UChicago Medicine cuts inpatient sleep disruptions with EHR tool

University of Chicago Medicine successfully reduced nighttime disruptions for patients by integrating a sleep-friendly tool into its EHR. Researchers described the initiative and its outcomes in a study published in the Journal of Hospital Medicine.

The study examined the outcomes of a UChicago initiative called Sleep for Inpatients: Empowering Staff To Act. As part of the SIESTA initiative, researchers implemented "nudges" in the hospital's EHR that encouraged physicians and nurses to avoid waking patients up for minimally valuable tasks, such as measuring vital signs.

To assess the initiative's outcomes, researchers looked at two 18-bed general medicine units where 1,083 patients were admitted between March 2015 and March 2016. Patients were either admitted to a SIESTA-enhanced unit or a normal hospital unit. Physicians trained to use the EHR nudges rotated between both units, but nurses in the SIESTA unit received additional coaching to advocate for patients' sleep.

Researchers found sleep-friendly EHR orders increased on both units. However, decisions to skip nighttime vital sign checks increased from 4 percent to 34 percent on the SIESTA unit. Sleep-friendly timing of nighttime medication administration also increased from 15 percent to 42 percent during the study period, while total nighttime room entries dropped 44 percent.

"Efforts to improve patients' sleep are not new, but they do not often stick because they rely on staff to remember to implement the changes," lead study author Vineet Arora, MD, professor of medicine at UChicago, said in a press release. "This illustrates the importance of engaging both nurses and physicians to create sleep-friendly environments in hospitals."

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