To use an evidence-based design process, you have to know what the best available evidence is. But research is published faster than anyone can read it. In this blog series, The Center for Health Design’s research team will provide insight into a few healthcare design research matters through a snapshot of 10 studies published since the 2016 Healthcare Design Expo & Conference. Serving as an inside look at a session held at the 2017 HCD Expo, the blogs will identify why this research matters and help readers ride the waves of an ocean of research without drowning.

The research
This study by Christine L. Locke and Diana S. Pope investigated the impact of an enhanced noise-reducing privacy curtain on medical-surgical (med-surg) patients’ ability to rest and their satisfaction with the level of noise in the environment. It also assessed the practical implications of adopting the enhanced curtains and found that the small benefits to patients were outweighed by cost and workload concerns.

Why does it matter?
Hospitalized patients require sleep for healing and are entitled to privacy when discussing protected health information. But the soundscape of hospitals does little to support either of these requirements. Privacy concerns may be especially problematic in facilities with multipatient rooms.

As part of a drive to incentivize value-based care, the Centers for Medicare and Medicaid Services (CMS) now ties hospital reimbursement to patient experience outcomes as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. National data continually shows that the HCAHPS measure of “quiet at night” is the lowest-scoring question on the survey.

Privacy curtains with enhanced sound-reducing properties have been proposed as a way to address perceived noise, while also providing improved privacy. This study helps to answer two important questions: First, how well do these enhanced privacy curtains work? And second, are they worth the investment?

How was the study done?
The enhanced privacy curtain chosen for this evaluation included sound-absorbent inserts and panels that could be zipped together to block sound. The manufacturer provided initial installation and training.

A crossover study design was used. A purposive sample of rooms across two units was chosen to represent the different environments patients might experience (e.g., older or refurbished rooms, single vs. multi-bed, near or far from the nursing unit or the door). During the first time period, half of these rooms received the enhanced privacy curtains, while the other half didn’t. During the second time period, the exposures were reversed.

Patients were eligible for inclusion if they were in the unit at least two nights, were medically stable, alert and oriented, and had no behavioral concerns. Participants were asked to complete a survey that included their perception of whether the room provided a restful environment. The researchers also compared HCAHPS scores from the time period of the study to those collected before and after. 

An important part of the study design was the early involvement of a broad range of staff stakeholders, including nursing, laundry, infection control, interior design, and housekeeping. While the initial study design was intended to look solely at the effectiveness of the enhanced privacy curtains, this participatory approach supported an expanded scope that included practicability/efficiency.

What was learned?
It’s difficult to draw strong conclusions about the primary outcome measures for this study because of a low patient response rate, challenges in integrating the curtains into real-world practice, and the unknown degree of overlap between study participants and HCAHPS respondents. The data suggest that enhanced privacy curtains may have a small positive impact.

The study provided more persuasive evidence that self-assessed sound-sensitivity and room location (near or far from noise sources) influenced patient perceptions.

The most important findings from this study were not part of the initial research question. The interdisciplinary team found that the negative implications of switching to enhanced privacy curtains on a practical level outweighed any benefits.

The curtain’s inserts required dedicated (vertical) storage on the unit while the curtains were being laundered. When the curtains were soiled or had been used for an isolation patient, the inserts had to be cleaned and the curtains replaced. The multilayered pockets that held the sound-absorbent panels required a special drying protocol. The curtains also required two times as many hangers as standard privacy curtains and it took twice as long for housekeeping workers to hang them.

It’s possible that further studies with stronger methods will find a level of benefit that justifies these practical challenges, but the authors concluded that the costs associated with the enhanced privacy curtains outweighed the benefits.

Are the results definitive?
In terms of its primary outcome measures, this study had a number of important limitations. In addition to those described above, the survey used to assess patient perceptions was not validated and some patient responses were difficult to interpret. The logistical challenges of using the enhanced privacy curtains made it impossible to adhere to the initial study protocol. The limitations also apply, in large part, to the secondary outcomes of self-assessed noise-sensitivity and room location on patients’ perceptions of a restful environment. In terms of identifying the multidisciplinary logistical challenges of using these curtains, however, the study results are far more persuasive, albeit not positive.

The takeaway
Even interventions that seem simple and straightforward can cause unexpected problems when applied to the messy world of healthcare. This study found that enhanced privacy curtains appeared to lead to modest improvements in the sleep environment in med-surg rooms, but they also created logistical difficulties that outweighed those benefits. Identifying and involving all staff stakeholders played an important role in enabling a more complete assessment.

Interested in the topic? Visit The Center for Health Design Knowledge Repository for more. Alan J. Card, PhD, MPH, CPH, CPHQ, CPHRM is a research associate at the Center for Health Design. He can be reached at acard@healthdesign.org.

Summary of:

Locke, C. L., & Pope, D. S. (2017). Assessment of Medical-Surgical Patients’ Perception of Hospital Noises and ReportedAbility to Rest. Clinical Nurse Specialist, 31(5), 261–267. https://doi.org/10.1097/NUR.0000000000000321