Christine Hedges1, Candice Hunt, Pamela Ball. 1. University of North Carolina Medical Center, Chapel Hill (Dr Hedges and Ms Ball); and UNC School of Medicine and UNC Health Care, University of North Carolina Institute for Healthcare Quality Improvement, Chapel Hill (Ms Hunt).
Abstract
BACKGROUND: A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff. LOCAL PROBLEM: Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study. METHODS: A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for quiet time (QT) and used HCAHPS "always quiet" scores as the primary outcome measure. INTERVENTIONS: The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. RESULTS: Quiet scores improved on both units after 11 months. CONCLUSIONS: Noise in hospitals is often beyond the scope of nurse-driven improvement; however, a QT protocol led by nurses, developed by multiple stakeholders, and focused on changing expectations for quiet can lead to measurable improvements in patient perception of quiet.
BACKGROUND: A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff. LOCAL PROBLEM: Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study. METHODS: A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for quiet time (QT) and used HCAHPS "always quiet" scores as the primary outcome measure. INTERVENTIONS: The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. RESULTS: Quiet scores improved on both units after 11 months. CONCLUSIONS: Noise in hospitals is often beyond the scope of nurse-driven improvement; however, a QT protocol led by nurses, developed by multiple stakeholders, and focused on changing expectations for quiet can lead to measurable improvements in patient perception of quiet.