Easy Listening

For more than 40 years, persons involved in medicine-researchers, doctors, nurses and patients-have written almost innumerable articles on the negative effect of hospital noise on both nurses and patients. Very little has been done beyond administrative controls ("Please talk quietly"), which are of limited effectiveness. The passage of legislation which includes requirements for speech confidentiality associated with medical
information, has provided an unprecedented opportunity to solve both problems.

The Health Insurance Portability and Accountability Act (HIPAA) is now law. It mandates that individually identifiable health information of patients be protected. Although written and computer files are obviously to be protected, verbal information must also be protected. Covered entities must make reasonable efforts to safeguard patient information from being overheard. The law itself gives no specific guidance on how this is to be accomplished, but a document released by the Department of Health and Human Services provides clarification with the phrase, "Health information whether it is on paper, in computers, or communicated orally."

The Office of Civil Rights has published a document on this issue. It states that the law does not require retrofitting spaces, such as soundproofing of rooms, in order to comply, effectively ruling out one of the three factors that creates speech privacy (noise source loudness, noise attenuation, background sound level). This limits solutions to low speech levels (administrative controls that do not work) or higher background levels.

Many medical facilities have already realized that compliance is wise and have begun considering what steps to take to conform. In order to avoid expensive structural retrofits and circumvent problems associated with administrative controls, we can take advantage of a third privacy tool: sound masking. This solution has had widespread and successful application to open and closed offices to provide speech privacy and so can be applied easily to hospitals and other medical facilities.

Sound masking is not only a very cost-effective solution, it also has another significant advantage over any structural solutions in that it can be adjusted, both centrally and automatically, at any time and in any place to meet changing local requirements. Costs can be further reduced by incorporating paging or music as part of the system.

If sound masking can be used to create speech privacy to comply with HIPAA, can it also be used to solve the long-standing hospital noise problem? An extensive survey by the Public Health Service in 1963 showed that patients interviewed were frequently disturbed by speech and distress sounds, some of which were caused by the staff during night hours. Many studies over the last 50 years have shown that the distraction and annoyance caused by the noise of people and hospital equipment has resulted in less rest and possibly longer recuperation times for patients. The increased socialization now permitted in hospitals, as well as the increased use of medical equipment, has exacerbated this problem.

Several studies have shown that the distraction and loss of sleep is caused by the change of sound level, not the steady average level. It is precisely this change in levels caused by speech that sound masking mitigates in offices. Measurements of the sound attenuation between noisy areas and patient rooms have shown that reasonable levels of sound masking in hospital corridors, nurses stations and patient rooms would provide both confidentiality and greatly reduced distractions of patients, just as it does in offices. Thus, application of sound masking to hospitals would solve both the regulatory one associated with HIPAA and the patient rest and recuperation one.

Sound masking also can be applied successfully to other medical facilities that must comply with the law-doctor's offices, medical laboratories, clinics, public health authorities, insurers, billing agencies, service organizations and pharmacies. There has been some reluctance to do so when contemplating the cost of structural changes. The use of sound masking should alleviate that concern and ease the path to compliance.