Acoustic burden in the emergency department: A latent operational Hazard

Hospital noise significantly impacts patient and clinician experience. Emergency departments (EDs) face unique acoustic challenges due to high patient volume, rapid turnover, equipment generated sound, and complex communication needs. This pilot study quantifies the severity of ambient noise patterns in an ED by comparing measured noise levels to recognized safety thresholds, while evaluating concurrent communication-related safety events to inform future communication interventions.

A descriptive analysis of noise measurements was conducted across a tertiary hospital ED. Three sound metrics were measured, including LAeq, equivalent continuous sound level; LAFmax, maximum fast time-weighted sound level; and LCPeak, maximum C-weighted sound level. Measurements were collected from May-September 2025 (n = 47) during ≥5-min sampling sessions across morning and afternoon time periods. Results were summarized descriptively and compared to WHO, OSHA, and NIOSH guidelines. Additionally, patient safety reports (n = 676) were extracted from the institutional reporting system, PressGaney SafetyNet. The reports were then reviewed for inclusion based on their relevancy to ED communication, then further classified and temporally binned.

Mean noise levels exceeded all referenced safety thresholds. Afternoon periods showed the highest noise levels (LAeq: 69.6 dB(A), LAFmax: 91.6 dB (A)), exceeding WHO guidelines by 29.6 dB(A) and NIOSH guidelines by 6.6 dB(A); while morning periods were relatively quieter (LAeq: 65.9 dB(A), LAFmax: 88.4 dB(A)), exceeding WHO guidelines by 25.9 and NIOSH guidelines by 3.4 dB(A). Among 676 safety events, 35 were identified as intra-department miscommunication events (5.2%). These miscommunication events occurred most frequently during afternoon periods (42.86%), which were previously identified as the louder of the two time periods.

ED noise levels exceed recognized safety guidelines across both time periods. Furthermore, increased occurrence of intra-departmental miscommunication events during peak noise level time periods suggests that elevated noise levels may contribute to patient safety risk. The unique challenges of ED operations create sustained acoustic burden that likely requires multifaceted mitigation strategies, including unified communication pathways beyond communication-focused interventions alone.