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The influence of APACHE II score on the average noise level in an intensive care unit: an observational study.

Park M, Vos P, Vlaskamp BN, Kohlrausch A, Oldenbeuving AW - BMC Anesthesiol (2015)

Bottom Line: The 24-hour trend of the noise level was obtained for the patients of length-of-stay (LOS) ≥1 day, which was compared to the timeline of the ICU routine events.When analyzed in alignment with the patient's admission (n=22), the daytime acoustic condition improved from Day 1 to 2, but worsened from Day 2 to 4, most likely in relation to the various phases of patient's recovery.Where these factors were argued to have causal relations to LAeq,24h, the APACHE II score was found to be most strongly correlated: LAeq,24h increased by 1.3~1.5 dB when the APACHE II score increased by 10 points.

View Article: PubMed Central - PubMed

Affiliation: Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands.

ABSTRACT

Background: Noise levels in hospitals, especially in intensive care units (ICUs) are known to be high, potentially affecting not only the patients' well-being but also their clinical outcomes. In an observational study, we made a long-term measurement of noise levels in an ICU, and investigated the influence of various factors on the noise level, including the acute physiology and chronic health evaluation II (APACHE II) score.

Methods: The average noise level was continuously measured for three months in all (eight) patient rooms in an ICU, while the patient data were also registered, including the APACHE II score. The 24-hour trend of the noise level was obtained for the patients of length-of-stay (LOS) ≥1 day, which was compared to the timeline of the ICU routine events. For the patients with LOS ≥4 days, the average noise levels in the first four days were analyzed, and regression models were established using the stepwise search method based on the Akaike information criterion.

Results: Features identified in the 24-hour trends (n = 55) agreed well with the daily routine events in the ICU, where regular check-ups raised the 10-minute average noise level by 2~3 dBA from the surrounding values at night, and the staff shift changes consistently increased the noise level by 3~5 dBA. When analyzed in alignment with the patient's admission (n=22), the daytime acoustic condition improved from Day 1 to 2, but worsened from Day 2 to 4, most likely in relation to the various phases of patient's recovery. Regression analysis showed that the APACHE II score, room location, gender, day of week and the ICU admission type could explain more than 50% of the variance in the daily average noise level, LAeq,24h. Where these factors were argued to have causal relations to LAeq,24h, the APACHE II score was found to be most strongly correlated: LAeq,24h increased by 1.3~1.5 dB when the APACHE II score increased by 10 points.

Conclusions: Patient's initial health condition is one important factor that influences the acoustic environment in an ICU, which needs to be considered in observational and interventional studies where the noise in healthcare environments is the subject of investigation.

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Related in: MedlinePlus

Layout of ICU. The layout of the intensive care unit at St. Elisabeth Hospital in Tilburg, The Netherlands, where the current study was carried out. All patient rooms numbered A to H had windows facing outside. Room F was an isolation room with pressure control facility in the ante room. ‘Prep. room’ stands for medication preparation room.
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Fig1: Layout of ICU. The layout of the intensive care unit at St. Elisabeth Hospital in Tilburg, The Netherlands, where the current study was carried out. All patient rooms numbered A to H had windows facing outside. Room F was an isolation room with pressure control facility in the ante room. ‘Prep. room’ stands for medication preparation room.

Mentions: A continuous measurement of the noise levels was carried out in one of the ICUs at St. Elisabeth Hospital in Tilburg, The Netherlands from September to November, 2012. In the ICU, there were 8 single-bed patient rooms along an L-shaped corridor where offices and a nursing station were located on the opposite side of the patient rooms, as shown in Figure 1. One part of the nursing station was an open space with a counter, and most of the sliding doors in the unit (both patient rooms and nursing station) were usually kept open for the observation of the patients. Among the three entrances in the ICU, the one next to Room H was used most frequently, whereas the entrance next to Room A was not in use. Room F was an isolation room with an ante room for pressure control, and when in use for the isolation, the hinged door was obviously kept closed.Figure 1


The influence of APACHE II score on the average noise level in an intensive care unit: an observational study.

Park M, Vos P, Vlaskamp BN, Kohlrausch A, Oldenbeuving AW - BMC Anesthesiol (2015)

Layout of ICU. The layout of the intensive care unit at St. Elisabeth Hospital in Tilburg, The Netherlands, where the current study was carried out. All patient rooms numbered A to H had windows facing outside. Room F was an isolation room with pressure control facility in the ante room. ‘Prep. room’ stands for medication preparation room.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389973&req=5

Fig1: Layout of ICU. The layout of the intensive care unit at St. Elisabeth Hospital in Tilburg, The Netherlands, where the current study was carried out. All patient rooms numbered A to H had windows facing outside. Room F was an isolation room with pressure control facility in the ante room. ‘Prep. room’ stands for medication preparation room.
Mentions: A continuous measurement of the noise levels was carried out in one of the ICUs at St. Elisabeth Hospital in Tilburg, The Netherlands from September to November, 2012. In the ICU, there were 8 single-bed patient rooms along an L-shaped corridor where offices and a nursing station were located on the opposite side of the patient rooms, as shown in Figure 1. One part of the nursing station was an open space with a counter, and most of the sliding doors in the unit (both patient rooms and nursing station) were usually kept open for the observation of the patients. Among the three entrances in the ICU, the one next to Room H was used most frequently, whereas the entrance next to Room A was not in use. Room F was an isolation room with an ante room for pressure control, and when in use for the isolation, the hinged door was obviously kept closed.Figure 1

Bottom Line: The 24-hour trend of the noise level was obtained for the patients of length-of-stay (LOS) ≥1 day, which was compared to the timeline of the ICU routine events.When analyzed in alignment with the patient's admission (n=22), the daytime acoustic condition improved from Day 1 to 2, but worsened from Day 2 to 4, most likely in relation to the various phases of patient's recovery.Where these factors were argued to have causal relations to LAeq,24h, the APACHE II score was found to be most strongly correlated: LAeq,24h increased by 1.3~1.5 dB when the APACHE II score increased by 10 points.

View Article: PubMed Central - PubMed

Affiliation: Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands.

ABSTRACT

Background: Noise levels in hospitals, especially in intensive care units (ICUs) are known to be high, potentially affecting not only the patients' well-being but also their clinical outcomes. In an observational study, we made a long-term measurement of noise levels in an ICU, and investigated the influence of various factors on the noise level, including the acute physiology and chronic health evaluation II (APACHE II) score.

Methods: The average noise level was continuously measured for three months in all (eight) patient rooms in an ICU, while the patient data were also registered, including the APACHE II score. The 24-hour trend of the noise level was obtained for the patients of length-of-stay (LOS) ≥1 day, which was compared to the timeline of the ICU routine events. For the patients with LOS ≥4 days, the average noise levels in the first four days were analyzed, and regression models were established using the stepwise search method based on the Akaike information criterion.

Results: Features identified in the 24-hour trends (n = 55) agreed well with the daily routine events in the ICU, where regular check-ups raised the 10-minute average noise level by 2~3 dBA from the surrounding values at night, and the staff shift changes consistently increased the noise level by 3~5 dBA. When analyzed in alignment with the patient's admission (n=22), the daytime acoustic condition improved from Day 1 to 2, but worsened from Day 2 to 4, most likely in relation to the various phases of patient's recovery. Regression analysis showed that the APACHE II score, room location, gender, day of week and the ICU admission type could explain more than 50% of the variance in the daily average noise level, LAeq,24h. Where these factors were argued to have causal relations to LAeq,24h, the APACHE II score was found to be most strongly correlated: LAeq,24h increased by 1.3~1.5 dB when the APACHE II score increased by 10 points.

Conclusions: Patient's initial health condition is one important factor that influences the acoustic environment in an ICU, which needs to be considered in observational and interventional studies where the noise in healthcare environments is the subject of investigation.

Show MeSH
Related in: MedlinePlus