If you were to score the soundtrack to an Intensive Care Unit, the relentless din would likely be too overwhelming for even a Blockbuster thriller—a barrage of random beeps, sirens, and the endless, low-frequency hum of anxiety. Hospitals generate a range of noises that not only leave patients sleepless but, according to studies, actually impede recovery. Recently, the World Health Organization (WHO) traced a link between noise, sleep disturbance, and sickness, including data on increased blood pressure and rising cortisol levels. The toll this ruckus takes on healthcare providers is also palpable–when alarms sound, whether for minor issues or genuine emergencies, doctors and nurses, unable to decipher the critical from the routine, become desensitized, a syndrome known as “alarm fatigue.”

In 2011, the Boston Globe reported that more than 100 patients had died over five years as a result of alarm fatigue; many of these jarring sounds are entirely unnecessary. According to a 2013 report by the Joint Commission, a healthcare non-profit, an estimated 85 to 99% of all hospital alarms “do not require clinical intervention,” citing a critical need to cut through the noise to provide a more soothing environment. In response, a small but interconnected collective of specialists—from electronic musicians to healthcare consultants to sound designers—has begun to devote their attention to improving the sound experience in hospitals, and their work is already shaping the future of global care facilities.

Electronic musician Yoko Sen first encountered this battery of alarms when she was admitted to the ICU in 2014.  “As a musician, I am sensitive to noise, so I was disturbed by the endless beeps.” Upon recovery, she formed Sen Sound and decided to chart a typical patient’s sound experience using her musician’s skills, prototyping sound environments, creating sound maps of hospitals, and giving workshops on sensory skills to healthcare executives. 

Mapping sound to space

As an artist-in-residence at Sibley Innovation Hub at Johns Hopkins Sibley Memorial Hospital in Washington D.C. between 2016 and 2018, she explored how sound impacts the environment and experience of patients and team members. She found that a more soothing atmosphere improved both patient care and employee retention rates. The result was the prototype and implementation of the “Staff Tranquility Room,” an immersive relaxation space, which contains a series of lights and screens, said by some to be reminiscent of the Northern Lights, for hospital team members to take a moment of respite from the sensory and emotional overload of the hospital. During this period, Sen also began working with neuroscientists to create research-backed sound environments, including one designed to soothe babies. In 2017, she was hired by medical device company Medtronic to design and modify the feedback noises patients interpret from their home cardiac monitors. Through her work, Sen has proven that redefining the sound experience in hospitals is not only crucial to patient care, but could potentially open up a new, highly innovative market, for tech companies and medical supply distributors.

A soundscape map for a unit in the Johns Hopkins Sibley Memorial hospital visualizes the location, type and intensity of sound observed in a one hour period.
Yoko Sen mapped the sound of Johns Hopkins Sibley Memorial Hosptial. Image credit Yoko Sen.

Her most ambitious project to date is an end of life database, the “My Last Sound” project, conceptualized during a 2015 residency at Open IDEO‘s End of Life Challenge, which draws on Sen’s astute observations that the hospital soundscape is ripe for disruption. “Since our sense of hearing is the last sense to dissipate before death, why should patients hear the beeps of the ICU?” wondered Sen, who created the prototype for a “last sound registry,” which she later introduced and scored using the voices and “sound wishes” of attendees at the 2016 Stanford Medicine X conference. Sen’s project has since brought her from Iceland to Brazil, identifying sounds others would prefer to hear and creating a series of pieces featuring their voices. She is now collaborating with a team at Roundglass to create a “Last Sound Registry,” in which people can share stories, and, ultimately register their last sound wishes.

Making a musical experience

Hospital noise and its effect on the work of doctors is not a new concern. In the ’80s, a group of anesthesiologists determined that noise levels inside operating rooms were unacceptable, and enlisted the help of Roy Patterson, an English psycho-acoustician who had recently experimented with a series of mass transit alarms. Patterson proposed a progression of sounds, blunted so they wouldn’t startle, with brief moments of silence, to shape a clinician’s thoughts and reactions. He introduced a set of specific tones to monitor and evaluate functions, like oxygenation and temperature, with a general alarm available in two moods signaling “caution” and “emergency.” Patterson worked closely with Judy Edworthy, a psychologist considered the godmother of alarm design, to develop “auditory icons” able to replace alarms with musical phrases. 

Their work has inspired many, including Joseph Schlesinger, a jazz musician and assistant professor of anesthesiology and critical care medicine at Vanderbilt. “From a selfish standpoint, this is where I work,” said Schlesinger, explaining his passion for improving sound in hospitals. “It’s incredibly fatiguing coming to work and dealing with the plethora of monitors and alarms. I see that my patients don’t sleep well; they get delirious.” For patients with PTSD, he noticed that noise can intensify mental health issues, creating longer stays and complicating treatment. 

Through his work on multi-sensory environments that utilize vision, touch, and audio, Schlesinger connected with Sen and this fall will be releasing a special issue of the health publication MMD Journal, the Journal of the International Association of Music & Medicine, co-edited by Dr. Priscilla Hirst, for which Sen contributed an article exploring how sound impacts our experience during vulnerable moments. Included will be a musical piece, “My Last Sound – Music and Medicine version,” which features the voices of editors and reviewers of the journal sharing the last sound they wish to hear.

Designing a better alarm 

One of the more high-profile projects in this area comes from audio branding studio Man Made Music, which created a series of alarms using upbeat sounding melodies instead of conventional alarms as part of a commission for the 2017 Cooper Hewitt exhibition The Senses: Design Beyond Vision. The project represented a bold approach to curbing alarm fatigue: concealed within is a system of tones that indicate dramatic drops in patients’ vital signs, like heart rate and blood pressure, swapping alarms for gentle intonations.

One of the pioneers in this field is Sonia Rhodes of The Experience Lab, a group that works across disciplines to improve patient experiences in hospitals. Rhodes spent two decades in the healthcare field before launching The Experience Lab, driven by what she observed in practice, and what she found lacking in patient care. “It still amazes me how much work needs to be done across our industry,” she explained. As CEO of The Experience Lab, Rhodes has led a series of gatherings to inspire and motivate healthcare executives in collaboration with artists, creatives, and thinkers to transform the hospital experience, asking “How do we create a better experience” for all those involved. She explains, however, that real change must come from the top down. “It’s impossible to sustain any improvement for patients if we aren’t focused first on the organization as a whole.” 

Unfortunately, in dire emergencies, traditional alarms will still be needed, and it’s an open secret within the medical community that many of these warning noises are designed to prevent manufacturers from getting sued—devices must be loud enough to cut through ambient hospital noise to make it through FDA approval but, hopefully, a new era of critical innovation is coming.

In the future, a shift to wearables may be able to silently alert nurses to changes in patient vitals, entirely replacing the disrupting beep of monitors. The Josie Robertson Surgery Center, an outpatient facility of Memorial Sloan Kettering Cancer Center in New York, has already begun to provide patients, family, and staff with badges connected to real-time locating systems, facilitating more efficient communication between the staff and families. But this support is far from widespread and, for now, the focus is on achieving incremental change, based on research that is still quite new and often surprising. In a 2015 study it was shown that, following surgery, children who listened to music or a story of their own choosing for thirty minutes dramatically reduced their pain, compared to those who faced recovery in silence. If something as limited as 30 minutes per day of soothing sound can provide such a clear improvement in recovery experience, imagine what a thorough overhaul could do, not just for patients but for caregivers and grateful loved ones as well.

This article was produced in partnership with AIGA Eye on Design.