor exposure assessment using high precision noise sensors was conducted in a female medical ward (FMW), isolated ward (SLW), emergency ward (EMW), and intensive care unit (ICU) in a public hospital in Muscat city, Oman. Self-administered questionnaire was randomly distributed among respondents using both online and field survey approach to ascertain annoyance, health effects, and potential risks associated with exposure. The study found that 24-h noise levels (LAeq) ranged from 55.2 to 61.7 dB(A) in the hospital wards and ICU rooms, which exceeded WHO's hospital indoor rooms critical limit of 35 dB(A) by 58-76%. A total of 150 participants took part in the survey. Among the respondents, 53% reported moderate annoyance at the hospital wards, while 56% felt sensitivity to the noise levels. Noise annoyance was reported by the majority of the patients across the various wards and emergency rooms as causing slight annoyance (50%) and intermittent sleep disturbances (49%). The majority (73%) of the medical staff have complained that the current noise levels affect overall work performance (p = 0.004), while 70% of them have further complained of it as a cause of workplace distraction (p = 0.011). Logistic binary regression analysis has revealed that the complaint of noise sensitivity has a positive association with noise levels in VCW (OR: 1.54; 95% CI: 0.92-2.58), and reported loss of concentration by the medical staff also associated with noise levels at the EMW (OR: 1.61; 95% CI: 0.65-4.01). Quantitative risk estimates showed that both the percentages of highly annoyed (HA) persons (16%), and highly sleep-disturbed (HSD) persons (9%) were very high in FMW, while ICU was found to have the lowest risk. However, the greater number of the respondents (87%) believed that there are possibilities of mitigating (p < 0.001) the current noise levels.
Collapse
Affiliation(s)
- Patrick Amoatey
- Department of Civil and Architectural Engineering, College of Engineering, Sultan Qaboos University, Al-Khoudh, P.C. 123, P.O. Box 33, Muscat, Sultanate of Oman
| | - Issa Al-Harthy
- Department of Civil and Architectural Engineering, College of Engineering, Sultan Qaboos University, Al-Khoudh, P.C. 123, P.O. Box 33, Muscat, Sultanate of Oman.
| | - Muntasar Ali Al-Mushaifari
- Department of Civil and Architectural Engineering, College of Engineering, Sultan Qaboos University, Al-Khoudh, P.C. 123, P.O. Box 33, Muscat, Sultanate of Oman
| | - Khalifa Al-Jabri
- Department of Civil and Architectural Engineering, College of Engineering, Sultan Qaboos University, Al-Khoudh, P.C. 123, P.O. Box 33, Muscat, Sultanate of Oman
| | - Abdullah Al-Mamun
- Department of Civil and Architectural Engineering, College of Engineering, Sultan Qaboos University, Al-Khoudh, P.C. 123, P.O. Box 33, Muscat, Sultanate of Oman
| |
Collapse
|
33
|
Imbriaco G, Gazzato A, Monesi A, Scquizzato T, Semeraro F. Evaluation of noise levels in COVID-19 and non-COVID-19 intensive care units in Italy. Intensive Crit Care Nurs 2022; 68:103167. [PMID: 34736832 PMCID: PMC8554007 DOI: 10.1016/j.iccn.2021.103167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Guglielmo Imbriaco
- Corresponding author at: Centrale Operativa 118 Emilia Est - Prehospital Emergency – Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Largo Bartolo Nigrisoli 2, 40133 Bologna, Italy
| | - Arianna Gazzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
| | - Alessandro Monesi
- Critical Care Nursing Master Course, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy; Intensive Care Unit, Maggiore Hospital Carlo Alberto Pizzardi, Largo Bartolo Nigrisoli 2, 40133 Bologna, Italy.
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
| | - Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Largo Bartolo Nigrisoli 2, 40133 Bologna, Italy.
| |
Collapse
|
34
|
Erne K, Knobel SEJ, Naef AC, Gerber SM, Fischer T, Mast FW, Schefold JC, Zante B, Nef T, Jeitziner MM. Influence of noise manipulation on retention in a simulated ICU ward round: an experimental pilot study. Intensive Care Med Exp 2022; 10:3. [PMID: 35089432 PMCID: PMC8799802 DOI: 10.1186/s40635-022-00430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Noise exposure leads to a reduction in cognitive abilities in diverse settings, however, only limited data exist examining the effects of environmental ICU noise on the cognitive performance of ICU professionals. A frequently occurring and demanding retention task in ICUs are ward rounds, which are considered key for the provision of medical care. Here, we investigate the influence of noise on information retention in a simulated ward round. Methods ICU professionals were exposed to a recorded, ICU ward round, simulated partly with and partly without environmental ICU noise. Ward rounds were followed by specific questions about previously provided information. Results 56 ICU professionals (aged 26–59 years) were included. A logistic mixed model showed a reduction of 27% (P < 0.001) in the ward round test performance when participants were exposed to environmental ICU noise. Furthermore, advanced age was associated with reduced retention (− 28%, P < 0.001), questions containing important information performed better (+ 36%, P < 0.001), and higher stress led to better performance in retention (+ 24%, P = 0.01). Conclusions Our data showed a considerable negative influence of environmental ICU noise during a simulated ward round. Therefore, reduction of environmental ICU noise is recommended. The influence of additional factors, including stress, priorities, and demographic factors should be pursued in subsequent investigations. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00430-1.
Collapse
Affiliation(s)
- Katja Erne
- Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Samuel E J Knobel
- Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Aileen C Naef
- Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Stephan M Gerber
- Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Tim Fischer
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Fred W Mast
- Department of Cognitive Psychology, Perception and Research Methods, University of Bern, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland. .,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland. .,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
35
|
Yu CV, Foglia J, Yen P, Montemurro T, Schwarz SKW, MacDonell SY. Noise in the operating room during induction of anesthesia: impact of a quality improvement initiative. Can J Anaesth 2022; 69:494-503. [PMID: 35014000 DOI: 10.1007/s12630-021-02187-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Noise in the operating room (OR) is common and associated with negative effects on anesthesiologists, surgeons, and patient outcomes. Induction of anesthesia is among the loudest perioperative periods. Despite its critical nature, there is little data on noise levels during induction, associated patient and anesthesiologist satisfaction, and the effects of noise reduction strategies. METHODS We conducted a two-part prospective interventional quality improvement project on the care of adult patients receiving general anesthesia for elective noncardiac surgery. For part A, we measured average and peak noise (dB[A]) levels during anesthesia induction in N = 100 cases and administered a satisfaction questionnaire to anesthesiologists. We then applied a multidisciplinary educational program to OR personnel on active noise reduction strategies and subsequently collected data during N = 109 cases in a post-intervention phase. For part B, we administered satisfaction questionnaires to N = 100 patients pre- vs postintervention, respectively. RESULTS Median [interquartile range] noise levels throughout induction were 66.0 [62.5-68.6] dB(A) preintervention vs 63.5 [60.1-65.4] dB[A] post-intervention (Hodges-Lehmann estimator of the difference, - 2.7 dB[A]; 95% confidence interval [CI], - 4.0 to - 1.5; P < 0.001). Peak noise levels during induction were 87.3 [84.0-90.5] dB(A) preintervention and 86.2 [81.8-89.3] dB(A) postintervention (Hodges-Lehmann estimator of the difference, - 1.8 dB[A]; 95% CI, - 3.3 to - 0.3; P = 0.02). Noise-related anesthesiologist satisfaction postintervention was significantly improved in multiple domains, including assessment of noise having distracted anesthesiologists. Patient satisfaction was high pre-intervention and did not significantly improve further. CONCLUSION In this quality improvement project, average noise levels during induction of anesthesia, anesthesiologist satisfaction, and anesthesiologists' perceived ability to perform were improved following a multidisciplinary educational program on noise reduction in the OR. STUDY REGISTRATION www.ClinicalTrials.gov (NCT04204785); registered 19 December 2019.
Collapse
Affiliation(s)
- Charles V Yu
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Julena Foglia
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Paul Yen
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Trina Montemurro
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada
| | - Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada
| | - Su-Yin MacDonell
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada. .,Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada.
| |
Collapse
|
36
|
Lim WY, Aung HT, See KC. Patterns and predictors of sound levels in hospital rooms. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:55-57. [PMID: 35091732 DOI: 10.47102/annals-acadmedsg.2021396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Wei Yang Lim
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
| | | | | |
Collapse
|
37
|
Lam MTY, Malhotra A, LaBuzetta JN, Kamdar BB. Sleep in Critical Illness. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
The Influence of Audible Alarm Loudness and Type on Clinical Multitasking. J Med Syst 2021; 46:5. [PMID: 34812925 DOI: 10.1007/s10916-021-01794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
In high-consequence industries such as health care, auditory alarms are an important aspect of an informatics system that monitors patients and alerts providers attending to multiple concurrent tasks. Alarms levels are unnecessarily high and alarm signals are uninformative. In a laboratory-based task setting, we studied 25 anesthesiology residents' responses to auditory alarms in a multitasking paradigm comprised of three tasks: patient monitoring, speech perception/intelligibility, and visual vigilance. These tasks were in the presence of background noise plus/minus music, which served as an attention-diverting stimulus. Alarms signified clinical decompensation and were either conventional alarms or a novel informative auditory icon alarm. Both alarms were presented at four different levels. Task performance (accuracy and response times) were analyzed using logistic and linear mixed-effects regression. Salient findings were 1), the icon alarm had similar performance to the conventional alarm at a +2 dB signal-to-noise-ratio (SNR) (accuracy: OR 1.21 (95% CI 0.88, 1.67), response time: 0.04 s at 2 dB (95% CI: -0.16, 0.24), which is a much lower level than current clinical environments; 2) the icon alarm was associated with 27% greater odds (95% CI: 18%, 37%) of correctly addressing the vigilance task, regardless of alarm SNR, suggesting crossmodal/multisensory multitasking benefits; and 3) compared to the conventional alarm, the icon alarm was associated with an absolute improvement in speech perception of 4% in the presence of an attention-diverting auditory stimulus (p = 0.031). These findings suggest that auditory icons can provide multitasking benefits in cognitively demanding clinical environments.
Collapse
|
39
|
Saha S, Noble H, Xyrichis A, Hadfield D, Best T, Hopkins P, Rose L. Mapping the impact of ICU design on patients, families and the ICU team: A scoping review. J Crit Care 2021; 67:3-13. [PMID: 34562779 DOI: 10.1016/j.jcrc.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/25/2021] [Accepted: 07/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Scoping review to map outcomes and describe effects of intensive care unit (ICU) design features on patients, family, and healthcare professionals (HCPs). MATERIALS AND METHODS Iteratively developed search strategy executed across seven databases. We included studies (January 2007 to May 2020) exploring ICU design features using any study design. We grouped studies into 12 design features and categorized outcomes into four domains. RESULTS Of 18,577 citations screened, 44 studies met inclusion criteria. Newly built or renovated ICUs/ICU rooms were evaluated in 27 (61%) studies; 17 (39%) evaluated existing designs/features. Most commonly evaluated design features were lighting (24, 55%), single vs multi-occupancy rooms/pods (17, 39%), and family-centered design (13, 30%). We identified 63 distinct outcomes in four domains; HCP-related (20, 45%); patient-related (20, 45%); family-related (11, 25%); and environment-related (7, 16%). Eleven (25%) studies measured patient/family-reported outcomes. In studies evaluating single occupancy rooms, three reported increased family satisfaction, two reported decreased delirium burden, while six reported negative consequences on HCP wellbeing and working. CONCLUSION Studies evaluating ICU design measure disparate outcomes. Few studies included patient/ family-reported outcomes; fewer measured objective environment characteristics. Single room layouts may benefit patients and family but contribute to adverse HCP-related outcomes.
Collapse
Affiliation(s)
- Sian Saha
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Harriet Noble
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Daniel Hadfield
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Thomas Best
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Philip Hopkins
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| |
Collapse
|
40
|
Lin YC, Lin TJ, Liu CH, Chen YT, Lai HL. Effects of an earplug placement intervention on sleep quality in patients in a medical intensive care unit: A randomized controlled trial. Int J Nurs Pract 2021; 28:e13016. [PMID: 34541752 DOI: 10.1111/ijn.13016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/26/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non-ventilated intensive care unit patients. METHODS A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6-sulfatoxymelatonin levels, relaxation responses measured using the Richards-Campbell Sleep Questionnaire, liquid chromatography-mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am. RESULTS Overall, 28.03% of participants showed virtually no 6-sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6-sulfatoxymelatonin and vital signs. CONCLUSIONS The effects of using earplugs alone on sleep quality, urinary 6-sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality.
Collapse
Affiliation(s)
- Yun-Chian Lin
- Department of Nursing Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tsung-Jen Lin
- Program in Pharmacology and Toxicology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chin-Hung Liu
- Program in Pharmacology and Toxicology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Ting Chen
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hui-Ling Lai
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
41
|
Darbyshire JL, Greig PR, Hinton L, Young JD. Monitoring sound levels in the intensive care unit: A mixed-methods system development project to optimize design features for a new electronic interface in the healthcare environment. Int J Med Inform 2021; 153:104538. [PMID: 34343956 PMCID: PMC8417813 DOI: 10.1016/j.ijmedinf.2021.104538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
Understanding the user experience is key to effective design. Agile design practices foster efficient systems development. Implementing technological change requires socio-cultural understanding of teams. User-testing data from multiple sources allows for better systems evaluation. A well-designed system requires little training or explanation to use.
Background Intensive care units (ICU) are busy round the clock and it is difficult to maintain low sound levels that support patient rest. To help ICU staff manage activities we developed a visual display that monitors and reports sound levels in real-time. This facilitates immediate feedback, encouraging proactive behavior change to limit disturbances. Methods Following the principles of user-centered design practices we created our ‘user persona’ to understand the needs and goals of potential users of the system. We then conducted iterative user testing with current members of the ICU team, primarily using the ‘think aloud’ method to refine the design and functionality of our novel system. Ethnography evaluated team use of the display. Results The final design was simple, clear, and efficient, and both functional and aesthetically pleasing for the key user demographic. We identified challenges in the implementation and adoption process that were separate from the ‘usability’ of the system itself. Conclusions Embedding the design process within the core user demographic ensured the final product delivered relevant information for key users, and that this information was intuitive to interpret. Initiating sustainable change is not straightforward. It requires recognition of cultural practices within teams, departments, professions, organizations, and strategies to maximize engagement.
Collapse
Affiliation(s)
- Julie L Darbyshire
- Nuffield Department of Clinical Neurosciences, Unhiniversity of Oxford, UK.
| | - Paul R Greig
- Nuffield Department of Clinical Neurosciences, Unhiniversity of Oxford, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lisa Hinton
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, Unhiniversity of Oxford, UK
| |
Collapse
|
42
|
The relationship between sensory stimuli and the physical environment in complex healthcare settings: A systematic literature review. Intensive Crit Care Nurs 2021; 67:103111. [PMID: 34247937 DOI: 10.1016/j.iccn.2021.103111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/28/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This systematic review presented the current status of literature on the outcomes resulted from sensory stimuli in critical care environments as well as the environmental interventions that can improve or impede the impact of such sensory stimuli. METHODS Articles found through a systematic search of PsycINFO, Web of Science, and PubMed databases, in combination with a hand search, were reviewed for eligibility by two independent coders. Reporting and quality appraisals were based on PRISMA and MMAT guidelines. RESULTS Out of 1118 articles found, and only 30 were eligible. Final articles were comprised of issues related to noise, lighting, and temperature. Identified sensory stimuli resulted in psychological and physiological outcomes among both patients and staff. Examples include impacts on stress, delirium, sleep disturbances, poor performance and communication. The environmental factors that influence sensory stimuli included layout, room size, artificial lighting, presence of windows and acoustical interventions. CONCLUSION Literature on the impact of sensory stimuli on staff is scarce compared to patients. Studies on environmental interventions are inadequate and lack structure. The physical environment can impact the patient and staff outcome resulting from noise, lighting, and temperature. When applied strategically, sensory stimuli can result in positive outcomes among patients and staff.
Collapse
|
43
|
Balsan MJ, Burns J, Kimock F, Hirsch E, Unger A, Telesco R, Bloch-Salisbury E. A pilot study to assess the safety, efficacy and ease of use of a novel hearing protection device for hospitalized neonates. Early Hum Dev 2021; 156:105365. [PMID: 33857731 PMCID: PMC8771502 DOI: 10.1016/j.earlhumdev.2021.105365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Loud noises in the neonatal intensive care unit (NICU) exacerbate patient cardiac and respiratory activity, disrupt sleep, and may contribute to hearing deficits, speech and language disorders, and neurodevelopmental delays among NICU graduates. AIMS This study evaluated infant-patient tolerance and nurse ease of use of a novel frequency-selective hearing protection device, DREAMIES (NEATCap Medical, LLC). STUDY DESIGN AND SUBJECTS Fifty neonates receiving care in a Level III NICU participated in a 2-phase prospective study. In Phase 1, 25 infants (mean 36.6 wks GA) wore DREAMIES for two consecutive 30-min periods. In Phase 2, 25 infants (mean 34.8 wks GA) wore DREAMIES between care and feeding times during an 8-h Device-On period followed by an 8-h Device-Off period for three consecutive days. OUTCOME MEASURES Subject tolerance was defined by device-related skin irritation, vital sign measurements, and behavioral state. Device fit and ease of use were also evaluated by NICU nurses. RESULTS No skin breakdown was reported in any infant in either phase. Only transient skin erythema was observed. Periods when infants wore DREAMIES resulted in lower heart and respiratory rates and increased sleep (P < 0.001). Nurses reported little to no difficulty in applying or removing the device. CONCLUSION Findings suggest DREAMIES are a safe, easy to use, and effective device that reduces exposure to NICU noise, and may improve cardio-respiratory activity and promote sleep among neonatal patients. Further studies are warranted to examine longer term use and potential benefits of DREAMIES for improving outcomes in infants receiving NICU care. This trial is registered on clinicaltrials.govNCT02744066.
Collapse
|
44
|
Leong RW, Davies LJ, Fook-Chong S, Ng SY, Lee YL. Effect of the use of earplugs and eye masks on the quality of sleep after major abdominal surgery: a randomised controlled trial. Anaesthesia 2021; 76:1482-1491. [PMID: 33881774 DOI: 10.1111/anae.15468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
Significant sleep disturbance can occur following major abdominal surgery. We aimed to evaluate the effectiveness of earplugs and eye masks in improving sleep quality and patient satisfaction, reducing nursing demands and in the incidence of delirium in patients after major abdominal surgery. We conducted a randomised controlled trial in 100 patients undergoing major abdominal surgery. We randomly allocated participants to sleep with or without earplugs and eye masks on postoperative days 1-3. The primary outcome measure was sleep quality as measured by the Richards-Campbell Sleep Questionnaire. Secondary outcomes were patient satisfaction, frequency of nursing demand and incidence of delirium measured by the Neelon and Champagne Confusion Scale. Median (IQR [range]) sleep scores were 64 (38-74 [0-100] and 60 (44-82 [18-100]) for the control and intervention groups, respectively (p = 0.310). Age and Pittsburgh Sleep Quality Index scores were found to be significant factors affecting sleep quality. There were no differences in patient satisfaction, reduction in frequency of nursing demands or incidence of delirium on postoperative days 1-3 after major abdominal surgery. The compliance rate in the intervention group was 60-65%. This study has demonstrated that the use of earplugs and eye masks did not contribute to improvements in sleep quality. Of note, sleep quality was moderate, with higher age and worse baseline sleep quality contributing to worse sleep scores. More studies are needed to investigate interventions to improve sleep quality after major abdominal surgery.
Collapse
Affiliation(s)
- R W Leong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - L J Davies
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - S Fook-Chong
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - S Y Ng
- Department of Surgical Intensive Care, Anaesthesia, Singapore General Hospital, Singapore
| | - Y L Lee
- Department of Surgical Intensive Care, Anaesthesia, Singapore General Hospital, Singapore
| |
Collapse
|
45
|
Koomen E, Webster CS, Konrad D, van der Hoeven JG, Best T, Kesecioglu J, Gommers DA, de Vries WB, Kappen TH. Reducing medical device alarms by an order of magnitude: A human factors approach. Anaesth Intensive Care 2021; 49:52-61. [PMID: 33530699 PMCID: PMC7905747 DOI: 10.1177/0310057x20968840] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The intensive care unit (ICU) is one of the most technically advanced environments in healthcare, using a multitude of medical devices for drug administration, mechanical ventilation and patient monitoring. However, these technologies currently come with disadvantages, namely noise pollution, information overload and alarm fatigue—all caused by too many alarms. Individual medical devices currently generate alarms independently, without any coordination or prioritisation with other devices, leading to a cacophony where important alarms can be lost amongst trivial ones, occasionally with serious or even fatal consequences for patients. We have called this approach to the design of medical devices the single-device paradigm, and believe it is obsolete in modern hospitals where patients are typically connected to several devices simultaneously. Alarm rates of one alarm every four minutes for only the physiological monitors (as recorded in the ICUs of two hospitals contributing to this paper) degrades the quality of the patient’s healing environment and threatens patient safety by constantly distracting healthcare professionals. We outline a new approach to medical device design involving the application of human factors principles which have been successful in eliminating alarm fatigue in commercial aviation. Our approach comprises the networked-device paradigm, comprehensive alarms and humaniform information displays. Instead of each medical device alarming separately at the patient’s bedside, our proposed approach will integrate, prioritise and optimise alarms across all devices attached to each patient, display information more intuitively and hence increase alarm quality while reducing the number of alarms by an order of magnitude below current levels.
Collapse
Affiliation(s)
- Erik Koomen
- Department of Paediatrics, Paediatric Intensive Care, Wilhelmina Children's Hospital, Academic Medical Centre Utrecht, Utrecht, The Netherlands
| | - Craig S Webster
- Department of Anaesthesiology and Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - David Konrad
- Department of Perioperative Medicine and Intensive Care at Karolinska University Hospital, Stockholm, Sweden
| | | | - Thomas Best
- Department of Critical Care, King's College Hospital, London, UK
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, Academic Medical Centre Utrecht, Utrecht, the Netherlands
| | - Diederik Ampj Gommers
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Willem B de Vries
- Department of Neonatology, Academic Medical Centre Utrecht, Utrecht, The Netherlands
| | - Teus H Kappen
- Department of Anaesthesia, Intensive Care and Emergency, Academic Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
46
|
Kebapcı A, Güner P. "Noise Factory": A qualitative study exploring healthcare providers' perceptions of noise in the intensive care unit. Intensive Crit Care Nurs 2020; 63:102975. [PMID: 33277155 DOI: 10.1016/j.iccn.2020.102975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/21/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to explore healthcare providers' perceptions of noise in the intensive care unit. DESIGN A qualitative exploratory study was conducted using group interviews. SETTING The setting comprised a total of 15 participants (five physicians and ten registered nurses) working in an 18-bed medical surgical intensive care unit at a teaching hospital in Istanbul, Turkey. Semi-structured questions were formulated and used in focus group interviews, after which the recorded interviews were transcribed by the researchers. Thematic analysis was used to identify significant statements and initial codes. FINDINGS Four themes were identified: the meaning of noise, sources of noise, effects of noise and prevention and management of noise. It was found that noise was an inevitable feature of the intensive care unit. The most common sources of noise were human-induced. It was also determined that device-induced noise, such as alarms, did not produce a lot of noise; however, when staff were late in responding, the sound transformed into noise. Furthermore, it was observed that efforts to decrease noise levels taken by staff had only a momentary effect, changing nothing in the long term because the entire team failed to implement any initiatives consistently. The majority of nurses stated that they were now becoming insensitive to the noise due to the constant exposure to device-induced noise. CONCLUSION The data obtained from this study showed that especially human-induced noise threatened healthcare providers' cognitive task functions, concentration and job performance, impaired communication and negatively affected patient safety. In addition, it was determined that any precautions taken to reduce noise were not fully effective. A team approach should be used in managing noise in intensive care units with better awareness.
Collapse
Affiliation(s)
- Ayda Kebapcı
- Koç University School of Nursing, Istanbul, Turkey.
| | - Perihan Güner
- Istanbul Bilgi University School of Health Sciences, Istanbul, Turkey
| |
Collapse
|
47
|
Peacock A, Ten Eyck P, Sapp C, Allan L, Hasan D, Rogers WK. Effects of patient-level noise abatement orders on sound levels experienced by critically ill subarachnoid hemorrhage patients: an observational study. Hosp Pract (1995) 2020; 48:258-265. [PMID: 32729755 PMCID: PMC7805414 DOI: 10.1080/21548331.2020.1801008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND/OBJECTIVE Patients with aneurysmal subarachnoid hemorrhage (aSAH) may be at risk for complications related to excessive environmental noise. Our ICU utilizes a variety of universal interventions to minimize ambient noise levels, but patients with aSAH additionally have specific orders intended to further minimize physiologic stress and noise exposure. It is unknown whether such orders can have a supplementary reductive effect on noise exposure. METHODS Sound levels were measured for at least three consecutive days in the rooms of 17 patients with aSAH and implemented 'subarachnoid precautions' orders. Sound levels were similarly recorded in the rooms of 11 geographically-proximate, critically-ill control patients without aSAH. RESULTS Linear mixed models were used to assess the difference in measurements between groups. Observations were combined into fifteen-minute windows, then group means and their differences were calculated and plotted to help identify what times of the day had significant differences. aSAH patients consistently experienced lower sound levels than control patients, with a statistically significant difference (p < 0.05) in mean sound levels at 62 of 96 intervals throughout the day. Overall, the mean sound level for aSAH patients was always between 62-63dBA, while the mean sound level experienced by control patients ranged between 64-66dBA. CONCLUSIONS Implementation of patient-specific orders can have a supplementary reductive effect on noise exposure for aSAH patients in an intensive care unit that already utilizes universal noise abatement interventions.
Collapse
Affiliation(s)
- Amanda Peacock
- Marcella Niehoff School of Nursing, Loyola University Chicago , Chicago, IL, USA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa , Iowa City, IA, USA
| | - Caitlin Sapp
- Department of Communication Sciences and Disorders, University of Iowa , Iowa City, IA, USA
| | - Lauren Allan
- Department of Surgery, University of Iowa , Iowa City, IA, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa , Iowa City, IA, USA
| | - W Kirke Rogers
- Department of Anesthesia, University of Iowa , Iowa City, IA, USA
| |
Collapse
|
48
|
Cox F. Noise and light are the primary drivers for disrupting sleep in adults in intensive care. Evid Based Nurs 2020; 24:121. [PMID: 32855175 DOI: 10.1136/ebnurs-2020-103327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/03/2022]
|
49
|
Tronstad O, Flaws D, Lye I, Fraser JF, Patterson S. The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: A qualitative study to inform design of the 'ideal' bedspace. Aust Crit Care 2020; 34:15-22. [PMID: 32684406 DOI: 10.1016/j.aucc.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND While the impact of the intensive care environment on patients' experiences and outcomes has been extensively studied, relatively little research has examined the impact on clinicians and their provision of care in the intensive care unit (ICU). Understanding staff experience and views about the environment is needed to optimise the ICU environment, patient outcomes and staff wellbeing. OBJECTIVE The objective of this study was to inform design of an optimised intensive care bedspace by describing clinicians' views about the current environment, including experience, impact on performance of clinical duties, and experience and outcomes of patients and family members. METHODS A pragmatic, qualitative descriptive study was conducted, with data collected in focus groups and interviews with 30 intensive care clinicians at a large cardiothoracic specialist hospital and analysed using the framework approach. RESULTS Participants acknowledged that the busy and noisy ICU provided a suboptimal healing environment for patients, was confronting for visiting families and exposed clinicians to risk of psychological injury. The bedspace, described as small and cluttered, hindered provision of clinical care of various kinds and contributed to an increased risk of staff physical injuries. Participants noted that the bland, sterile environment, devoid of natural light and views of the outside world, negatively affected both staff and patients' mood and motivation. Aware of the potential benefits of natural light, cognitive stimulation and visually appealing environments for patients and families, clinicians were frustrated by their inability to personalise the bedspace. Some participants, while acknowledging the importance of family contact for patients, were concerned about the impact of visitors on care delivery, particularly within already crowded bedspaces, suggesting restrictions on visiting. CONCLUSIONS Intensive care clinicians perceive that the current intensive care environment is suboptimal for patients, their families and staff and may contribute to suboptimal patient outcomes. The intensive care bedspaces need to be redesigned to ensure they are built around the needs of the people using them. Optimisation is dependent on engaging all stakeholders in future design processes.
Collapse
Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Northside Medical School, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Dylan Flaws
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
| | - India Lye
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Menzies Health Institute QLD, Griffith University, Gold Coast, Australia.
| | - John F Fraser
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Northside Medical School, University of Queensland, Brisbane, Australia.
| | - Sue Patterson
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; School of Dentistry, University of Queensland, Brisbane, Australia.
| |
Collapse
|
50
|
Contribution of alarm noise to average sound pressure levels in the ICU: An observational cross-sectional study. Intensive Crit Care Nurs 2020; 61:102901. [PMID: 32660883 DOI: 10.1016/j.iccn.2020.102901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore sound levels, alarm frequencies and the association between alarms and sound levels. DESIGN A single center observational cross-sectional study. SETTING Four intensive care units. MAIN OUTCOME MEASURES Contribution of alarms: red (life threatening), yellow (indicate excess of limits) and blue (technical) to sound pressure levels dB(A) at nursing stations. RESULTS Mean sound pressure levels differed significantly between day (56.1 ± 5.5), evening (55.1 ± 5.7) and night periods 53.6 ± 5.6; p < 0.01. 175,996 alarms were recorded of which 149,764 (85%) were yellow, 18,080 (10%) were red and 8,152 (5%) were blue. The mean sound levels without alarms (background) is 56.8 dB(A), with only red: 56.0 dB(A), only yellow: 55.6 dB(A), only blue: 56.0 dB(A) and mixed alarms: 56.3 dB(A). Yellow alarms (b = -0.93; 95% CI: -1.26 to -0.6; p < 0.001) were weakly but significantly associated with mean sound levels and lead to a slight decrease in noise level (1 dB), Red alarms (b = -0.3; 95% CI: -1.237 to 0.63; p = 0.52). The R Square of the model with all alarms was 0.01 (standard error of estimate, 6.9; p < 0.001). CONCLUSIONS Sound levels were high during all day-periods. Alarms exceeding limits occurred most frequently. However, the contribution of alarms to sound levels measured at the nursing station is clinically limited.
Collapse
|