All of these kinds of changes can help, said Planetree’s Dr. Frampton. But they don’t get at the real problem for most patients.
“Low scores on quiet at night [questions on patient surveys] are not because it’s overly noisy … but because patients are woken up repeatedly,” she said. “Their sleep is disturbed so they’re lying awake.”
To address that, hospitals may need to look at less obvious questions. At New York’s Mount Sinai Hospital, doctors are rethinking when they prescribe medicines as well as what kind, said Dr. Rosanne Leipzig, a professor of geriatrics and palliative medicine, and who practices at the hospital. For instance, some antibiotics can be given at 6-hour intervals rather than 4-hour intervals, reducing the need for nighttime interruptions. And some drugs usually given every 6 hours can instead be given four times a day during the hours patients are usually awake.
The hospital is also working to develop a system to classify patients who need repeated checks from the medical staff, such as those who might face imminent health threats or are at risk for serious infections such as sepsis. For those patients, frequently checking vitals is important, even if patients sleep less, Dr. Leipzig said. But not every patient’s condition requires that they be roused every 4 hours, she added.
About half of all patients woken up for vitals checks probably don’t need to be, according to a 2013 study published in JAMA Internal Medicine. The study suggests waking those patients may contribute to bad patient results and dissatisfaction, and could increase the odds of patients having to come back to the hospital.
Another study, published in 2010 in the Journal of Hospital Medicine, looked at efforts to encourage patient sleep – particularly by rescheduling activities, nighttime checks, and overnight medication doses so as not to wake patients. That paper, cowritten by Dr. Bartick, a Harvard professor, found a 49% drop in the number of patients who were given sedatives. That can have the added benefit of improving patient outcomes, since sedatives are associated with dangerous side effects such as falling or hospital delirium or confusion.
“Sleep disruptions are actually not benign as far as patients are concerned,” said Dr. Dana Edelson, an assistant professor of medicine at the University of Chicago and an author on the 2013 study. “We’re putting them at unnecessary risk when we’re waking them up in the middle of the night when they don’t need to be.”
And possibly making the recovery a bit more difficult.
“Patients will tell you, ‘I was so exhausted, I couldn’t wait to get home and go sleep,’ ” said Yale’s Dr. Pisani.
Kaiser Health News (KHN) is a nonprofit national health policy news service.