Intended for healthcare professionals

Views And Reviews Acute Perspective

David Oliver: Tackling noise pollution in hospital

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1027 (Published 27 April 2022) Cite this as: BMJ 2022;377:o1027
  1. David Oliver, consultant, geriatrics and general internal medicine
  1. Berkshire
  1. Davidoliver372{at}googlemail.com
    Follow David on Twitter @mancunianmedic

Hospital wards are meant to be therapeutic and healing environments, so we need more concerted action to tackle noise pollution in wards. Being surrounded by a cacophony of noise doesn’t help patients get better, and it’s not a nice environment for staff to work in.

On a recent ward round, in one five bedded bay I found myself turning off radios next to three of the patients so that I could chat to them. They told me that they weren’t listening to the music anyway: “Leave it off!” they said, when I offered to switch it back on.

And it’s not just music from the radio—there are multiple sources of noise: beeping devices with alarms that are often ignored (though they’re nominally there to prompt action); noisy patient call buttons and ward entry intercom bells; ward phones, often ringing unanswered; loud lids on metal waste bins; rattling cage trolleys full of ward supplies; dispensers for hand towels or aprons; staff pagers and phones; sometimes overloud conversations from staff in the course of their job or from visitors at bedsides; teams responding to emergencies; and—though they should never be blamed—other patients in distress or calling for help.12

Of course, noise annoys, but it’s more than an irritant. Sleep is crucial to recovery, yet so many of our patients complain of sleep disturbance in hospital. Numerous people have told me that noise was what they dreaded most about hospital admission or the reason they self-discharged. On any ward round some patients complain to me about it.

A high proportion of inpatients have hearing loss or cognitive impairment. Background noise impairs communication and can be especially bad for patients with hearing aids or presbycusis. Whether in intensive care or more general ward areas, delirium is prevalent in hospital3—and multiple, alien, noises and voices can compound it.

Patients prone to sensory overload, for instance, and some with autistic spectrum disorder or a learning disability, can be especially upset by noise. Those with dysphonia, dysarthria, or dysphasia or for whom English isn’t their native language, or those who are sick or dying, can struggle to communicate with staff or visiting families above the noise. And, let’s face it, noise levels are also an irritant to many patients who don’t have those problems and to staff working there every day who can’t always hear themselves speak or think, let alone hear colleagues properly. Studies on intensive care wards have even found that decibel meters showed higher noise levels on wards than on busy main roads.4

What we lack is a concerted effort to move from awareness of the problem to implementing serious, sustained solutions. We’ve ignored the noise pollution problem for too long and grown too comfortable with accepting it. It’s time to do something about it.

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