Introduction: Intensive care unit (ICU) noise is known to have deleterious effects on sleep, healing, stress levels and recovery times as well as patient and family satisfaction. With this in mind, we engaged in a multidisciplinary effort to reduce noise through a variety of interventions. Methods: The main sources of noise (alarms and conversation) were identified through decibel monitoring paired with focused observation and subjective feedback from patients and families. The Quiet ICU team then adopted a multi-faceted, multidisciplinary approach to tackle three distinct initiatives: establishment of discrete quiet times for day and night shifts, reduction of unnecessary physiologic alarms, and a campaign to reduce overall noise. In preparation for these initiatives, the team met with stakeholders to identify barriers and strategize solutions. Stakeholders included critical care and consulting providers, staff nurses, respiratory therapy, physical and occupational therapy, dietary and environmental services. Focused efforts to engage staff in the culture change were instrumental including a vigorous promotional campaign with large-scale, multi-format signage placed at the unit entrances, throughout hallways and on patient room doors. Additionally, the team worked with the ICU Patient Family Advisory Council to develop a brochure for visitors. Quiet times from 2:00 to 4:00 pm and 10:00 pm to 6:00 am were established. A checklist was created to help staff prepare for quiet time and noise meters were installed to raise real time awareness of noise levels. An intensive review of baseline alarm data was completed and the team partnered with Phillips® to educate nursing staff how to tailor alarms and configure settings to reduce false alarms. ICU teams were encouraged to round at the bedside and plan on-unit elective procedures outside of prescribed quiet times. Finally, the team organized a structure for engagement of staff including education sessions, weekly emails, and recruitment of champions. Results: Following monitor training, the number of alarms per patient per day decreased from 72.3 to 61.8. Decibel monitoring data revealed an average decrement of 6 dB in one ICU and nearly 3 dB in the second ICU. In response to the HCAHPS question "How often was the area around your room quiet at night?" the combined ICU's score increased from the 5th to the 61st percentile. Conclusions: The success of this project hinged on the multidisciplinary, multi-faceted, approach to engage providers and staff in the efforts and change culture. Future efforts will focus on the continued tracking of metrics including rates of delirium, extended work on alarm reduction, and further work on attaining a Quiet ICU 24/7. It is clear that durable change will require ongoing championing and consistent engagement in the culture of quiet.