A recent study has highlighted some of the avoidable disruptions that are keeping patients up at night

BY ABIGAIL CUKIER 

Sleep is critical for recovery from illness, helping reduce pain and anxiety and improving blood pressure and the ability to fight infection, said Dr. John Fleetham. But noisy neighbours, overhead announcements, 2 a.m. vital signs checks and beeping IV machines make the hospital a less than ideal place to get that sleep.

"Your sleep is affected by your illness and you are in an unfamiliar place. There are also certain medications, such as Prednisone, that can keep you up. Some departments, such as the ICU, can have high levels of light and alarms going off from machines. A hospital really is a 24-hour place," said Dr. Fleetham, founder and co-director of the Leon Judah Blackmore Centre for Sleep Disorders at UBC Hospital.

Dr. Fleetham was encouraged though, when hospital sleep was raised as an issue at the 2019 World Sleep conference in Vancouver.

"It is slowly climbing the hierarchy of interest and its importance is being recognized," he said. "There is a move to make hospitals more sleep friendly. There are some things you can't change, but there are certainly things you can do."

Hamilton Health Sciences is making changes across all of its facilities to reduce sleep disruption. Single rooms are the norm in any new builds and, except for emergencies, overhead paging has been eliminated, with physicians and staff being called directly to their pagers or cellphones. Obstetrics staff work with women identified at risk for postpartum mental illness to develop a plan that includes more care for their baby to allow moms to get more sleep. For example, when St. Joseph's Healthcare Hamilton rebuilt its West 5th Campus in 2014, the organization ensured every patient had a single room. During overnight patient safety checks at the mental health services facility, staff take steps to minimize light intrusion and opening, closing or unlocking doors. A 2017 study in the Health Environments Research and Design Journal used actigraphy before and after the facility move to monitor rest and wakefulness cycles during sleep. The study found significant improvements in patients' sleep quality in the new building.

Dr. Barbara Liu, a geriatrician at Sunnybrook Health Sciences Centre, says hospitals can make changes to improve sleep for patients.

"To the extent possible, they can change scheduling for blood tests and delivery of medications. They can supply ear plugs or have patients bring their own. They can help patients stay awake in the day, limit excessive daytime napping and increase activity if possible," she said, adding that some hospitals use white noise machines or monitors that turn green, yellow or red depending on noise levels to warn staff and patients to quiet down.

At University of Chicago Medicine, a survey of patients, doctors and nurses highlighted that patient sleep was a problem and that there were preventable disruptions that could be targeted, including the way the electronic health record defaulted to order vital signs and medications.

The 2019 SIESTA study found that the electronic health record could be modified to "nudge" doctors to order vital signs and medications in a more sleep-friendly way for routinely hospitalized patients who do not need aggressive monitoring. Specifically, there were patients who did not need vital signs checks through the night or could get medication to prevent blood clots before they went to sleep.

The study found nighttime room entries dropped by 44% and patients were more likely to report no disruptions for nighttime vital signs than those in the standard unit.

"Studies from our group and others show that even one hour of less sleep in the hospital is associated with poor health, namely higher morning blood pressure, higher morning blood sugar and increased risk of delirium or poor cognition," said the study's lead author, Dr. Vineet Arora.

"Hospitals should start by asking patients what disrupts them and consider how to systematically identify patients who do not need aggressive monitoring, who can forgo nighttime vital signs."

To learn more about SIESTA study tools, email siesta@uchicago.edu or check online for a hospital sleep strategies pocket card.

This item originally appeared in the Canadian Healthcare Manager newsletter. Registration is free and easy for healthcare managers.