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EHR-based sleep intervention reduces nighttime disruptions

The Sleep for Inpatients: Empowering Staff to Act, or SIESTA, intervention, which incorporates EHR “nudges” and interprofessional education, reduced unnecessary nighttime room entries and improved inpatient experience, according to research published in the Journal of Hospital Medicine.

“Although sleep is critical to patient recovery in the hospital, hospitalization is not restful, and inpatient sleep deprivation has been linked to poor health outcomes,” Vineet M. Arora, MD, MAPP, professor of medicine at the University of Chicago Medicine, and colleagues wrote.

“However, interventions to improve inpatient sleep are not widely implemented,” they added.

Arora and colleagues created the Sleep for Inpatients: Empowering Staff to Act (SIESTA) intervention to target routine overnight disruptions, then examined how effective it was in terms of improving nocturnal sleep disruptors. The researchers enrolled 1,083 patients from two general medicine units. Based on patient interviews, overnight vitals, medications and phlebotomy were identified as significant barriers to sleep.

Participants were assigned to receive either the SIESTA intervention or standard intervention.

The SIESTA unit used EHR “nudges” to advise physicians and nurses to skip unnecessary nocturnal visits to check vital signs or administer nonurgent medication. The intervention also offered interprofessional education on how to use the tools.

The standard unit used all interventions except for nursing education and empowerment.

The researchers found that both units demonstrated an increase in sleep-friendly orders, but the most significant improvements were observed in the SIESTA unit.

There was a 44% decrease in nighttime room entries, or 6.3 less disruptions per room, in the SIESTA unit. Compared with patients in the standard unit, those in the SIESTA unit had greater odds of reporting no disruptions for nighttime vital signs (70% vs. 41%) and medications (84% vs. 57%).

Decisions to skip nighttime visits to check vital signs every 4 hours significantly increased from 4% to 34% in the SIESTA unit, compared with an increase from 3% to 22% in the standard unit. Additionally, promoting sleep-friendly timing of nighttime medications increased from 15% to 42% in the SIESTA unit, compared with 12% to 28% in the standard unit.

“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,” Arora and colleagues 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. While the initial decrease in nocturnal room entries post-SIESTA eventually faded, sustainable changes were observed only after SIESTA was added to nursing huddles, which illustrates the importance of using multiple methods to nudge staff.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.