Are noise reduction interventions effective in adult ward settings? A systematic review and meta analysis

Abstract

ObjectiveHigh levels of environmental noise in hospitals disturbs sleep. We aimed to identify, critically appraise and summarise primary research that reports studies that tested interventions to reduce night-time noise levels in ward-settings. DesignSystematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sourcesKey health-related and specialist acoustic databases (CINAHL, EMBASE, MEDLINE, The Cochrane Library, PsycINFO, NHS Evidence, Knovel, Journal of the Audio Engineering Society, Journal of the Acoustical Society of America, IEEE Xplore Digital Library, Acta Acustica and Acoustics in Practice) were searched from their inception to April 2017, with no language restrictions. Review methodsExperimental, quasi-experimental and observational study designs assessing the effect of noise reduction interventions on patient outcomes and/or environmental noise levels were included. Two reviewers independently conducted a quality appraisal using a published framework. ResultsIn total, 834 records were identified with nine studies meeting inclusion criteria. Quality appraisal showed that the level of evidence was generally weak. A range of noise reduction interventions were identified: one study implemented a single intervention, whilst the remainder were complex, multi-faceted interventions. Findings from individual studies showed mixed results but preliminary evidence suggests that noise reduction interventions can reduce environmental noise levels in ward settings and improve patients' sleep ratings. Quantitative data from 6 studies were pooled. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in total hours sleep (no intervention – intervention) was −0.11 h (95% CI −0.46 to 0.25 h; p = 0.556), with moderate statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in awakenings per night (no intervention – intervention) was 0.05 (95% CI −0.20 to 0.29; p = 0.715), with negligible statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the odds ratio for disturbed nights (no intervention: intervention) was 0.75 (95% CI 0.55 to 1.01; p = 0.059), with low statistical heterogeneity. ConclusionsIndividual studies show that noise reduction interventions are feasible in ward settings and suggest they have potential to improve patients' in-hospital sleep experiences. However meta-analyses show insufficient evidence to support the use of such interventions at present. There is a lack of appropriately designed studies to test intervention effectiveness. Robust studies are required to identify the most effective interventions to address this significant and ubiquitous problem. What is known about the topic•Noise levels in hospital impact on quantity and quality of sleep and patient experience.•Disturbed sleep can have a detrimental impact on health and extend patient recovery.•Noise reduction interventions do not receive the priority they deserve. What this paper adds•A comprehensive review of noise reduction interventions used in general ward settings.•Noise reduction interventions show the potential to reduce environmental noise and improve patient sleep ratings.•Appropriately designed studies are required to provide definitive evidence to demonstrate the effectiveness of noise reduction intervention in ward settings.