TOPLINE

Noise levels in an emergency department (ED) consistently exceeded the safety thresholds given by the World Health Organization (WHO), Occupational Safety and Health Administration (OSHA), and National Institute for Occupational Safety and Health (NIOSH) during daytime hours, potentially contributing to miscommunication events and patient safety concerns, a study found. Noise levels and intra-departmental miscommunication events peaked in the afternoons.

METHODOLOGY

• Researchers analyzed ambient noise in the ED of a tertiary hospital in the US between May and September 2025.
• They measured three sound metrics using the NIOSH Sound Level Meter app: equivalent continuous sound level (LAeq; A-weighted), maximum fast time-weighted sound level (LAFmax; A-weighted), and peak sound level (LCpeak; C-weighted).
• A total of 47 noise measurements were collected during the mornings (6 AM-12 PM) and afternoons (12 PM-6 PM) across multiple ED areas, including triage, fast track, the main ED, the emergency resuscitation unit, the observation unit, and pediatrics. Noise levels were compared with recognized thresholds established by WHO, OSHA, and NIOSH as well as an ED-specific threshold.
• Researchers reviewed 676 patient safety reports submitted to the hospital's safety reporting system to identify intra-departmental miscommunication events and analyze their subtypes and temporal distribution.

TAKEAWAY

• Mean LAeq noise levels exceeded the WHO daytime guideline value by 29.2 dB(A) overall, with excesses of 29.6 dB(A) during afternoon periods and 25.9 dB(A) during morning periods; levels also exceeded the ED-specific limit by 24.2 dB(A).
• Mean LAFmax was 91.4 dB(A), exceeding both NIOSH- and OSHA-recommended limits by 6.4 dB(A). Mean LAFmax was 91.6 dB(A) during afternoon periods and 88.4 dB(A) during morning periods.
• Mean LCpeak was 114.5 dB, exceeding the NIOSH maximum limit by 14.5 dB.
• Among 130 care coordination safety events, 35 were classified as intra-departmental miscommunication events. Staff awareness failures (34.3%), delays in care (31.4%), and patient handoff failures (28.6%) accounted for most events. The events occurred most frequently during afternoons (42.9%), followed by mornings (25.7%), nights (22.9%), and evenings (8.6%).

IN PRACTICE

"This analysis reveals that ED noise levels consistently exceed recognized safety and health guidelines, while also presenting a potential correlation between increased noise levels and higher rates of miscommunication events," the authors wrote. 

"The convergence of elevated noise levels and incidence of safety events highlights noise as a potential contributor to patient safety risk," they added.

SOURCE

The study was led by Siriesha Patnaik, Icahn School of Medicine, Mount Sinai, New York City. It was published online on July 1, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS

The study was limited by its single-center design, small convenience sample with predominantly afternoon measurements, lack of evening and nighttime noise sampling, potential seasonal bias, sampling during ED renovations, inability to control for confounding factors, inability to account for patient volume and operational factors, reliance on staff-reported safety events that may have been affected by reporting bias, and potential inaccuracy in the timing of safety events.

DISCLOSURES

The study did not receive any specific funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.