Quality Improvement Initiative to Reduce Nighttime Noise in a Transplantation and Cellular Therapy Unit

Abstract

Sleep is an essential biologic function vital for physiologic rest, healing, and emotional well-being. Sleep disruption is commonly seen in patients and caregivers with lengthy hospital stays such as patients undergoing hematopoietic stem cell transplantation and cellular therapy (TCT). Sleep disruption can lead to increased stress and fatigue, affecting caregivers' ability to support their loved one. The global aim of our quality improvement initiative was to improve sleep quality in TCT patients and caregivers. The smart aim of our project was to decrease nighttime hallway noise from 47 dB to 43 dB and decrease the number of overnight noise peaks greater than 60 dB from 865 to 432 in 6 months. Through a cross-sectional quantitative and qualitative evaluation of sleep we had previously identified poor sleep quality, and with a cross-sectional focus group analysis of patients, caregivers, and medical staff we identified the factors associated with poor sleep. Hallway noise was a major factor. A simplified failure mode analysis identified 4 main key drivers; unobtrusive nighttime cleaning process, nighttime awareness maintenance system, quiet nighttime nursing system, and reliable nighttime awareness system. Several plan-do-study-act interventions took place and were adopted. From January to June 2018 the overnight mean decibel level decreased from 47 dB to 44 dB (6% reduction). Overnight noise spikes above 60 dB decreased from a mean of 865 spikes to a mean of 463 spikes (46% reduction). With a quality improvement initiative, we identified the causes of hallway nighttime hospital unit noise that negatively impact sleep and through a teambased approach performed interventions that successfully mitigated these factors.

Hospital Environmental Disruptors and Caregiver Sleep During Hospitalization

“…3 Although caregivers report that nurses do their job quietly during the night, 18 the delivery of care to a hospitalized adult patient undoubtedly generates noise. Because of that, some studies have been conducted in the ICU 48 and in general hospital wards, 49,50 with positive results in reducing noise and/or improving patients' sleep. These studies aimed to implement sleep promotion strategies, such as conducting multiple tasks in 1 visit to minimize sleep interruptions, reducing light, and limiting staff conversations by the bedside of patients.…”

Sleep and Circadian Disruptors: Unhealthy Noise and Light Levels for Hospitalized Pediatric Stem Cell Transplant Patients

“…21,25,26 Although environmental factors are known to be the most common sleep disruptors, the majority of sleep-promoting interventions target individuals' behaviors, not their environments. 5 Due to the known challenges with sustaining interventions targeting patients or providers, institutions should make systematic changes that prioritize sleep and circadian function (e.g., reducing overnight noise or consolidating procedures 7,27,28 ). 29 Almost all section chiefs of hospital medicine rate patient sleep as important, but fewer than half of their hospitals have adopted sleep friendly practices.…”

“…5 Noise often spikes during the night on pediatric oncology units as a result of staff room entries, medication administrations, and alarms. [6][7][8] Irregular and "unnatural" light-dark cycles can cause circadian disruptions. 9,10 Noise and light disruptions are independently associated with less sleep among children with cancer.…”

Noise effects, analysis and control in hospitals - A review

“…Many research papers have been published on this issue. Some papers are discussed here; the study of Badia 18 and Buxton 19 were focused on sleeping disturbance in hospitals. Sleep difficulties in hospitals are due to disruptions and can be understood how patients, hospital doctors, and nurses notice sleep disruptions.…”

“…20 The noise in hallway also is a key factor for sleep disturbance. 18 Elliott et al 21 considered critically ill patients and defined two types of factors i.e., intrinsic, and extrinsic. These factors affect the sleep of the patients.…”