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The Sleep in the Intensive Care Unit: Lowering Elements of Noise in the Critical Care Environment (SILENCE) research programme was funded by a feasibility study grant awarded by the NIHR Research for Patient Benefit scheme, and was sponsored by the University of Oxford. For all enquires about the SILENCE project please email: silence@ndcn.ox.ac.uk The project ended in 2018 and results from the study have been published. See details below.

Intensive care © Chaikom/Shutterstock

 

Sound levels in the ICU are well above the recommended levels suggested by the World Health Organisation (WHO). Lowering these levels, even modestly, may help patients to sleep, and may result in fewer episodes of ICU-acquired delirium experienced by patients during their stay. Patients who develop delirium tend to have longer hospital stays and often have long-term health problems after they have been discharged home.

The NIHR funded SILENCE programme was a series of studies designed to lower noise levels, improve sleep hygiene, and ultimately reduce the incidence of ICU-acquired delirium.

The team reviewed transcripts from narrative interviews conducted with patients and their relatives with experience of the ICU. From these transcripts and companion ethnography sessions the SILENCE team identified some key areas of noise generation that could be addressed through targeted intervention. The team also organised an 'experience-based co-design' event. This meeting of medical and nursing staff, patients, and members of the research team resulted in a multi-faceted environmental intervention to reduce noise levels in the ICU.

Some simple environmental changes were implemented, a new training module was designed, and the team worked closely with the Institute of Sound and Vibration Research, University of Southampton to design and install a new noise monitoring system. 

Alongside the noise reduction work, the SILENCE project also set out to evaluate methods of sleep measurement in the ICU. 

For more information please see the project publications list below.

For all enquires about the SILENCE project please email: silence@ndcn.ox.ac.uk

SILENCE in the media

Julie was interviewed for BBC Gardeners' World magazine for their series 'Grow Yourself Healthy'. The May 2019 issue focuses on how being outside and getting some exercise can improve sleep. Julie was also interviewed for a short news slot on BBC Radio Oxford on Friday 24th May. Julie also wrote a piece for the University of Oxford Science Blog.

Lauren Hall, reporter for ITV spent a few hours with Julie, Pete, and Matt Holdaway for a short news feature which was broadcast on local news networks Anglia, Central, Meridian, and West Country on 15th June 2017. This feature was also acknowledged by the healthtalk.org team on their website blog which includes links out to the original patient interviews that were at the heart of this project

Dr Mark Porter from BBC Radio 4 Inside Health came to the John Radcliffe Hospital in September 2016 to interview the team about noise levels and the problem of delirium for patients in the intensive care unit.

In the broadcast on 18th October Fiona and Catherine talk about their experiences of ICU, and Mark Borthwick (Intensive Care Pharmacist) and Julie Darbyshire (lead researcher for the SILENCE project) talk about how common the problem is, and the importance of recognising it early, and what can be done to help patients understand what is happening.

The episode about noise levels was broadcast on 4th October. It is available from the BBC iPlayer and the interviews are at the end of the programme, beginning at 20:35 with a clip of our simulated noise recording that we use for training here in Oxford. There is also a transcript of the interview available on the website.

Lisa Hinton, our senior qualitative researcher from the Health Experiences Research Group and Julie were interviewed in early June 2016 by Claudia Hammond for BBC World Service 'Health Check'

Lisa & Julie were also interviewed for the Daily Mail. The piece 'Why are hospital wards so infernally noisy?' appeared in print on 14th June 2016.

To coincide with the publication of the related publication in PLoSOne, the University of Oxford Science Blog featured early work from the SILENCE project that explores what patients think is happening to them when in the intensive care unit

We enjoyed some media attention at the beginning of April 2016. Julie and Pete Edmonds (patient representative for the project) were interviewed by Nicky Campbell and Rachel Burden on BBC5Live breakfast show on 1st April and Julie appeared later that morning on the Victoria Derbyshire show on BBC2. Victoria Derbyshire later tweeted a short clip from the interview.

As well as coverage in the local press, a number of national newspapers picked up the story and we featured in the Telegraph, the Daily Mail, and the Sun.

We have also appeared in the Nursing Standard.

Julie wrote a blog piece for the Hippocratic Post at the end of April

The SILENCE project featured in the University of Oxford Science Blog at the end of March 2016

Academic PUBLICATIONS from the silence project

conference PRESENTATIONS from the silence project

European Society of Intensive Care Medicine 33rd Annual Congress, Digital/Online, (Oral), Measuring sleep: Be quiet!, Julie L Darbyshire, December 2020

39th International Symposium on Intensive Care and Emergency Medicine, (Poster), Understanding sound pressure levels in the Intensive Care Unit, Julie L Darbyshire, J Duncan Young, Jonathan Bedford, Oliver Redfern, Robert A Hatch, Brussels, March 2019; conference abstracts published here

27th Update in Critical Care for Physiotherapists, (Oral), Noise pollution in the Intensive Care Unit, Julie L Darbyshire, London, November 2018

33rd Annual British Association of Critical Care Nurses Conference, (Oral), "You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face": Experiential teaching in the ICU, Julie L Darbyshire, Paul R Greig, Peter Edmonds, Carolyn Barrett, Lisa Hinton, J Duncan Young, Bournemouth, September 2018

What's new in ICU Edinburgh Critical Care Research Group study day, Edinburgh (Oral), Reducing noise in the Intensive Care Unit: Why and how?, Julie L Darbyshire, May 2018

Make: Oxford IT Services (Presentation with Q&A), SILENCE is golden: mapping noise levels in intensive care, Julie L Darbyshire, May 2018

Royal College of Nursing Education Forum National Conference and Exhibition, Newcastle (Poster), "By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest": Developing a training package to reduce noise levels in the Intensive Care Unit, Julie L Darbyshire, Paul R Greig, Peter Edmonds, Carolyn Barrett, Lisa Hinton, J Duncan Young, Mar 2018

Wessex Clinical Research Network Anaesthesia & Critical Care Research Meeting, (Oral), SILENCE - sleep in the Intensive Care Unit, Julie L Darbyshire, Jan 2018

Intensive Care Society State of the Art 2017, 2017 (Panel session) Lights, sound, action! Noise in the ICU and the SILENCE trial, Julie L Darbyshire, December 2017

European Society of Intensive Care Medicine 30th Annual Congress, Vienna, (Poster), SILENCE - Patient sleep in the intensive care unit remains elusive, Julie L Darbyshire, J. Duncan Young, September2017

173rd Acoustical Society of America, Boston, Massachusetts, June 2017 (Oral), Machine listening in combination with microphone arrays for noise source localization and identification, Markus Müller-Trapet; Jordan Cheer; Filippo M. Fazi; Julie Darbyshire; J. Duncan Young, The Journal of the Acoustical Society of America 141, 3964 (2017); doi: http://dx.doi.org/10.1121/1.4989025

Wessex Clinical Research Network Anaesthesia & Critical Care Research Meeting, (Oral), SILENCE - sleep in the Intensive Care Unit, Julie L Darbyshire, May 2017

Intensive Care Society State of the Art, (Poster) Deep experience is never peaceful: Raising awareness of noise sources in the ICU, Darbyshire JL, Barrett C, Edmonds P, Young JD, Hinton L, London, December 2016

Thames Valley Clinical Research Network Urgent Care Research Symposium, (Oral) Sleep deprivation in the Intensive Care Unit Darbyshire JL, Young JD, Oxford, November 2016

Thames Valley Clinical Research Network Urgent Care Research Symposium, (Poster) An Audit to Review Rehabilitation Practices within Intensive Care Hird C, Wright C, Beck L, Greig PR, Darbyshire JL, Oxford, November 2016

Thames Valley Clinical Research Network Urgent Care Research Symposium, (Poster) Acoustic Source Localisation with Microphone Arrays for Remote Noise Monitoring in an Intensive Care Unit, Markus Mueller-Trapet, Jordan Cheer, Filippo Maria Fazi, Julie L Darbyshire, J Duncan Young, Oxford, November 2016

DIPEx International Meeting, (Oral), Experiential learning in the ICU: Using the AEBCD approach in practice, Hinton L, Darbyshire JL, Tenerife, 13th November 2016

Markus Mueller-Trapet presented at the MENSUS industry Showcase, Southampton, 11th October 2016

31st Annual British Association of Critical Care Nurses Conference, (Oral), Experiential learning in the ICU: Using the AEBCD approach in practice, Darbyshire JL, Edmonds P, Khan N, Hinton L, Glasgow, September 2016

Intensive Care Society State of the Art, (Poster) Noises in the Intensive Care Unit: What goes bump in the night?, Darbyshire JL, Jeffs EL, Vollam S, Hinton L, Young JD, Journal of the Intensive Care Society November 2015 16: 104-128, doi:10.1177/1751143715615287 

Thames Valley Clinical Research Network Critical Care Research Symposium, (Poster) Measuring sleep in the intensive care unit: A systematic review of the literature, Emma L Jeffs, J Duncan Young, Julie L Darbyshire, Oxford, November 2015

Thames Valley Clinical Research Network Critical Care Research Symposium, (Oral) Noises in the Intensive Care Unit: What goes bump in the night?, Darbyshire JL, Jeffs EL, Vollam S, Hinton L, Young JD, Oxford, November 2015

Kings Fund: Transforming patient experience, (Oral) Patients and staff join researchers to design environmental changes in the Intensive Care Unit, Julie L Darbyshire, J Duncan Young, Carolyn Barrett, Peter Edmonds, Lisa Hinton, London, November 2015

33rd Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Congress (Oral), Sleep in the ICU: Recovering patients continue to experience sleep deprivation, Senaratne, DNS, Young, JD, Darbyshire, JL, Acta Anaesthesiologica Scandinavica 59:41-41 · June 2015

SILENCE project TImeline

January 2020: Julie Darbyshire, lead researcher for the SILENCE project, successfully defended her DPhil thesis (Sleep in the intensive care unit: limiting elements of noise in the critical care environment) which was based on data collected for the SILENCE project. 

December 2019: Julie Darbyshire took part in a panel discussion at the Intensive Care Society 'State of the Art' (SOA19) national conference in Birmingham.

May 2019: Julie Darbyshire spoke to Jonathan Downham for his critical care focus podcast series about the problems patients can have with sleep in the intensive care unit and what we can do about it. Podcast 106 "Enough with the noise already!" is available online.

March 2019: Julie Darbyshire presented at the 39th International Symposium on Intensive Care and Emergency Medicine

December 2018: Sleep measures and assessment measures results published in Journal of the Intensive Care Society 

November 2018: Julie Darbyshire presented at 27th Update in Critical Care for Physiotherapists, highlighting the problems of noise in the ICU for both patients and staff

October 2018: Sleep assessment results submitted for publication....

June 2018: The final project report has been submitted to the NIHR Research for Patient Benefit secretariat.

May 2018: Julie Darbyshire presented at the Edinburgh Critical Care Research Group What's New in ICU study day to highlight the importance of managing noise levels in the ICU.

April 2018: A final prototype system has been delivered. Full reporting of the whole project will follow this year.

March 2018: Several iterations of the live noise level display screen have been tested with ICU staff. We are now building a final version incorporating their views and comments.

February 2018: Prototype live noise level display screen active in the intensive care unit. The next steps will be to ask staff what they think about the design, and to use their suggestions to improve usability and functionality. For some background information to the design process, read our case study reported in Oxford Computer Consultants' latest newsletter.

January 2018: After data checking, the total number of patients recruited to the SILENCE study is 583. Of these, 487 completed at least part of the sleep questionnaire and have been entered into the analysis set.  

December 2017: Julie Darbyshire (CI) joined Hugh Montgomery and Danny Bryden in the Intensive Care Society State of the Art 'Lights, sound, action!' panel session on Tuesday 5th December to talk about the importance of the ICU environment, both for patient recovery and staff wellbeing.

November 2017: With the patient-focussed sleep assessment phase of SILENCE now complete we are moving on to the final phase to design a visual soundscape of the intensive care unit. This will provide live feedback to help staff monitor and manage noise levels proactively.

October 2017: The (non-verified) final recruitment figure for the SILENCE study is 566. Many thanks to all our sites who recruited for us. Outline results should be available in the new year, with full results to follow.

September 2017: Recruitment closed to the SILENCE study on 30th September. Non-verified final recruitment is 560 patients - numbers may change as we process the data. Interim results from the sub-set of patients recruited from the Oxford sites were presented at the European Society of Intensive Care Medicine (ESICM) conference LIVES2017 in Vienna at the end of the month. 

August 2017: As we enter the final month of recruitment, we have 420 patients recruited to the multi-site sub-study and a total of 469 including those recruited to the electronic monitoring study in Oxford. All sites are now live and actively recruiting patients and we're hoping for a record month of recruitment in September.

July 2017: Recruitment is going well with just over 400 patients recruited (>350 in the multi-site sub-study). The final sites to join us are in the Midlands and will recruit for the last two months before study close at the end of September.

June 2017: Over 250 patients have now been recruited to the SILENCE study (more than 200 in the questionnaire only sub-study). New sites across the Wessex region have opened this month, and we're hoping to be fully operational across all sites by the end of July. 

May 2017: 150 patients have now been recruited to the questionnaire only sub-study. We are also opening recruitment to some more new sites next month. 

April 2017: >100 patients have now been recruited to the questionnaire only sub-study, bringing the total number of patients recruited overall to 152. The study is still open to interested sites who can guarantee a fast set-up and commit to 2-3 patients each week until recruitment close on 30th September.

March 2017: Yeovil District Hospital and the Royal Berkshire in Reading opened to recruitment. Also: >100 patients have now been recruited to the SILENCE study overall (including those recruited to the electronic sleep monitoring phase in Oxford).

February 2017: Sherwood Forest Hospitals NHS Foundation Trust, Kettering General Hospital NHS Foundation Trust, and Portsmouth Hospitals NHS Trust are now open to recruit patients to the SILENCE study.

January 2017: First non-Oxford site open! Patients admitted to intensive care units in Buckinghamshire Healthcare NHS Trust (High Wycombe and Stoke Mandeville) are now eligible for the SILENCE study.

October 2016: Bespoke environmental noise monitoring equipment designed and built by Institute of Sound and Vibration Research at the University of Southampton installed in the ICU.

September 2016: HRA approval received & sleep assessment study documentation submitted to local sites for review

July 2016: Ethics amendment submitted to extend sleep assessment study to multi-site project as a questionnaire only sub-study.

June 2016: Interim results from first phase of noise reduction strategy indicate lower sound levels in the ICU

April 2016: Online e-learning module made available to staff working on the adult intensive care unit. This includes information about common sources of noise, and their effect on patients, as well as an overview of noise levels in the intensive care unit.

February 2016: New alarm management guidelines released to help staff manage noise levels and patient safety on the unit.

January 2016: Experiential teaching sessions start to be delivered to staff in adult intensive care unit. These give staff the opportunity to understand what it can be like to be a patient in the unit.

December 2015: Plastic lidded bins delivered to the adult intensive care unit - just in time for Christmas!

October 2015: New research collaboration with the Institute of Sound and Vibration Research at the University of Southampton to help design and implement array microphones and multi-site sound data collection within the ICU.

July 2015: Joint patient/staff/research meeting to plan noise reduction strategies for the adult intensive care unit at the Oxford University Hospitals NHS Foundation Trust.

February 2015: Grant funded project work begins!

August 2014: First patient recruited to intensive care sleep assessment study.

June 2014: Ethics approval (14/SC/0164) secured to monitor sleep in the intensive care patient population.

March 2014: University of Oxford Medical Research Fund awarded for early phase project work.

March 2014: Funding award (PB-PG-0613-31034) confirmed.

September 2013: Funding application submitted.

SILENCE