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A Sound Education

Sick and Tired of Sound

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"A hospital is no place to be sick."

Samuel Goldwyn

Getting hospitalized can be bad for your health. There's an old saying that patients can't wait to go home so they can get some rest. They're losing a lot of sleep for two reasons: the constant poking and prodding at all hours; and the overwhelming cacophony of sound. The World Health Organization (WHO) addressed this issue in 1995 by releasing guidelines for sound level ranges at the patient's bedside (35 dB with a maximum of 40 dB overnight). Yet in 2005 (ScienceDaily, 2005), the average daytime sound levels in hospitals were measured at 72 dB, double the WHO's recommendations, and a disturbing 60 dB at night. Another study found noise levels peaked at near chain-saw levels (80 dB)!

Let's put those numbers in context. The average sound level of a conversation at six feet is 60 dB, and a vacuum cleaner whirs at about 70 dB. Studies have shown that Intensive Care Units are the loudest, mostly because of the increased activity, raised voice levels, machinery, intercoms, pagers, and alarms. Traditional hospital architecture is also to blame because floors and walls that must be non-porous and smooth for easy sanitization can amplify sound instead of absorbing it like carpet and acoustic tiles would. All of this adds to the stress level of patients who sleep less (an average of 90 minutes of lost sleep in one study), and recover more slowly. And it's not only the patients that are suffering. Hospital staff have complained for decades that repeated exposure to these high noise levels increases stress levels, contributes to burnout, and can lead to medical errors.

For the last few decades hospitals and researchers have been quietly finding solutions that reduce noise for patients and staff. Some can be implemented easily, such as lowering voice levels at night, installing sound muffling materials, using "clang-less" trash cans, and eliminating intercom systems by delivering messages directly to individuals. Some hospitals that are now in the planning stages ditch the traditional layout of units and allow nurses to check on patients by "line of site" instead of leaving patient room doors wide open.

The quest for more quiet healthcare doesn't stop there. By introducing sound masking into a noisy care unit, conversations and other noise distractions can be concealed. This is accomplished with a low level background sound generator, similar to white noise but specifically tuned to each environment, that's installed in ceiling grids. Going to the source of unwanted noises, manufacturers of health monitoring and life saving devices are starting to rethink how loud their products are. For instance, vacuum pumps are one of the most obtrusive devices in a patient's room. Newer units are being redesigned with sound dampening materials, vibration-reducing mounts, mufflers, and larger or additional pumps for quieter operation.

One of the more interesting ways to reduce discord in the hospital room is to think harmoniously. Apparatuses that employ diagnosis or warning sounds have persistent and somewhat simple, but irritating tones. Nurses are trained to distinguish between emergency alarms and nuisance alerts, but patients have to endure every blaring sound when they shift their body the wrong way or bend their arm. In the 1980s, a group of anesthesiologists tried to address the problem by hiring a psycho-acoustician to come up with pleasing, but informative sounds for these machines. These didn't pass the audition because on-board audio devices were very limited in functionality at the time. But by 2003, musician turned clinician Dr. Frank Block, Jr. had convinced the International Electrotechnical Commission (IEC) to include his music-based tones as a standard for medical warning tones. Sadly, most tone-deaf manufacturers just stuck with the boring fixed pitch sounds they'd already been using.

When electronic music artist Yoko K. Sen was hospitalized in 2014, she had to endure the constant disruptions from the hallways and dissonance from the out of tune health monitors. As a musician, the stressful sonic experience stayed with her – enough that she set out to solve this problem of alert tones gone wild. She has worked for many years researching, auditioning, and composing different melodies and rhythms that will eventually be incorporated into the latest monitors from healthcare giant Medtronic. Her goal is to produce alerts that are more "uh-oh" than "OH NO!," and alarms that can quickly cut through the noise of other monitors.

Other researchers are working to tie all of a patient's monitors together into one alert system (like the overhead monitor in the Enterprise's sickbay on Star Trek). In the Netherlands, Delft Design Labs has created "Care Tunes," a musical-based monitoring system for a nurse's station that uses rising and falling chords and tempos for alerts.
See and hear their demonstration on YouTube here. And some manufacturers have developed pleasant musical feedback sounds into surgery equipment that reduces tension in the operating room. There is hope on the horizon for quieter hospitals, but like everything else in the world, it will just take time and patience.

I want to leave you on a high note. When Richard Atkinson was in medical school, he didn't hear the conglomeration of monitors as pandemonium, he heard a rainforest with exotic birds. So he sampled the machines and created a musical piece around his experiences in a hospital.
Listen here.


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