Brief ReportNoise in the ED
Introduction
Although much has been written about stress in emergency medicine and threat of burnout among emergency physicians, the emergency department (ED) itself has been little studied. As a source of “stress in the workplace,” the bright lights, loud noises, hard tile floors, lack of air circulation, and lack of food services at off-hours have not been examined. Interestingly, it is these stressors that a well designed ED should be able to improve that emergency health care workers have control over, that is, one may not be able to predict when the next pediatric cardiac arrest will present, but one can control the lights, the noises, and the smells that characterize so many EDs. We attempted to quantify one of these factors, noise, in a large inner city ED in Los Angeles.
The impact of noise pollution on both patient and patient care provider has been extensively studied in the neonatal intensive care unit (ICU) and in other critical care units [1], [2], [3], [4], [5]. Noise pollution makes errors more probable and is one of the risk factors for provider burnout and negative outcomes for patients [6].
As there are no known published studies of the typical noise level in the ED, the purpose of this pilot study was to record and analyze noise in a large urban level I trauma center. The hypothesis was that there are excessive noise levels in the ED that may contribute to the already stressful work environment.
Section snippets
Methods
A 3-channel noise dosimeter, Quest 300 from Quest Technologies, was used in this study. A dosimeter (Fig. 1) is used to monitor workplace noise levels to ensure that they do not exceed Occupational Safety and Health Administration (OSHA) regulations. It was calibrated according to the manufacturer specifications.
Initially, the dosimeter was placed as a stand-alone unit at an 8-ft elevation on the wall of the main resuscitation booth in the ED. One of the 3 channels was set to OSHA hearing
Results
In the first part of the study, given that the percentage dose doubles for every 5-dB change, the TWA for this study, 43 dB is greater than the dosage recommended by the Environmental Protection Agency (EPA) for the 12 hours studied. The average sound levels peaked 25 times during that period. Individually measured peak levels of 90.1 (equal to a pneumatic drill) to 127.2 dB (equal to a boom box in a car) occurred every minute.
Our findings in part 2 of the study were similar. Once again, the
Discussion
“Job stress” is an expectation for physicians in emergency medicine. The type of cases that present to the ED, the lack of control over who presents, the shift work, and the environment itself, all contribute to the stress placed on the health care providers. From the beginning of emergency medicine residency, Whitley et al [7] found that residents experience constant stress. Mean levels of stress and depression were higher for women residents, and unmarried residents reported more symptoms of
Conclusion
There indeed appears to be excessive noise levels in the ED, and the sources are easily identifiable. As is done in the ICUs, identification and modification of these noise sources may assist in decreasing job stress, provider burnout, and physician error. It will also allow us to provide a more pleasant and peaceful environment for our patients. Further research in this area might focus on the other modifiable environmental stressors within the ED that contribute to stress: lighting styles and
Acknowledgments
We would like to thank Master Sergeant Ronald G. Courts and Major Arnold Zigman for the dosimeter and the use of the Quest software. In addition, special thanks to Tim Saunders for meticulously logging the noise sources in our ED.
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