• Minna E Holleck, Kei Tikkanen, Jürgen L Holleck, Cynthia Frank, Nicholas Falco, Danielle Cosentino, and John J Chang.
• Georgetown University, Washington, DC, USA.
• J Gen Intern Med. 2023 Jul 1; 38 (9): 209120972091-2097.

BackgroundNighttime sleep disruptions negatively impact the experience of hospitalized patients.ObjectiveTo determine the impact of adopting a sleep-promoting nighttime clinical workflow for hospitalized patients on nocturnal disruptions and sleep.DesignSurvey-based pre- and post-intervention cross-sectional study using convenience samples.ParticipantsHospitalized veterans on a 23-bed general medical ward at a tertiary Veterans Administration Hospital.InterventionsBaseline 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 MeasuresFrequency 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 ResultsAfter restructuring nighttime clinical workflow, medication administration as a source of nighttime disruption decreased from 40% (59/149) to 4% (4/99) (p<0.001). Blood pressure checks as a source of disruption decreased from 56% (84/149) to 42% (42/99) (p=0.033). Fewer patients reported taking longer to fall asleep in the hospital vs. home (39% pre-intervention vs. 25% post-intervention, p=0.021). Similarly, fewer patients experienced waking up more frequently in the hospital vs. home (46% pre-intervention vs. 32% post-intervention, p=0.036). Fewer patients reported sleeping worse in the hospital (44% pre-intervention vs. 39% post-intervention), though this trend was not statistically significant (p=0.54).ConclusionsNighttime disruptions in hospitalized patients frequently interfere with sleep. Restructuring of the clinical workflow significantly reduced disruptions and improved sleep.© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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