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Quiet at Night

Reducing noise, promoting sleep

The busy atmosphere of a hospital can sometimes prevent patients from sleeping soundly, which can be detrimental to effective recovery and healing. While some noise is unavoidable, the Quiet at Night initiative, which supports Barnes-Jewish Hospital's mission of providing exceptional care, has shown success in reducing nighttime noise levels on inpatient floors. The initiative has two elements:

  1. Nightly rounding: Between 9 p.m. and 11 p.m., nurses check in or “round” on their patients, asking if they can shut their doors so they can rest. This ensures patients understand why the door is being shut and that a nurse is always available if they need assistance by using the call button.
  2. Dimming lights: Every evening around 10 p.m., nurses dim lights in hallways and nurses' stations to create a more calming atmosphere conducive to sleeping.

These simple acts not only signal to the patient that it's time to rest, but they also remind the staff that it's time to lower their voices and allow their patients to sleep. Some patient comments gathered in 2014 regarding Barnes-Jewish's quietness include:

  • "I was very impressed by the quietness of the floor. In other situations it had been noisy, but it was quiet and restful."

  • "The nurse took extra steps to make sure the room was quiet so I could rest."

  • "The environment was very quiet"

Lead charge nurses now receive a reminder page every night at 10 p.m., reminding them to begin their Quiet at Night initiatives. Because nurses work in shifts that begin and end throughout the day and night, it's often easy for them to lose track of the hour. The reminder page has proven to be an effective tool to ensure Quiet at Night is consistently implemented.

The hospital also is providing "quiet kits", which contain a sleeping mask and earplugs. In September 2014, the kits were piloted on two inpatient floors. The majority of patients using the kits said the items helped them get restful sleep, particularly if they had a noisy roommate.

Improving responsiveness to hospitalized patients' needs

With a vision to be a national leader in patient experience, Barnes-Jewish Hospital strives to be as responsive as possible to its patients’ requests. Delivering on this commitment becomes more vital for hospitalized patients, who are often more dependent on their nursing staff for basic needs such as taking medication or going to the restroom.

One way the hospital measures its overall effectiveness is through nationally standardized patient satisfaction surveys, which are conducted after hospitalization. The Barnes-Jewish Hospital patient experience team partners with the leadership team to identify where their efforts are effective and where there is room to improve. For this 2014 responsiveness initiative, the team focused on answers to the question "How often did you receive help as soon as you needed it after you used your call light?" In an ideal scenario, every patient would answer "always."

In December 2014, Barnes-Jewish Hospital improved the percentage of patients answering "always" by four percent—twice its goal. This improvement was achieved through two efforts:

  1. Purposeful hourly rounding: This is a structured routine in which nurses and technicians proactively check in or round on their patients. The team member will ask about the patient's pain level, if they need to use the restroom, if they are comfortable and if they have everything they need. This proactive system not only reduces the patients' need to use their call light, but also makes more efficient use a nurse's time.
  2. Call light registrations: The system was upgraded with tools that allow a unit's secretary to directly text a nurse's pager when a call light is pushed, ultimately getting patients what they need faster. If a call is not answered immediately, the system will also remind the staff of the call light, so team members don't have to rely on memory when they're busy with other tasks.

While many Barnes-Jewish Hospital departments showed improved satisfaction scores using these tools, one trauma and acute general surgery floor's efforts yielded a 22 percent increase in patient satisfaction scores from early 2014 to early 2015. An effort for 2015 is underway to standardize purposeful hourly rounding practices hospital-wide, to ensure responsiveness continues to trend upward.

Through these initiatives and others, Barnes-Jewish Hospital continues to deliver on its promise to provide an excellence experience to all its patients.

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