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Monday, August 6, 2012

Poor Patient Care Due to Hospital Noise?

Less hospital noise improves patient care reports the NYTimes. #dox #li

How does less noise improve care?  I believe the link is sleep disturbance, specifically a circadian rhythm disturbance.  A noise hospital environment leads to sleep fragmentation.  In addition, there are multiple non-urgent patient room intrusion around the clock--the nursing aid comes at one hour to take your vital signs, the doctor at another, the radiologist at another, the phlebotomist at yet another, the case manager, the respiratory therapist, the physical therapist, nutrition etc. You are not allowed to sleep.

Many of these intrusions are important but non-urgent.  The schedule is around our (doctors' and hospitals') convenience rather than around the patient's.  These services may be coordinated to a block of time--say 1-2 hours during the night to get all done.  That is, the radiologist, phlebotomist, respiratory therapist and nursing aid may all perform their functions during the same hour.  Indeed, this can be done and some hospitals are doing so.

Furthermore, well meaning hospital policies such as "hourly rounding", which requires a care provider to check on you every hour to make sure you are satisfied, further fragment and disrupt your sleep.

So how why does such disruptions to the circadian rhythm lead to worse patient care?

Delirium!

Hospitalized patients who develop delirium have a 30% higher mortality rate, length of say is one week longer and, on average, have a hospital bill $22,000 higher than those patients who do not develop delirium.

Other factors are predisposing to delirium of course, such as medications, acuity of illness, underlying chronic illnesses, immobility and absence/limited natural light exposure.  But you needn't have may of these other factors to suffer the ill effects of chronic sleep disruption.  How would you expect to feel if such disruptions occurred in your own home while you were well?