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Overnight vital sign assessments based on risk may improve sleep, increase patient satisfaction

NATIONAL HARBOR, Md. — Low-risk patients who did not receive overnight vital sign assessments reported improved satisfaction with the care they received and did not appear to have any increased risk for adverse events compared to low-risk patients receiving standard care, according to findings presented at Hospital Medicine 2019.

“Sleep disruptions for routine care, such as vital sign assessments, are common during hospitalization and are associated with negative health outcomes and patient satisfaction,” Dana P. Edelson, MD, MS, of the University of Chicago Medicine, and colleagues wrote. “While higher risk patients may benefit from increased monitoring at night, the tradeoff is less obvious for lower risk patients.”

To determine if basing overnight vital sign assessment on patient acuity was feasible — and if it would result in improved sleep and increased patient satisfaction — researchers conducted a randomized controlled trial of 149 surgical inpatients (mean age, 48 years; 72% white; 52% women).

Patients were randomized to either intervention or control with the intervention consisting of instructions to the nursing staff to avoid assessing nighttime vital signs on nights the patients were deemed low risk by their nightly eCART score. The score, calculated by an electronic early warning analytic, determined risk for cardiac arrest, ICU transfer or death within the following 8 hours. Standard care for the control group consisted of vital signs every 4 hours regardless of risk.

All patients had a continuous vital sign monitoring device under their mattress as a safety precaution.

Patients were then surveyed about their subjective sleep quality and satisfaction.

Researchers found that low-risk patients in the intervention were more likely to report vital signs not being disruptive the night before (P < 0.001) than were low-risk patients in the control group.

In addition, researchers noted that low-risk patients in the intervention were more likely to report sleeping soundly (P = .1), to have sleep be less disturbed by noise (P = .05) and to have increased satisfaction with nursing care over the preceding day (P = .16) than were low-risk patients in the control group.

“Hospitals may be able to save cost and improve patient experience by redirecting resources away from nighttime vital signs in low-risk patients,” Edelson told Healio Primary Care Today. “Future research should investigate what constitutes low risk as there are likely even more patients who would benefit from being allowed to sleep uninterrupted at night.” – by Melissa J. Webb

Reference:

Edelson DP, et al. Acuity-based nighttime vital sign assessments: a randomized controlled trial. Presented at: Hospital Medicine 2019. March 25-27; National Harbor, Md.

Disclosures: Healio Primary Care Today was unable to confirm relevant financial disclosures prior to publication.