In critical care environments like the Intensive Care Unit (ICU) , patients are surrounded by an abundance of unwanted sounds from the medical alarms and equipment that often lead to heightened stress, confusion and psychological discomfort. This graduation project explores how the acoustic environment of the Adult Intensive Care Unit can be reimagined to support the critically ill patients using a soundscape system. The context of this project is the Leiden University Medical Centre (LUMC) and the stakeholders considered in this project along with the patients are the healthcare providers and loved ones.

Existing literature and field studies reveal that while sound is a vital component for healthcare professionals (HCP) to monitor patient status, it is often a source of disruption and emotional strain for patients and their loved ones. The project identifies a gap in current interventions, which largely focus on reducing noise rather than enhancing the patient’s experience. A soundscape is defined as the acoustic environment as perceived or experienced and/or understood by a person or people, in context (ISO 12913, 2014). The current acoustic environment has been outlined through a context study, along with its impact on key stakeholders. This provided a clear understanding how the current ICU soundscape hinders the emotional well - being of the patients. A multi-method research approach was conducted, including contextual observations at LUMC, interviews with healthcare providers, and a review of ICU patient experiences to identify the affected psychological needs of patients.
From these insights, a detailed patient journey map was created, highlighting critical moments where the auditory environment could support or hinder well-being. Through a thorough understanding of the journey map , four unfulfilled psychological needs were identified - Lack of autonomy , relatedness, security and comfort. Following literature, these unfulfilled psychological human needs can be fulfilled by providing the right sonic ambience at the right moment. A need for connectedness with the outside world through these sonic ambiences was investigated to be fulfilled to meet the identified fundamental needs. Literature explores how need based sonic ambiences should be tested for their functional role i.e. to comfort, to distract during long stretches of time without visitation or spontaneous breathing trails etc. Connectedness to environment became a facet to explore as a design direction which was further explored in the event based journey map of the patient through different times of the day and modes for sonic ambiences which could fulfil the desired functions. These findings underlined the importance of a personalized approach to creating meaningful soundscapes within the ICU. By mapping out key moments of interaction, the framework for the system was outlined detailing when and how each stakeholder would be engaged. Implementation touchpoints were identified as: patients pre-admission, loved ones at the beginning of the ICU stay, and healthcare providers throughout the admission, who would be responsible for tailoring and adjusting the sonic experience. This multi-stakeholder approach became essential for integrating the system into the complex ICU environment.
Several mobile and tablet based prototypes were created to conduct usability tests with fellow students to test the engagement on the app and how easily sounds are selected based on contextual cues like related to specific given environments (like forest, beach ,Café )leading to the most intuitive methods to be implemented in the real world setting.
The resulting design, SoulSound, is a soundscape system integrated into the ICU room to deliver personalized auditory experiences that help patients feel a sense of connectedness to positive environments in an otherwise sterile and unsettling atmosphere. The system includes an interface for input collection by patients, family members, or HCPs and dynamically adjusts sound based on changing needs throughout the day. Four key sonic functions were defined: calming, distracting, activating, and reassuring. These roles help support patients during moments of loneliness, discomfort, or procedural stress, waking up or sleeping times of the day. Usability testing with design students validated the concept’s interaction model and the emotional outcomes of the sound experience , while expert evaluation highlighted practical challenges and ethical considerations. Positive responses from participants indicated that personalized sound could serve as a subtle yet powerful tool to support mental well-being during ICU admission by reducing stress and meaningfully involving loved ones and HCPs in the care journey. However, concerns were raised regarding the appropriateness of certain sounds and aspects of integration into clinical workflows, leading to a set of recommendations for future research. The feedback and insights gathered from these tests resulted in recommendations for future research. Finally an overall reflection on the study concluded the research.

Introduction: The Intensive Care Unit (ICU) is a highly monitored environment where alarm overload poses risks to patient safety and staff well-being. SpO2 alarms contribute significantly and are often clinically irrelevant. This contributes to alarm fatigue, delayed responses, and disrupted workflows while excessive noise adversely affects patient recovery and nurse mental health. The aim was to analyse the auditory alarm landscape in the ICU at Leiden University Medical Center (LUMC) with a focus on SpO2 alarms. Furthermore, SpO2 alarms were annotated for actionability through the integration of contextual data and SpO2 trends were evaluated.
Methods: A retrospective analysis was conducted on ICU patients admitted between December 2023 and October 2024. Alarm, oxygen saturation, and patient data were extracted from monitoring systems and patient data management systems. The alarm dataset was explored using descriptive statistics. Audible SpO2 alarms were annotated for actionability using predefined criteria based on clinical context, signal quality, and response to alarms, including respiratory support therapy escalation and ventilation or oxygen parameter adjustments. SpO2 trends surrounding alarms were analysed to find patterns between actionable and non-actionable events.
Results: Among 635,717 auditory alarms recorded over 2261 patient-days, 32% were SpO2 alarms, with 88.7% classified as non-actionable. The median response time for actionable alarms was 8.17 minutes, with most interventions involving FiO2 increases. Temporal analyses revealed alarm frequency peaks during morning and afternoon shifts. SpO2 trends at the time of actionable alarms correlated with significant desaturation events, while non-actionable alarms reflected minor, transient changes.
Conclusion: This study analysed the auditory alarmscape in the LUMC ICU, revealing that SpO2 alarms, while significant contributors to alarm burden, are mostly non-actionable, increasing the alarm load and its associated challenges unnecessarily. By annotating alarms based on clinical context, it has laid groundwork for developing robust predictive algorithms to suppress non-actionable alarms.