Between 10 p.m. and 6 a.m., I did not go more than an hour without some kind of interruption.
As I have already suggested, some of these interruptions are necessary. But many are not. And the consequence of too many sleep interruptions is that
patients do not heal as quickly as they would otherwise, thereby not only reducing their quality of life but also driving up medical costs. Indeed, as I have written elsewhere: sleep disturbance is a leading cause of hospital
complications, such as falls and delirium. Poor sleep has also been linked
to reduced immune function,worsening blood pressure control and mood disorders. All of these problems potentially impair the ability of patients to
recover from the acute illnesses that caused them to be hospitalized.
How do we improve hospital sleep?
First, hospitals could make simple organizational changes. During my recent hospital stay, for example, a major contributor to my interrupted sleeping was
the specialization of tasks across different hospital personnel. When the IV machine beeped, it was the nurse who helped out, her training being necessary
to monitor the IV lines and medications. When it came to measuring my vital signs, though, a nurse's aide was sent to accomplish the task. And a
phlebotomist came to draw my blood. Specialization matters. The doling out of these duties to different people -- with different skills and different pay
grades -- makes great economic sense, and in many ways improves hospital quality of care. But such specialization interferes with sleep, because the
different people performing each of these duties enter patient rooms at different times of the night.
There is a better way to coordinate these various clinicians to reduce sleep interruptions. For example, phlebotomists could coordinate their work with
nursing aides. Imagine that instead of coming into patient rooms one hour apart from each other, the two came in together: "We are here to check your blood
pressure and draw some blood," they would say (maybe even in unison!). That little change would eliminate one interruption. A second change could also
improve patient sleep: more flexibility in the timing of vital sign measures. If, for example, a patient's IV machine beeps at 11 p.m. and the next check
of her vital signs is due at midnight, the nurse could bump up the vital sign measures by an hour, since the patient is already awake.
Indeed, it was an 11 p.m. vital signs wake-up call that led to research that proves the value of my second approach to improving patient sleep: increasing
the use of sleep protocols designed to minimize unnecessary interruptions. More on
sleep protocols in a bit, but first let me tell you about that 11 p.m. wake-up call.
Melissa Bartick is a hospitalist in the Harvard medical system, a physician who focuses mainly on inpatient rather than outpatient care, treating patients
who have been hospitalized with acute or chronic illnesses. Spending as much time in hospitals as she does, Bartick has long recognized the problems
created when patients have difficulty sleeping. But it took her own hospitalization to convince her how fixable this problem is.