Reducing Nighttime Interruptions and Improving Sleep for Hospitalized Patients by Restructuring Nighttime Clinical Workflow

Background Nighttime sleep disruptions negatively impact the experience of hospitalized patients. Objective To determine the impact of adopting a sleep-promoting nighttime clinical workflow for hospitalized patients on nocturnal disruptions and sleep. Design Survey-based pre- and post-intervention c...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2023-07, Vol.38 (9), p.2091-2097
Main Authors: Holleck, Minna E., Tikkanen, Kei, Holleck, Jürgen L., Frank, Cynthia, Falco, Nicholas, Cosentino, Danielle, Chang, John J.
Format: Article
Language:English
Subjects:
Blood pressure
Cross-Sectional Studies
Disruption
Heparin
Hospitalization
Hospitals
Humans
Internal Medicine
Intervention
Medicine
Medicine & Public Health
Night
Nighttime
Original Research
Patients
Prophylaxis
Sleep
Sleep - physiology
Statistical analysis
Surveys
Telemetry
Tertiary Care Centers
Thromboembolism
Workflow
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Summary:Background Nighttime sleep disruptions negatively impact the experience of hospitalized patients. Objective To determine the impact of adopting a sleep-promoting nighttime clinical workflow for hospitalized patients on nocturnal disruptions and sleep. Design Survey-based pre- and post-intervention cross-sectional study using convenience samples. Participants Hospitalized veterans on a 23-bed general medical ward at a tertiary Veterans Administration Hospital. Interventions Baseline sleep surveys ( N =149) identified two major sources of interruptions: blood pressure checks at 4 am for telemetry patients and subcutaneous (SQ) heparin injections between 4:30 and 6 am for venous thromboembolism prophylaxis. Clinical workflow was restructured to eliminate these disruptions: moving 4 am blood pressure checks to 6 am and providing daily SQ enoxaparin at 9 am as an alternative to Q 8-h SQ heparin, which had prompted an injection between 4:30 and 6 am. The impact of these changes was assessed in a second round of surveys ( N =99). Main Measures Frequency and sources for nighttime sleep disruptions; percentage of patients reporting longer time to fall asleep, more interruptions, and worse sleep quality (vs. home) before and after restructuring nighttime clinical workflow. Key Results After restructuring nighttime clinical workflow, medication administration as a source of nighttime disruption decreased from 40% (59/149) to 4% (4/99) ( p
ISSN:0884-8734
1525-1497
1525-1497
DOI:10.1007/s11606-022-08005-2