Opportunity

For places with so many beds, hospitals are far from restful. Studies show that patients sleep, on average, two fewer hours in the hospital than at home. Clinical care, such as medication administration, vital sign checks, lab draws, and even baths, continues throughout each night, disregarding natural sleep cycles. Nocturnal disruptions prevent patients from actively participating in daytime care, negatively impacting experience and health outcomes and increasing length of stay and readmission rates. Currently, there is no unit-based approach for improving sleep and preventing patient delirium.

Intervention

Catching Zs aims to improve hospital patients’ sleep, starting with neurology inpatients, by targeting the most substantial drivers of poor sleep identified by the project team: 1) clinician-driven interruptions, 2) patient anxiety and discomfort, and 3) the invisibility of poor sleep.

1. Minimizing clinician disruptions with “sleep-friendly” default orders: For each hospital patient, there is an associated set of instructions called orders that direct the treatment of that patient. This intervention changes the default orders to a “sleep-friendly” set designed to minimize interruptions at night.
2. Reducing patient anxiety with a slate of amenities: Patients are given a “sleep menu” with options intended to support their comfort, build a bedtime routine, and ease anxiety. Sample options include guided meditation, pet therapy, chaplain service, soothing music, earplugs, and blankets.
3. Raising the visibility of poor sleep among clinicians with a “sleep data card”: Sleep data, such as duration and number of interruptions and subjective sleep scores, are collected and presented to care teams at rounds the next day.

Impact

The results from pilot studies suggest that Catching Zs interventions can improve both the quantity and quality of sleep. Patients who received the interventions slept 70 percent more than those who didn’t: an average of 7 hours and 20 minutes compared to 4 hours and 20 minutes. In addition, the interventions yielded one-third fewer awakenings, and sleep scores were rated as “good” on average instead of “poor.” Overall, 75 percent of patients participating in the interventions met the expert-recommended six hours of sleep, compared to 25 percent of patients without interventions.

This project is part of our 2021 Innovation Accelerator class. In phase two, the team plans to implement a randomized control trial to rigorously test the interventions in a broader inpatient population. The trial will test refined versions of the original three interventions and two notable additions to help reduce clinician disruptions: a wireless patch for measuring vital signals and a mechanism for needleless blood draws.