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Fred Donovan

The University of Chicago Medicine was able to adjust hospital EHR use and educate doctors and nurses on how to reduce in-hospital sleep deprivation, thereby improving sleep for patients staying at the hospital.

The University of Chicago Medicine was able to adjust hospital EHR use and educate doctors and nurses on how to reduce in-hospital sleep deprivation, thereby improving sleep for patients staying at the hospital.

The changes were part of a study designed by UChicago Medicine researchers called Sleep for Inpatients: Empowering Staff to Act (SIESTA), which examined the effects of nighttime sleep interruptions on patients in the hospital environment and how to improve patient sleep.

For the study, SIESTA employed electronic “nudges” using the patients EHR to urge doctors and nurses to avoid sleep disruptions that have minimal value, such as waking patients at night to take vital signs or administering nonurgent medications.

“Efforts to improve patients’ sleep are not new, but they do not often stick because they rely on staff to remember to implement the changes,” said Dr Vineet Arora, a professor of medicine at the University of Chicago and the study’s lead author.

For the study, the researchers interviewed patients about sleep barriers. During the interviews, the researchers found that major barriers to sleep were taking vital signs, administering medications, and drawing blood during sleep hours.

The researchers also found out that doctors did not know how to change the default vital signs order for every four hours or how to batch-order morning blood draws at a time other than 4 am.

Based on the interviews, the researchers developed and integrated electronic nudges into the EHR and taught doctors and nurses about the sleep friendly tools in the system. Taken together, these changes reduced the number of unnecessary sleep interruptions.

The researchers published the results of the study in the January 2019 issue of the Journal of Hospital Medicine.

The one-year study focused on two 18-bed general medicine units at UChicago Medicine. Between March 2015 and March 2016, 1,083 patients were admitted either to the SIESTA-enhanced unit or to a standard hospital unit nearby.

Both units had doctors who were trained in the use of nighttime orders, but only the SIESTA unit had nurses who were trained to advocate for patients with the doctors.  

For the SIESTA unit, decisions by doctors and nurses not to take vital signs every four hours increased from 4 percent to 34 percent and sleep friendly timing of medication administration rose from 15 percent to 42 percent. Nighttime room entry decreased by 44 percent.

For the standard unit, decisions not to take vital signs every four hours increased from 3 percent to 22 percent, sleep friendly timing of medication administration increased from 12 percent to 28 percent.

As a result, patients in the SIESTA unit had six fewer nighttime room entries, four times fewer sleep disruptions for medication administration, and three times fewer sleep disruptions for vital signs.

The researchers concluded that adjustments to the EHR system along with doctor and nursing education significantly reduced the number of nighttime vital sign orders and led to better timing of nighttime administration of medications in both units.

However, the study found that having the nurses as patient champions helped to sustain the benefits of a sleep friendly environment in the SIESTA unit over time.  

Sara Ringer, a patient in the SIESTA unit, said that the changes enabled her to sleep more soundly. “As a frequently hospitalized patient, I am used to being woken up as often as every 1 to 2 hours. It never feels like your body has a chance to rest and heal. My last hospitalization at University of Chicago was one of the easiest I've had because the hospital staff made it possible for me to sleep.”

“This illustrates the importance of engaging both nurses and physicians to create sleep-friendly environments in hospitals,” concluded Arora.

The research was funded by the National Institute on Aging and the National Heart, Lung and Blood Institute.