The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients

Oystein Tronstad; Sue Patterson; Barbara Zangerl; Dylan Flaws; Robert Holdsworth; Lacey Irvine; Stephanie Yerkovich; India Pearse; John F Fraser

doi:10.1016/j.aucc.2024.02.011

The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients

Aust Crit Care. 2024 Apr 10:S1036-7314(24)00053-5. doi: 10.1016/j.aucc.2024.02.011. Online ahead of print.

Authors

Oystein Tronstad¹, Sue Patterson², Barbara Zangerl³, Dylan Flaws⁴, Robert Holdsworth³, Lacey Irvine³, Stephanie Yerkovich⁵, India Pearse³, John F Fraser⁶

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia. Electronic address: oystein.tronstad@health.qld.gov.au.
² Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; School of Dentistry, University of Queensland, Brisbane, Australia.
³ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
⁴ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
⁵ Menzies School of Health Research and Faculty of Health, Qld University of Technology, Brisbane, Australia.
⁶ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Australia.

PMID: 38604917
DOI: 10.1016/j.aucc.2024.02.011

Abstract

Background: ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff.

Objective: The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU.

Methods: This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration.

Results: Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep.

Conclusion: The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.

Keywords: Alarms; Intensive care; Noise; Patient monitor; Sound; Sound reduction.