A STUDY in a recent issue of the Journal of Hospital Medicine asked hospital medicine section chiefs how their institutions try to improve patient sleep. The results weren’t encouraging.
Researchers selected “Honor Roll Hospitals” from the U.S. News & World Report rankings, thinking those hospitals would likely be high achievers in health care. But their data found that not only did many of these institutions not have standardized sleep-friendly practices, but that these practices generally receive less attention than concerns such as hand hygiene.
Out of a total of 23 respondents, (15 section chiefs from adult hospitalist programs and eight section chiefs from pediatric hospitalist programs), 96% rated sleep as important, but only 43% said they were satisfied with their institution’s efforts to improve sleep. That’s probably because just over half (52%) of respondents said that their hospitals had no sleep-friendly protocols in place at all.
Among the 11 institutions that have a sleep-friendly protocol, 10 reduced overnight vitals monitoring, 10 decreased ambient ward lights, eight adjusted lab and med schedules, and seven had some form of quiet hours. The study found no major differences in sleep strategies between adult and pediatric hospitals.
During interviews of the section chiefs, researchers identified some themes. Respondents said that buy-in from hospital staff would be key to strategies like reducing room entries through batched care or enforcing quiet hours among peers.
One theme was that barriers to success in improving patient sleep were related to inflexible workflow, time conflict and noisy alarms. Noisy IV pumps and lab draws at 5 a.m. were two examples of workflow issues that interrupt patients’ sleep.
A growing body of evidence details the problems inpatients have due to sleep deprivation. Read Tips to reduce hospital sleep interruptions.
One respondent suggested forcing clinicians to click a button in the EHR to sign off on interrupting a patient’s sleep for a blood draw or vital signs check. That would force clinicians to really consider the impact workflow has on a patient’s sleep.
Another barrier is the practice of some clinicians to provide the same level of care to low-risk and high-risk patients. That can lead clinicians to default to more, not less, interventions, which harms patient sleep.
Another respondent thought that the emphasis on HCAHPS scores may ultimately help hospitals focus more on sleep, since the patient’s entire experience is being rated using these scores.