Pebble Partner Affinity Health System's St. Elizabeth Hospital, located in Appleton, Wisconsin, applies Lean principles to identify and eliminate waste, evidence-based design (EBD) practices to enhance the patient experience, and sustainable criteria to design and build environmentally friendly buildings. All three concepts-Lean, EBD, and sustainable design-are required to help carry out Affinity Health System's promise of personalized care of listening, treating patients with respect, and putting their needs and interests first. As part of implementing evidence-based design in a renovation of the Emergency Department (ED) waiting room, Affinity Health System selected a new acoustically absorbing wallcovering product to use on the ED waiting room walls. To evaluate the effectiveness of this approach, Affinity partnered with fellow Pebble Partner Johns Manville and product manufacturer SoundTech to measure both the acoustical change in the room and the perceived noise and privacy from patients, families, and staff in the ED.
Acoustics in healthcare-What are the issues?
Noise in healthcare facilities is a major cause of stress for patients and a negative distraction for caregivers (Bayo, Garcia and Garcia, 1995; Blomkvist et al, 2005). According to David Sykes, cochairman of the International Workgroup on Healthcare Acoustics, Speech Privacy, and LEED, “noise is the number one healthcare complaint and noise in hospitals is twice what it was just two decades ago”. According to the World Health Organization, the guideline values for continuous background noise in patient rooms are 35dBA (A-weighted decibel) during the day and 30dBA during the night, with nighttime peaks in wards not to exceed 40dBA (Berglund et al, 1999). Alarmingly many studies have actually found background noise levels in hospitals to be 72dBA during the day and 60dBA during the night (Bush-Vishniac et al, 2005).
The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at mgoodman@healthdesign.org.
In emergency departments, noise can be an even larger issue. Higher overall noise levels have been measured in EDs than in inpatient care units in several studies (Orellana, Bush-Vishniac, and West, 2007). One study conducted at Johns Hopkins Hospital in Baltimore, Maryland, revealed higher overall noise levels in the ED than the inpatient care units and pointed to the potential impact of noise upon patient safety in the ED, as well as privacy concerns with patients disclosing information to caregivers (Orellana, Bush-Vishniac, and West, 2007). It has been identified that ED staff spend 80% of their time communicating verbally (Vincent and Wears, 2005) and perceptions of privacy within the ED environment may affect patient disclosures to caregivers which could impact ED patient diagnosis and care (Barlas, 2001).
Acoustical materials for healthcare are generally readily available, and include ceilings and carpeting, with very little acoustic treatment typically applied to walls, due to infection control, cleanability, and durability concerns. Products and/or materials for the ceilings and floors alone will often not achieve the desired overall noise reduction. The wall space must also be addressed.
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