- Hospitals can improve patient sleep quality and hospital experience by leaving patients undisturbed during resting hours and only checking vital signs when clinically necessary, according to research published in the journal Patient Experience.
This proof-of-concept study is an important step forward in improving the overall patient experience. Many patient experience measures, including the HCAHPS surveys and some benchmarks set by the AHA, say that quality of sleep in the hospital is integral to a positive patient experience as well as patient recovery.
The HCAHPS survey specifically asks patients whether the hospital and their patient rooms were quiet enough for a restful sleep overnight.
However, nurses interrupting patients to check vital signs often hinders efforts to create a space amenable to a good night’s sleep. Most hospitals check a patient’s vitals regardless of health status every four to six hours. While checking vital signs is indeed essential to improving patient health, that high frequency may not be necessary for less clinically rigorous cases.
Interrupting a patient’s rest may have adverse effects on the hospital experience that may outweigh the clinical benefits of checking vitals, the researchers posited.
“The frequency at which vital signs are obtained is not based on evidence and usually occurs at intervals regardless of the level of severity of illness,” the research team said. “Previous studies have shown that patient perception of sleep quality is often worsened by sleep interruption from human and environmental disturbances. In fact, the most disruptive intervention on quality of sleep has been found to be the act of obtaining vital signs.”
The researchers tested a “Quiet at Night” intervention on 39 patients during which nurses did not interrupt sleep to check vitals between the hours of 10 p.m. and 5 a.m. unless out of clinical necessity.
Nurses continued hourly rounding but did not wake the patient unless medically needed.
“This is vital because although nurses were not recording vital signs, the practice provided reassurance to the patients that they not clinically abandoned during the night hours,” the research team explained.
The team also had a control group of 41 patients.
All test patients underwent a low-risk medical procedure and only required one night in the hospital.
Upon hospital discharge, all patients completed a patient experience survey about their sleep quality.
The surveys showed that patients in the intervention group – or who did not have their vitals monitored – had better overall sleep compared to their control group counterparts. Seventy-eight percent of the intervention group had at least moderate, if not excellent, sleep in the hospital, compared to 64 percent of control group respondents saying the same.
More patients in the intervention group also rated their hospital sleep quality as equal to or better than their home sleep quality compared to the control group.
Although patients in the intervention group reported higher sleep quality, there was negligible difference in hospital quality scores between the intervention and control groups.
“These findings may not be unexpected as satisfaction with hospital stay is impacted by various factors, such as patient demographic and health status factors, health outcomes, perceptions of the quality of interactions with the care team, and perceived understanding of medical events that occurred during the hospitalization,” the researchers explained.
Additionally, it may have been difficult to determine a significant difference in overall hospital quality due to the fact that no participant stayed in the hospital longer than one day.
Importantly, the researchers found no adverse clinical events amongst the intervention group. Care did not falter because nurses did not take vitals during sleeping hours, the team reported.
“Most importantly, neither the length of stay nor mortality changed significantly after these policies were implemented,” the team stated. “These successes enabled the success of this study.”
Also important to note is nurse willingness to wake an intervention patient when clinically necessary. Nurses woke and tested seven interventions during the night, the team reported.
“For all patients, nurses rounded every two hours at the patient’s bedside, resulting in 18 percent of the intervention group receiving vital monitoring because of nursing concerns,” the researchers said. “Thus this initiative truly leveraged the idea of appropriate vitals for the appropriate patients at the appropriate intervals.”
Ultimately, these results point to a path forward in improving the hospital experience while still preserving clinical quality and patient safety.
When possible, nurses and other clinicians can allow patients the rest they need to recover. However, when necessary, they also have the autonomy to administer tests or other procedures, the researchers concluded.
This emerging standard of care may be applicable to other hospital patients, potentially leading to a new normal in the patient experience sphere.