title: Emergency department noise: mental activation or mental stress?
abstract: BACKGROUND
  Healthcare professionals working in emergency medicine are often exposed to noisy environments. We determined if there is any difference in cognitive task performance required for clinical decision-making of healthcare professionals in a quiet compared with noisy environment and to assess the subjective experience of participants with regard to performance in a noisy environment.
  
  
  METHODS
  This was a prospective cross-over study conducted at three academic hospitals in Johannesburg, South Africa. 41 doctors involved in the emergency management of patients were administered six matched and prevalidated medical questions over a 30-min period. Each doctor completed half of the questions with exposure to ambient noise (range 40-52 dB(A)) and the other half with exposure to pre-recorded background emergency department noise at 80-85 dB(A). The questions were completed in alternating quiet and noise: half of the physicians answered the odd questions in noise and half answered even numbered questions in noise. Each question was scored out of 10 and the time taken to complete each question was recorded.
  
  
  RESULTS
  Overall median test scores in quiet and noise were 18.5/30 and 20/30 (p=0.2), respectively; time for test completion was longer in quiet (836 s in quiet and 819 s in noise (p=0.006)). While there was no statistically significant difference in task performance, 65% of the doctors found the noise distracting with 88% experiencing varying degrees of stress.
  
  
  CONCLUSIONS
  Performance of mental tasks is maintained during noise exposure but noise exposure is associated with significant degrees of self-reported distress.
authors.affiliation: Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Gauteng, South Africa.
authors.forename: Lindy-Lee
authors.identifier: http://orcid.org/0000-0001-8283-2318
authors.initials: LL
authors.lastname: Folscher
authors.affiliation: Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Gauteng, South Africa.
authors.forename: Lara Nicole
authors.initials: LN
authors.lastname: Goldstein
authors.affiliation: Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Gauteng, South Africa.
authors.forename: Mike
authors.initials: M
authors.lastname: Wells
authors.affiliation: Occupational Medicine, National Institute for Occupational Health, National Health Laboratory Service and School of Public Health University of the Witwatersrand, Constitution Hill, Gauteng, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Rees
mesh_terms: D001288:Attention / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D018592:Cross-Over Studies; D004636:Emergency Service, Hospital; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D009622:Noise / Q000009:adverse effects*; D011446:Prospective Studies; D013019:South Africa; D013315:Stress, Psychological / Q000209:etiology*; D013647:Task Performance and Analysis
keywords: emergency department; emergency department management