A Quiet Design: Exploring HCAHPS Findings
Improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores is a top priority among healthcare administrators to ensure funding.
The latest HCAHPS Public Report from the Centers for Medicare & Medicaid Services (CMS) surveyed 2,786,920 discharged patients from 3,851 hospitals across the country. On average, results from the 27-question survey show that "Quietness of the Hospital Environment" was the worst "top-box" score among all other topics.
Top box scores are those to which patients usually answered "Always." So fewer people answered "Always" to the question: "During your hospital stay, how often was the area around your room quiet at night?" than the other 26 questions.
CMS further reported that patients who are dissatisfied with the noise in their rooms are often significantly less satisfied with their overall hospital experience.
Noise is a problem for hospitals and their patients. In fact, noise levels in hospitals are double what they should be according to the World Health Organization’s standard decibel (dB(A)) guidelines for continuous noise in patient rooms.
Standard noise levels should be 35 dB(A) during the day and 30 dB(A) at night with nighttime peaks in wards not to exceed 40 dB(A).
However, studies reported by the Center for Health Design indicate peak hospital noise levels often exceed 85 dB(A) to 90 dB(A). Noises from medical equipment, such as an X-ray machine, that exceed 90 dB(A) are comparable to walking next to a busy highway when a motorcycle or large truck passes.
Healthcare administrators' biggest design request is to find ways to control or offset noise. Based on administrators’ demand for designers to come up with innovative ways to create quiet spaces, this blog series will highlight noise problem areas and give quiet design strategies, starting with patient rooms.
Patients spend the majority of time in their room, and this space should be a calm, quiet, healing oasis. When designing patient rooms, it’s helpful to use the right materials, give patients privacy, and start with an efficient spatial layout.
Tips and materials
Ways to reduce patient room noise with design materials include:
- Installing headwall acoustical panels wrapped in acoustical fabric to buffer equipment noise. Remember that acoustical fabric must be a loose-knit, cleanable fabric (thin enough to blow smoke through) so that sound can pass through the fabric and be absorbed into the acoustical panels.
- Dropping ceilings or ceiling tiles to a lower ceiling height, which reduces the floating room for noise. Ceiling heights should not exceed 9 feet.
- Using acoustical ceiling tiles to absorb noise. Look for tiles with a Noise Reduction Coefficient (NRC) of 08 or higher. NRC ranges from 0 (concrete flooring) to 1.0 (high performance acoustical tiles).
- Framing acoustical fabric drapes with an acoustical cornice board to catch more noise. This is a creative way to add design interest to a window area while increasing the amount of acoustical fabric used in a space.
- Installing a sound reduction system. Give patients the option to mask outside conversations and sound with a PA system that quietly hisses or sounds like a fan.
Semi-private or two-person rooms are a design don't. Shared patient rooms can not only lead to higher infection rates, medical errors, and stress, but can also increase noise levels in a room (double medical equipment noise and staff interruptions) and lead to an overall lower-quality patient experience.
Collaboration between nurses and doctors should happen away from patients, which is why efficient space planning is crucial for keeping patient rooms quiet. Patient floor designs should follow the race track method.
Designers and architects should envision the patient floor as a rectangular racetrack with the hallway as the track. Patient rooms should be positioned on the outside of the track, nurse stations and waiting areas placed at the corners of the track, and food areas and smaller sub nurse stations floated through the middle of the track.
This layout will reduce noise and increase patient privacy, while still maintaining an efficient staff workflow layout that keeps walking distance to a minimum.
The next Quiet Design blog will discuss how to create a quiet critical care unit.