Hospital SIESTA project reduces inpatient sleep interruptions

January 08, 2019

Selective tinkering with the medical center's electronic health records (EHR) system, plus a 20-minute presentation to doctors and nurses on the consequences of in-hospital sleep deprivation, was able to change the behavior of caregivers in ways that allowed more patients to sleep undisturbed through the night.

Although patients may spend much of their time sitting in a chair or recovering in bed, hospitalization is seldom restful. Nighttime awakenings for various tests can disrupt sleep. This can cause grogginess, delirium and falls. To ameliorate this problem, researchers at the University of Chicago Medicine designed a study known as SIESTA (Sleep for Inpatients: Empowering Staff To Act).

SIESTA uses "nudges" through the patients' EHRs, urging doctors and nurses to avoid disruptions that are only minimally valuable, such as awakening patients overnight to measure their vital signs or to administer non-urgent medications.

"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," said the study's lead author Vineet Arora, MD, professor of medicine at the University of Chicago and an authority on optimizing patient care in teaching hospitals, including disrupted sleep.

In the January 2019 issue of the Journal of Hospital Medicine, Arora and colleagues describe their experiment, designed to measure the effects of SIESTA. They interviewed patients about barriers to sleep, integrated SIESTA's sleep-friendly nudges into the EHR, and taught physicians and nurses how to use the sleep-friendly tools in the computer system. These efforts helped prevent needless disruptions.

The study focused on two 18-bed general medicine units and lasted one year. From March 2015 to March 2016, 1,083 general medicine patients were admitted either to the SIESTA-enhanced unit or to a nearby standard hospital unit. While physicians who were trained in use of the nighttime orders rotated in both units, nurses in the SIESTA-enhanced unit received additional coaching to advocate for patients with physicians in that unit. While sleep-friendly orders increased in both units, the SIESTA-enhanced unit saw the most significant changes.

In the SIESTA unit, decisions to forego nighttime vital signs every four hours increased dramatically, rising from 4 percent to 34 percent. Sleep-friendly timing of nighttime medications such as anticoagulants to prevent blood clots rose from 15 percent to 42 percent. Nighttime room entries decreased by 44 percent.

Patients experienced six fewer room entries during sleeping hours. Patients noted four times fewer disruptions due to medications and three times fewer disruptions due to routine vital signs. The unit also saw an increase in the nationally used quiet-at-night patient experience measure.

The authors conclude that physician and nursing education, coupled with changes to the EHR, led to a significant reduction of orders for overnight vital signs. It also led to more appropriate administration of nighttime medications in both the SIESTA and the standard unit.

They add, however, that the virtues of a sleep-friendly environment "depend on the unit-based nurses championing the cause." The initial emphasis on limiting nighttime room entries, for example, eventually faded, but sustained improvements were seen after nurses added SIESTA to their nursing unit huddles.

"This illustrates the importance of engaging both nurses and physicians to create sleep-friendly environments in hospitals," Arora said.
-end-
This study was funded by the National Institute on Aging and the National Heart, Lung and Blood Institute. Additional authors were Nolan Machado, Samantha Anderson, Nimit Desai, William Marsack, Stephanie Blossomgame, Ambrosio Tuvilleja, Jaqueline Ramos, Mary Ann Francisco, Andres Valencia, Shannon Martin, Cynthia LaFond, David Meltzer, Jeanne Farnan and Babak Mokhlesi from the University of Chicago; Jay Balachandran from Columbia-St Mary's in MeQuon, Wisconsin; Kristen Knutson from Northwestern University; and Edward Leung from Children's Hospital, Los Angeles.

University of Chicago Medical Center

Related Sleep Articles from Brightsurf:

Size and sleep: New research reveals why little things sleep longer
Using data from humans and other mammals, a team of scientists including researchers from the Santa Fe Institute has developed one of the first quantitative models that explains why sleep times across species and during development decrease as brains get bigger.

Wind turbine noise affects dream sleep and perceived sleep restoration
Wind turbine noise (WTN) influences people's perception of the restorative effects of sleep, and also has a small but significant effect on dream sleep, otherwise known as REM (rapid eye movement) sleep, a study at the University of Gothenburg, Sweden, shows.

To sleep deeply: The brainstem neurons that regulate non-REM sleep
University of Tsukuba researchers identified neurons that promote non-REM sleep in the brainstem in mice.

Chronic opioid therapy can disrupt sleep, increase risk of sleep disorders
Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine.

'Short sleep' gene prevents memory deficits associated with sleep deprivation
The UCSF scientists who identified the two known human genes that promote 'natural short sleep' -- nightly sleep that lasts just four to six hours but leaves people feeling well-rested -- have now discovered a third, and it's also the first gene that's ever been shown to prevent the memory deficits that normally accompany sleep deprivation.

Short sleep duration and sleep variability blunt weight loss
High sleep variability and short sleep duration are associated with difficulties in losing weight and body fat.

Nurses have an increased risk of sleep disorders and sleep deprivation
According to preliminary results of a new study, there is a high prevalence of insufficient sleep and symptoms of common sleep disorders among medical center nurses.

Common sleep myths compromise good sleep and health
People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.

Sleep tight! Researchers identify the beneficial role of sleep
Why do animals sleep? Why do humans 'waste' a third of their lives sleeping?

Does extra sleep on the weekends repay your sleep debt? No, researchers say
Insufficient sleep and untreated sleep disorders put people at increased risk for metabolic problems, including obesity and diabetes.

Read More: Sleep News and Sleep Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.