Yakety-Yak: The Yacker Tracker for Reducing Noise in Hospitals

I just wanted to yak a little about a noise monitor which some manufacturers call the “Yacker Tracker”. I first heard about it at the 2nd Annual American Delirium Society (ADS) conference, June 3-5, 2012 in Indianapolis, Indiana. The Yacker Tracker looks almost exactly like a traffic light.People were touting it as one of the ways to track noise on med-surg units as one of the ways of controlling noise which can interfere with sleep. The  general idea is that it can make nurses and other doctors more aware of when the decibel level is too high and would disturb patients’ sleep. However, the unit also has a noise alarm–which struck me as ironic.

When patients don’t get enough normal sleep, they could be at risk for delirium. Keeping the noise down in the hospital can be particularly challenging. A recent AMA Morningrounds item alerted me again to the problem of noise adversely affecting sleep quality. I posted about this recently, noting the problem of burst suppression EEG patterns found in intensive care unit patients, see link Burst Suppression EEG Patterns, Delirium, and Mortality Risk in the ICU « The Practical Psychosomaticist: James Amos, M.D.

In a study published on-line in the Annals of Internal Medicine (Typical hospital noises may disrupt sleep | Reuters), researchers found that electronic sounds at decibel levels not much above a whisper could awaken relatively young, healthy volunteers [1]. The average patient in the hospital is elderly and is likely to be even more sensitive to noise and other issues that affect sleep quality.

I have seen the Yacker Tracker in various units at our hospital, but didn’t know what they were called until now. I checked with several units including general medicine, general psychiatry, the Medical-Psychiatry Unit, and an oncology unit. I also asked for an opinion from one of our psychiatry nurse consultants. It was difficult for anyone to say unequivocally that the Yacker Trackers are helpful for reducing noise levels on med-surg units. One person told me that the noise alarm and the sensitivity were routinely turned down the Yacker Tracker in one unit. This reminded me of the problem with medical alarm fatigue, which has also been a hot topic lately [2].

Just in case you’re interested, some Yacker Trackers cost about $100, and a siren goes off when a certain preset noise level is reached–which can be turned off.

Your thoughts?

1. O.M. Buxton, J. M. E., W. Wang, A. Carballeira, S. O’Connor, D. Cooper, A.J. Gordhandas, S.M. McKinney, and J.M. Solet. (2012) Sleep Disruption Due to Hospital Noises. Annals of Internal Medicine
Background: Sleep plays a critical role in maintaining health and well-being; however, patients who are hospitalized are frequently exposed to noise that can disrupt sleep. Efforts to attenuate hospital noise have been limited by incomplete information on the interaction between sounds and sleep physiology.

Objective: To determine profiles of acoustic disruption of sleep by examining the cortical (encephalographic) arousal responses during sleep to typical hospital noises by sound level and type and sleep stage.

Design: 3-day polysomnographic study.

Setting: Sound-attenuated sleep laboratory.

Participants: Volunteer sample of 12 healthy participants.

Intervention: Baseline (sham) night followed by 2 intervention nights with controlled presentation of 14 sounds that are common in hospitals (for example, voice, intravenous alarm, phone, ice machine, outside traffic, and helicopter). The sounds were administered at calibrated, increasing decibel levels (40 to 70 dBA [decibels, adjusted for the range of normal hearing]) during specific sleep stages.

Measurements: Encephalographic arousals, by using established criteria, during rapid eye movement (REM) sleep and non-REM stages 2 and 3.

Results: Sound presentations yielded arousal response curves that varied because of sound level and type and sleep stage. Electronic sounds were more arousing than other sounds, including human voices, and there were large differences in responses by sound type. As expected, sounds in non-REM stage 3 were less likely to cause arousals than sounds in non-REM stage 2; unexpectedly, the probability of arousal to sounds presented in REM sleep varied less by sound type than when presented in non-REM sleep and caused a greater and more sustained elevation of instantaneous heart rate.

Limitations: The study included only 12 participants. Results for these healthy persons may underestimate the effects of noise on sleep in patients who are hospitalized.

Conclusion: Sounds during sleep influence both cortical brain activity and cardiovascular function. This study systematically quantifies the disruptive capacity of a range of hospital sounds on sleep, providing evidence that is essential to improving the acoustic environments of new and existing health care facilities to enable the highest quality of care.

Primary Funding Source: Academy of Architecture for Health, Facilities Guidelines Institute, and The Center for Health Design.

2. Hannibal, G. B. (2011). “Monitor alarms and alarm fatigue.” AACN advanced critical care 22(4): 418-420.
This issue’s ECG Challenges column is devoted to a topic that affects every nurse who works in an acute or critical care unit. Hospital alarms can come from telephones, ventilators, heart monitors, intravenous pumps, antiembolism devices, sleep apnea devices, smoke alarms, patient-controlled analgesia pumps, pagers, cell phones, patient call systems, oxygen saturation devices, and fall prevention devices. Physiologic clinical alarms play a vital role in the information systems that acute and critical care nurses depend on for the daily care of their patients.

Although alarms serve as an indispensible part of modern hospital care, they can also be a detriment to patient comfort and affect ergonomic issues for nurses. Physiologic alarms are listed second among the top 10 technology hazards for 2011 by the ERCI Institute, a Pennsylvania patient safety organization.1 Alarm fatigue and misuse can lead to unintended consequences for patients and users. This column will review the use of clinical alarms and examine issues related to their effectiveness and safety.

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Comments

  1. It is slightly… paradoxical… Making noise to stop noise…
    I wonder if it wouldn’t wake even more people than simply loud talking…

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