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For Hospitals, Sleep and Patient Satisfaction May Go Hand in Hand

Sleep interruption puts patients at risk, studies find

It’s a common complaint — if you spend a night in the hospital, you probably won’t get much sleep.

There’s the noise. There’s the bright fluorescent hallway light. And there’s the unending barrage of nighttime interruptions: vitals checks, medication administration, blood draws, and the rest.

As hospitals chase better patient ratings and health outcomes, an increasing number are rethinking how they function at night — in some cases reducing nighttime check-ins or trying to better coordinate medicines — so that more patients can sleep relatively uninterrupted, according to an article posted on the Kaiser Health News (KHN) website.

Although few studies specifically link quality of sleep and patient outcomes, doctors interviewed said the connection is obvious: Patients need sleep. If they get more of it, they’re likely to recover faster.

Traditionally, hospitals have scheduled a number of nighttime activities around health professionals’ needs — aligning them with shift changes, or updating patient’s vital signs so the information is available when doctors make early-morning rounds. Both the sickest patients and those in less serious condition might get the same number of check-ins. In some cases, that can mean patients are being disturbed almost every hour, whether medically necessary or not.

Dr. Margaret Pisani, an associate professor at the Yale School of Medicine, is working with other staff at the Yale hospital to reduce unnecessary wake-ups, using strategies such as letting nurses re-time when they give medications to better match patient sleep schedules, changing when floors are washed, and giving nurses checklists of things that can and should be taken care of before 11 p.m.

Not only is the push for better patient sleep part of a larger drive to improve how hospitals take care of their patients, it also is fueled in part by measures in the Patient Protection and Affordable Care Act tying some Medicare payments to patient-approval scores. As more hospitals try to improve those numbers, experts said, more will likely home in on improving chances for a good night’s sleep.

Federal patient-approval surveys specifically ask about nighttime noise levels. A number of hospitals initially struggled to get good scores on that, said Richard Evans, chief experience officer at Massachusetts General Hospital in Boston.

His hospital instituted quiet hours –– a couple of hours in the afternoon and between 6 and 8 hours at night, depending on the hospital unit, during which lights are turned low and staff are encouraged to reduce their noise levels. Staff members are also encouraged to consider whether patients really need particular care at night before waking them.

At New York’s Mount Sinai Hospital, doctors are rethinking when they prescribe medications as well as what kind, said Dr. Rosanne Leipzig, a professor of geriatrics and palliative medicine who practices at the hospital. For instance, some antibiotics can be given at 6-hour intervals rather than 4-hour intervals, reducing the need for nighttime interruptions. And some drugs usually given every 6 hours can instead be given four times a day during the hours patients are usually awake.

The hospital is also working to develop a system to classify patients who need repeated checks from the medical staff, such as those who might face imminent health threats or are at risk for serious infections, such as sepsis. For those patients, frequently checking vitals is important, even if patients sleep less, Leipzig said. But not every patient’s condition requires that they be roused every 4 hours, she added.

About half of all patients woken up for vitals checks probably don’t need to be, according to a 2013 study published in JAMA Internal Medicine. The study suggests that waking those patients may contribute to poor clinical results and patient dissatisfaction, and could increase the odds of patients being readmitted to the hospital.

Another study, published in 2010 in the Journal of Hospital Medicine, looked at efforts to encourage patient sleep — particularly by rescheduling activities, nighttime checks, and overnight medication doses so as not to wake patients. That paper found a 49% drop in the number of patients who were given sedatives. That can have the added benefit of improving patient outcomes, since sedatives are associated with dangerous adverse effects, such as falling or hospital delirium or confusion.

“Sleep disruptions are actually not benign as far as patients are concerned,” said Dr. Dana Edelson, an assistant professor of medicine at the University of Chicago and a co-author of the 2013 study. “We’re putting them at unnecessary risk when we’re waking them up in the middle of the night when they don’t need to be.”

Source: Kaiser Health News; August 17, 2015.

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