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Silent Hospitals Help Healing

Under a program called Silent Hospitals Help Healing (SHHH), Montefiore Medical Center is addressing one of the biggest complaints patients have about hospitals: they are too noisy.

"Noise is not only an irritant, but an obstacle to healing," said Margaret Amato-Hayes, RN, clinical director of nursing. "Studies have shown a relationship between excessive noise and a slowing of the healing process. Noise also contributes to increasing stress and anxiety."

Elodia Mercier, RN, the administrative nurse manager who implemented the SHHH program, found that sources of noise were everywhere: squeaky cart wheels, telephones ringing, voices in the hallways late at night as staff delivered medications, televisions blaring, hospital alarms, and intercom announcements.

"Glucometer carts were so loud they sounded like the D train," said Mercier.

Mercier launched SHHH on her unit to give patients a quieter environment in which to receive care. Pieces of equipment, from IV poles to medication carts, were sent for lubrication and repair. Administrative nursing managers began monitoring hallway conversations to keep them to a minimum. Staff were reminded to switch their beepers to vibrate mode. Intercoms were turned down.

Signs placed in the corridors read "SHHH," and patients, staff, and visitors were given buttons that showed a nurse with her finger to her lips.

Sound meters were used in patient care areas, including on medical floors, in surgical units, and in the adult emergency department, to record ambient noise levels at different times, such as during the change in shifts, at mid-day, and in the evenings.

The effects of SHHH were remarkable. Within two weeks, patients slept better, and staff said they felt less stressed.

Decibel levels fell significantly. On Mercier's unit, for instance, noise levels had been as high as 78 decibels. They dropped to 50 to 60 decibels, a level more typical of libraries. When shifts changed, noise levels used to range from 62 to 70 decibels. After SHHH was implemented, noise levels were 55 to 60.

Mercier said that SHHH caught on quickly at Montefiore.

"Many staff members wanted to know how they could start their own SHHH programs, in the emergency department, for example," Mercier said. "I also overheard a visitor tell his son in the elevator, 'Shhh, there are signs on every floor that says we should be quiet.' I took the liberty to explain the program, and he agreed it was worthwhile and working."

Even other hospitals are taking interest in the SHHH program.

"When people are ill, they are sensitive to stressors like noise. We owe our patients quality care and compassion, including a quiet, calm environment in which they can heal," said Mercier. "It's just a matter of changing work habits."