501 - A Quiet Place: Noise Reduction Quality Improvement Project in a Level 3 NICU
Saturday, April 26, 2025
2:30pm – 4:45pm HST
Publication Number: 501.3676
Yenisy Randol, UF Health Jacksonville, Jacksonville, FL, United States; Holly m. Knight, UF Health Jacksonville, Jacksonville, FL, United States; Marwa M. Elgendy, University of Florida, Jacksonville, FL, United States; Melodie Logue, UF Health Jacksonville, Jacksonville, FL, United States; Matthew D. Garber, UF COM-Jacksonville, Jacksonville, FL, United States; Josef Cortez, UF Health Jacksonville, Jacksonville, FL, United States
Associate Professor of Pediatrics UF Health Jacksonville Jacksonville, Florida, United States
Background: Excessive NICU noise adversely affects sleep, growth, and development of infants. In our tertiary academic referral NICU, the average noise level frequently exceeded the 45-decibel (dB) threshold recommended by AAP. We aimed to decrease noise levels from a baseline average of 60 dB to 50 dB by December 2023. Objective: We aimed to decrease noise from a baseline average of 60 dB to 50 dB by December 2023. Design/Methods: We measured noise levels during a 12-hour dayshift in our open-bay NICU at 2 timepoints (between 8-10AM and between 2-4PM). We used the Ishikawa (fishbone) diagram to determine potential causes of noise (Table 1), performed Pareto analysis to identify high-priority issues (Table 2), and asked meaningful questions (5 Whys) to determine the root-cause(s) of high noise levels. We implemented interventions, plotted noise level measurements, and tracked the number of measurements as process measure. We used a statistical process control (SPC) chart (XmR) to analyze outcomes (Figure 3). Results: We identified 24 potential causes of noise in our NICU (Figure 1) of which conversations were among the loudest contributor (>42.6%, Figure 2), followed by sound generated by equipment (e.g. ventilators), crying infants, and alarms. Noise levels did not differ between the 2 daily timepoints. We implemented quiet times between 8-10 AM and 2-4 PM. We focused on talking more quietly during rounds, educated staff, posted signs around the NICU, and instituted an automated visual alarm noise sensor to provide feedback. We observed a moderate decrease in average noise level from 59.9 dB to 56.6 dB by December 2023 (Figure 3). Although we observed an unstable increasing trend from November 2022 to April 2023, it stabilized after incorporating quiet time education into the NICU weekly newsletter.
Conclusion(s): In our open-bay NICU, we modestly decreased noise levels but did not achieve our goal of 50 dB. We encountered challenges that may be related to our open-bay NICU design and we adjusted our interventions. SPC analysis showed special-cause variation associated with our interventions.
