A Strategy for Noise Reduction to Improve Patient Experiences With Sleep (SNORES)

The inpatient population is vulnerable to sleep disruption from multiple causes including phlebotomy, vital signs, medication administration, and noise from telemetry and intravenous pumps. ¹ At Thomas Jefferson University Hospital (TJUH), prior work shows that patients on the 5-West telemetry unit sleep an average of just 4.35 hours per night with an average of 4.33 awakenings per night. ² Sleep deprivation counteracts adequate healing and has been associated with impaired immunity, mood disorders, and delirium. ¹ This project assesses the impact of a white noise machine on patient sleep satisfaction on the 5-West telemetry unit at TJUH. Patient sleep satisfaction survey scores from the night with the machine were compared to the night without the machine over a 4-month time frame.

A survey used 5 items from the Dutch-Flemish Patient-Reported Outcomes Measurement Information System Sleep Disturbance item bank with consideration of recent work on sleep quality. ¹ A sixth item assessed if patients would recommend the white noise machine to another patient. A convenience sample of hospitalized cardiac patients were surveyed to obtain a baseline patient sleep satisfaction score. The machine was placed in the patient’s room and nursing was asked to turn on the machine when the patient was about to go to sleep. Each patient was surveyed on sleep satisfaction the day after use of the machine. The mean survey scores of patients from the night with the machine were compared to the night without the machine.

Between November 2018 and February 2019, 50 patients were enrolled and completed a survey. Each of the 5 sleep satisfaction items was answered using a 5-point Likert-type scale. A sleep satisfaction score was calculated after reverse-coding the fourth and fifth items, such that a higher score indicated better sleep satisfaction. Mean sleep satisfaction score prior to intervention was 0.80 (standard deviation [SD] 7.12, confidence interval [CI] −1.25 to 2.84) and was 8.84 (SD 6.23, CI 7.05 to 10.63) post intervention. A paired t test was performed, and mean improvement in sleep satisfaction score was 8.04 and significantly greater than zero (SD 8.77, t score 6.41, 2-tail P < .001, 95% CI 5.52 to 10.56), suggesting the white noise machine was associated with improvement in sleep satisfaction. Of 46 patients (92%) who answered the secondary outcome of whether they would recommend the machine to another patient, 37 (80%) answered yes, 5 (11%) answered no, and 4 (9%) answered unsure.

In a single-institution sample, a white noise machine improves patient sleep satisfaction on a telemetry-monitored hospital unit. Admitted patients who express difficulty sleeping in other hospital units may benefit from the machine in addition to other sleep hygiene techniques. Limitations to the study include that it was conducted at a single institution with predominantly cardiac patients on telemetry monitoring. Further studies should be conducted on general medicine and intensive care unit–level patients to determine if sleep satisfaction can be improved using the machine.