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. 2023 Jul 10;8(4):e666.
doi: 10.1097/pq9.0000000000000666. eCollection 2023 Jul-Aug.

Quasi-experimental, Nonrandomized Initiative to Minimize Sleep Disruptions among Hospitalized Children

Brianna Glover  1 , Leonid Bederman  2 , Evan Orenstein  1   3   4 , Swaminathan Kandaswamy  1 , Anthony Cooley  1   3 , Christy Bryant  4 , Sarah Thompson  4 , Sindhu Thomas  5 , Sarah Graham  5 , Selena Yamasaki  5 , Michelle Thornton  5 , Linda Perry  6 , Nicole Hames  1   3
Affiliations

Quasi-experimental, Nonrandomized Initiative to Minimize Sleep Disruptions among Hospitalized Children

Brianna Glover et al. Pediatr Qual Saf. .

Abstract

Hospitalized children experience frequent sleep disruptions. We aimed to reduce caregiver-reported sleep disruptions of children hospitalized on the pediatric hospital medicine service by 10% over 12 months.

Methods: In family surveys, caregivers cited overnight vital signs (VS) as a primary contributor to sleep disruption. We created a new VS frequency order of "every 4 hours (unless asleep between 2300 and 0500)" as well as a patient list column in the electronic health record indicating patients with this active VS order. The outcome measure was caregiver-reported sleep disruptions. The process measure was adherence to the new VS frequency. The balancing measure was rapid responses called on patients with the new VS frequency.

Results: Physician teams ordered the new VS frequency for 11% (1,633/14,772) of patient nights on the pediatric hospital medicine service. Recorded VS between 2300 and 0500 was 89% (1,447/1,633) of patient nights with the new frequency ordered compared to 91% (11,895/13,139) of patient nights without the new frequency ordered (P = 0.01). By contrast, recorded blood pressure between 2300 and 0500 was only 36% (588/1,633) of patient nights with the new frequency but 87% (11,478/13,139) of patient nights without the new frequency (P < 0.001). Overall, caregivers reported sleep disruptions on 24% (99/419) of reported nights preintervention, which decreased to 8% (195/2,313) postintervention (P < 0.001). Importantly, there were no adverse safety issues related to this initiative.

Conclusion: This study safely implemented a new VS frequency with reduced overnight blood pressure readings and caregiver-reported sleep disruptions.

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Conflict of interest statement

Dr. Evan Orenstein is a co-founder and holds equity in Phrase Health©, a clinical decision support analytics company. He receives no direct revenue and is the principal investigator on an R42 grant with Phrase Health funded by the National Library of Medicine (NLM) and the National Center for Advancing Translational Sciences (NCATS). He receives salary support from NLM and NCATS. The other authors have no financial interest to declare.

Figures

Fig. 1.
Fig. 1.
Key driver diagram.
Fig. 2.
Fig. 2.
Pareto Chart—categorization of sleep disruptions.
Fig. 3.
Fig. 3.
New VS frequency—Epic Systems© (Verona, Wis.).
Fig. 4.
Fig. 4.
Patient list column for new VS frequency—Epic Systems© (Verona, Wis.).
Fig. 5.
Fig. 5.
P-control chart—Average of Caregiver-Reported Sleep Disruptions Per Night.
Fig. 6.
Fig. 6.
Run chart—stratified measured VSs.
See this image and copyright information in PMC

References

    1. Irwin M, McClintick J, Costlow C, et al. . Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J. 1996;10:643–653. - PubMed
    1. Moldofsky H. Sleep and the immune system. Int J Immunopharmacol. 1995;17:649–654. - PubMed
    1. Aldabal L, Bahammam AS. Metabolic, endocrine, and immune consequences of sleep deprivation. Open Respir Med J. 2011;5:31–43. - PMC - PubMed
    1. Meltzer LJ, Davis KF, Mindell JA. Patient and parent sleep in a children’s hospital. Pediatr Nurs. 2012;38:64–71. - PubMed
    1. Erondu AI, Orlov NM, Peirce LB, et al. . Characterizing pediatric inpatient sleep duration and disruptions. Sleep Med. 2019;57:87–91. - PMC - PubMed