EHR-Based Intervention Reduces Inpatient Sleep Interruptions

Nicola M. Parry, DVM

January 10, 2019

Combining clinician education with an electronic health record (EHR)–based intervention can increase uninterrupted sleep for hospital inpatients, according to data from the SIESTA (Sleep for Inpatients: Empowering Staff To Act) study.

The changes were "associated with adoption of sleep-friendly vitals and medication orders, a decrease in nighttime room entries, and improved patient experience," write Vineet M. Arora MD, MAPP, from University of Chicago Medicine, Illinois, and colleagues, in an article published online January 8 in the Journal of Hospital Medicine.

For hospitalized patients, sleep deprivation can hinder recovery and adversely affect health outcomes. However, disrupted sleep is a reality for many hospital inpatients.

With this in mind, Arora and colleagues conducted SIESTA in two 18-bed general medicine units from March 2015 to March 2016.

During the study, 1083 patients were admitted either to the SIESTA-enhanced unit or to a nearby standard hospital unit.

Patients in the SIESTA-enhanced unit received the full sleep intervention, comprising physician education and EHR changes, as well as nursing education and empowerment. Patients in the standard unit received only physician education and EHR changes.

The researchers found that sleep-friendly orders increased in both units as a result of the intervention. However, the SIESTA-enhanced unit experienced the most significant changes.

From 6 months before the study to 6 months after, clinicians' waiving of assessment of overnight vital signs rose from 4% to 34% in the SIESTA unit and from 3% to 22% in the standard unit (P < .001 for both).

Similarly, use of sleep-promoting anticoagulant regimens rose from 15% to 42% in the SIESTA unit and from 12% to 28% in the standard unit (P < .001 for both).

Patients in the SIESTA-enhanced unit experienced a 44% reduction in overnight room entries (-6.3 disruptions/room, P < .001) from baseline and were more likely to report no overnight disruptions for vital signs (70% vs 41%, P = .05) or for medications (84% vs 57%, P = .031) than patients in the standard unit were.

"Our study is consistent with other research highlighting the hypothesis that altering the default settings of EHR systems can influence physician behavior in a sustainable manner," the authors conclude.

"However, our study also finds that, even when sleep-friendly orders are present, creating a sleep-friendly environment likely depends on the unit-based nurses championing the cause."

The study was funded by the National Institute on Aging and the National Heart, Lung, and Blood Institute. The authors have disclosed no relevant financial relationships.

J Hosp Med. Published online January 8, 2019. Full text

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