Reducing Disrupted Sleep At HospitalsC. Dixon
Getting the proper amount of quality sleep is important — every medical professional can agree with that. Sleep is necessary for our survival, and it helps the body in numerous ways. It improves our mental and emotional health, and it greatly improves our physical health; it positively affects our hormones, our immune system, blood pressure, cardiovascular health, and even our appetite.
So why is it that whenever we stay overnight at a hospital, it seems like doctors and nurses are checking on us every couple of hours? If everyone is aware of the power of a good night’s rest, why is the place that’s supposed to help patients heal contributing to fatigue?
A study led by Dr. Vineet Arora, a professor of medicine at University of Chicago, sought to address this problem and reduce the negative impact hospitals have on patient sleep.
During a previous study, published in 2011, Arora found that even brief amounts of lost sleep for hospital patients resulted in both an increase in blood pressure and in increase in blood sugar for at least the duration of their stay. For every hour of sleep lost at the hospital, blood pressure would go up by 6 mmHg the next morning.
In other studies, sleep loss has been associated with delirium, depression, pain perception, hospital-acquired infections, and an increase in hospital readmission rates.
“We’ve known [inpatient sleep deprivation] is a problem since Florence Nightingale in the 1800s, so why hasn’t it been fixed?” Arora said. “It’s a very patient-centered problem that also has health implications.”
So Arora worked to fix the problem.
The study was published in the January 2019 issue of the Journal of Hospital Medicine. Research was conducted at a Chicago hospital in two, 18-room general medicine units. One of the units utilized SIESTA (Sleep for Inpatients: Empowering Staff to Act) practices, and had clinicians who had been briefed on improving patient sleep. Prior to the study, the researchers spoke with patients about what was preventing them from sleep during their stay, so they could better address the core issues. The hospital’s electronic health records (EHRs) were also adjusted, with SIESTA “sleep-friendly nudges” incorporated into the system so that staff wouldn’t perform non-crucial checks during the night.
The other unit was a standard unit with no SIESTA staff training or goals to improve sleep.
Over the course of one year, from March of 2015 to March of 2016, 1,083 patients were admitted to both of these units.
In the SIESTA unit, the frequency of room entries overnight dropped by a whopping 44%. This was due in part to medical staff deciding to refrain from taking vitals every four hours. The percentage of time this decision was made in the unit jumped from 4% to 34%. In addition, the timing of certain medication was adjusted to be more “sleep-friendly” more often, rising from 15% to 42%.
Overall, during sleeping hours, there were six fewer room entries for patients. Disruptions due to meds dropped by four visits, and disruptions due to routine vital checks dropped by three visits.
The study concluded that changes to patients’ electronic health records combined with training for physicians and nurses resulted in significantly more sleep for patients. The sleep-friendly techniques they used were particularly dependent on the nurses who pushed the new initiatives in the nursing unit huddles.
Hopefully, hospitals across the world start implementing more sleep-friendly training like this.