Quiet Time for

Patients in Acute
Care
Group B
Evidence Based Practice
Presentation
Introduction

Quiet time: Effort to promote a more healing environment by dimming lights,

closing patient doors, silencing phones/technology, hushing staff conversations,
and limiting disruptions.

Problem: That current quiet time implementation does not decrease noise levels
on critical care units.

Nursing Significance: As health care providers, we want to promote rest,

relaxation, and healing to improve healthcare outcomes and decrease length of
stay of our patients.

Goal: Identify methods to best decrease noise levels within critical care units.
PICOT
What is the best method, protocol, or guideline to implement quiet time once
every 24 hours for adult patients on critical care units as compared to current
practices that are ineffective in decreasing noise levels?

P = adult patients (over 18 years old) on critical care units

I = using a method, protocol, or guideline to implement quiet time

C = as compared to current practices that are ineffective in decreasing noise

levels

O = effective quiet time once every 24 hours

T = at least once every 24 hours

Summary of Current Practice

Local - No policy exists within the ICU. However, hospital policy is for
quiet hours from 2000-0600 (overhead announcement, signs, and
reduced lighting in some areas)

State - No state policy for quiet time within ICUs. Standard practice is
a period of quiet time between 2200-0600 and/or 1400-1600 with
signs posted and education of visitors and medical personnel.

National - No national policy but continued research on the potential

benefits of quiet time. Silent Hospitals Help Healing, HCAHPS, and
WHO recommendations used to influence noise levels nationally.
 - Quiet time (QT) established to
Synopsis of Literature promote healing and decrease
length of stay by promoting sleep
- Noise level reduced during QT
- Not all rooms achieved EPA
recommendation 35-45dB
- Location of room
- Highest noise levels diminished
- Staff communication
- A.M. vs. P.M.
- Stress levels/Vitals
- Patient/Family satisfaction
- Staff satisfaction
Summary of Strengths

-Investigation of noise levels and sources

-Clearly written and posted QT protocol

-Multiple ICU specialties

-Large sample size

-Long duration
Summary of Limitations

-Short study length

-Day shift only

-No identification of noise sources

-Patient interaction

-Staff unfamiliar with protocol

-Family not asked to leave

EBP Recommendations
1.Implement quiet time in ICU environments between 1400-1600
each day.
a. Quiet Time Requirements: dimming lights, minimizing patient
interventions except those that are necessary, allowing family to stay,
customize alarm ranges to patients, putting up quiet time sign, show
nature videos or closed captioning instead of television volume on
b. Study referenced:
i. Maidl et al. (2014): consecutive quiet time resulted in better sleep
and lower levels of anxiety in ICU patients
ii. Konkani et al. (2012): customize alarm ranges to decrease nuance
alarms
iii. Reimer et al. (2015): after quiet time was implemented, light
levels, noise levels, and nurses stress levels decreased
Quiet Time Sign Picture taken by Kayla Meester

Picture taken by John Oller

EBP Recommendations
2. Place a decibel monitor (Yacker Tracker) at each nursing station in
the ICU.
a. Study referenced:

i. Watson et al. (2015): noise levels are consistently highest in staff

congregation areas; behavioral modification was found to be the
most effective to lower sound levels

b. Study referenced:

i. Tainter et al. (2016): noise levels were consistently above the

WHO recommendation of 40 dB, therefore use of decibel monitor
as a behavioral modifier can actively remind staff to lower their
voices via real time noise level feedback
Decibel Monitor

Yacker Tracker
EBP Recommendations
3. In order for quiet time to be successful, incorporate quiet time
training into continuing education credits for staff and add the
enforcement of consistent quiet time as a component of the unit managers
position.
a. Study referenced:
i. Maidl et al. (2014): requirement for medical staff education
regarding time and method for quiet time implementation will
increase awareness and correct implementation of quiet time
b. Study referenced:
i. McAndrew et al. (2016): education for staff promotes the
successful implementation of consistent and evidence-based
practices to reduce noise during quiet time
Timeline of Implementation: Day 1

1. Designate a team leader to enforce and promote quiet time prior

to implementation to help to make quiet time successful.

2. Print and hang signage around the unit. Place in staff rooms, on
the entrance of the unit, and outside of patients doors to remind
hospital staff and visitors of quiet time. Place Yacker Tracker at
nurses stations.
Timeline of Implementation: Day 1 -
Weeks

3. Day 1-Weeks: Team leader educates nursing staff about quiet time protocol
at staff meetings and morning huddle. This education would occur every
morning until all of the nurses on the unit received this initial education.

4. Day 1-Weeks: The nurse would then provide education to patients and
visitors on admission and as needed on the quiet time protocol and how it is
beneficial to the patients care.

5. Weeks-Months: Lengthier education on quiet time protocol would

be added to nurses continuous education and in-services.
Cost of Implementation

- Each Yacker Tracker would cost approximately

$80-$100
- If quiet time inadvertently delayed discharge or
transfer of a patient, increased costs are
associated with that
- One day of ICU stay: ~$3,500
- One day of floor stay: ~$1,200
Money Saved Through Implementation

- Increased patient satisfaction benefits the

hospital financially
- Saves money by reducing lighting
- If more studies are done showing a reduction in
ICU delirium, that saves money
Cost Analysis

- The cost of implementation is very low in regards to purchasing

needed supplies and training

- To reduce costs further, hospital staff must manage time so there

is not a delay in discharges

- If implemented appropriately, the costs of this practice are very

low

- Increase in patient satisfaction (noted in many studies) can

improve hospital rating and patient outcome

- Overall, the cost is not too high for this to be a viable

practice
Risks

Family dissatisfaction
If the family is asked to leave
If the family is not allowed to visit
Families feel like theyre being excluded from care
Cost of implementation
Patient safety
Low lights
Decreased alarm volume
Benefits

Improved quality of sleep for patients

Increased patient satisfaction
More quiet time for nurses to work (charting, etc.)
Less sedative medications required to achieve rest
Reduction in ICU delirium
Patient safety
Lower noise levels (able to hear more of what is happening, nurses are
less distracted)
Lowlights (decrease electricity usage)
Evaluation

-Noise level will not exceed yellow indicator on Yacker Tracker for
duration of quiet time.

-Patients will verbalize increased sleep satisfaction following quiet

time.

-Nurse will not disturb patient more than once unless medically
necessary during the designated quiet time.

-Nurses will attend one training seminar about QT protocol every three
months.

-Charge nurse will remind staff about QT protocols Yacker Tracker

indicates an increase in noise during QT.
Summary
-Quiet time promotes a healing environment for patients

-Problem: Implemented quiet time in critical care units did not reduce
noise levels

-Successful quiet time: staff need to be educated on ways to reduce

noise, set a specific time during the day for implemented quiet time
and use a visual aid (Yacker Tracker) to keep staff in check about their
noise levels.

-The benefits of quiet time outweigh the risks if implemented correctly.

-The initial cost of starting quiet time will eventually save the hospital
money
 The best bridge between despair and
hope is a good nights sleep.
-E. Joseph Cossman
 References
1
Harrington, Michelle, and Kathleen Deleskey. "Shh! Quiet Time in the ICU." Nursing
Management (Springhouse) 46.5 (2015): 21-23. Web.

2
Johnson, D. W., Schmidt, U. H., Bittner, E. A., Christensen, B., Levi, R., & Pino, R. M. (2013, July 4). Delay of transfer from the
intensive care unit: A prospective observational study of incidence, causes, and financial impact. BioMed Central, 17(4).
doi:10.1186/cc12807

3
Konkani, A., Oakley, B., & Bauld, T. J. (2012). Reducing Hospital Noise: A Review of Medical
Device Alarm Management. Biomedical Instrumentation & Technology, 46(6), 478-487. doi:10.2345/0899-8205-46.6.478

4
Maidl, C., Leske, S., & Gracia, A. (2013, July 10). The Influence of Quiet Time for Patients in
Critical Care. Sage Journals, 23. doi:10.1177/1054773813493000

5
Mcandrew, N., Leske, J., Guttormson, J., Kelber, S., Moore, K., Dabrowski, S. "Quiet Time for Mechanically Ventilated Patients
in a Medical Intensive Care Unit." Western Journal of Nursing Research 38.10 (2016):
1374-375. Web.
References
6
Park, M. J., Yoo, J. H., Cho, B. W., Kim, K. T., Jeong, W., & Ha, M. (2014). Noise in hospital
rooms and sleep disturbance in hospitalized medical patients. Environmental Health and
Toxicology, 29. doi:10.5620/eht.2014.29.e2014006

7
Riemer, H. C., Mates, J., Ryan, L., & Schleder, B. J. (2015). Decreased Stress Levels in Nurses:
A Benefit of Quiet Time. American Journal of Critical Care, 24(5), 396-402. doi:10.4037/ajcc2015706

8
Tainter, C. R., Levine, A. R., Quraishi, S. A., Butterly, A. D., Stahl, D. L., Eikermann, M., Lee,
J. (2016). Noise Levels in Surgical ICUs Are Consistently Above Recommended
Standards. Critical Care Medicine, 44(1), 147-152. doi:10.1097/ccm.0000000000001378

9
Watson, J., Kinstler, A., Vidonish, W. P., Wagner, M., Lin, L., Davis, K. G., Daraiseh, N. M.
(2015). Impact of Noise on Nurses in Pediatric Intensive Care Units. American Journal of
Critical Care, 24(5), 377-384. doi:10.4037/ajcc2015260