How patients can get better rest in the hospital
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Illustration: Maura Losch/Axios
Patients could get a better night's rest if hospitals changed how often staff check in on patients and deployed sleep tools, an investigation published Wednesday in JAMA Network Open found.
Why it matters: Lack of sleep is a ubiquitous problem among hospitalized patients and can impact their outcomes and satisfaction with care.
- While there's increasing recognition about the importance of sleep by hospitals, fewer than half of US News and World Report Honor Roll hospitals had formal practices to support sleep among their patients in 2022.
- "A major divide remains between the acknowledgment of sleep as an important element of recovery and the alignment of hospital practices in support of optimal sleep," an editorial comment that accompanied the new study points out.
How they did it: Researchers from the Healthcare Innovation Lab at BJC HealthCare sought to test ways to improve sleep in two inpatient wards of the Barnes-Jewish Hospital in St. Louis between May 2021 and December 2022.
- They first spoke to staff and patients to learn what disrupts people's sleep while they are in the hospital. "Nurses described pressures related to safety culture and role expectations (e.g. sleep interruptions in service of task completion and thorough handoff communications to the next shift) as barriers to rest," the authors wrote.
- Researchers began testing interventions, starting with distributing educational documents about the value of sleep to providers by email and placing them at nursing workstations, as well as offering informal education during pre-shift nurse huddles.
- In a second intervention, they focused on reducing unnecessary nighttime interruptions by planning clusters of care for patients. They also distributed red-wavelength flashlights to night-shift nurses with instructions to use them instead of overhead lights in patient rooms.
- In a third intervention, they encouraged staff to minimize unnecessary nighttime interruptions at their discretion for patients deemed stable while a fourth intervention tested personalized solutions, including sleep kits with eye masks and white noise machines for patients.
- They used electronic medical records to measure the amount of time between overnight clinical interruptions as well as patient satisfaction surveys to measure perceptions of nighttime noise.
What they found: Patients and staff said wards were "always" quiet at night 51% of the time pre-intervention versus 86% post-intervention.
- Patients' "sleep opportunity" increased from less than four hours of uninterrupted sleep on average to more than five hours of uninterrupted sleep after the interventions.
Yes, but: Overnight clinical interruptions did not substantially change during the project, although nurses took overnight blood pressure measurements less frequently during the study.
- "This raises the question of whether policies, clinical guidelines, or a lack of flexibility with physician orders limits the efficacy of sleep interventions," per the editorial comment.
The big picture: The study supports previous conclusions "that even modest changes to clinical environments and routines may improve the inpatient rest experience while highlighting this area as an opportunity for potential further improvements," the authors wrote.
- It also demonstrates nursing-led interventions "as potential avenues to decrease rest disruption in the hospital."
