通过重构夜间临床工作流程来减少住院患者夜间的中断并改善其睡眠。
Reducing Nighttime Interruptions and Improving Sleep for Hospitalized Patients by Restructuring Nighttime Clinical Workflow.
机构信息
Georgetown University, Washington, DC, USA.
Yale School of Public Health, New Haven, USA.
出版信息
J Gen Intern Med. 2023 Jul;38(9):2091-2097. doi: 10.1007/s11606-022-08005-2. Epub 2023 Jan 25.
BACKGROUND
Nighttime sleep disruptions negatively impact the experience of hospitalized patients.
OBJECTIVE
To determine the impact of adopting a sleep-promoting nighttime clinical workflow for hospitalized patients on nocturnal disruptions and sleep.
DESIGN
Survey-based pre- and post-intervention cross-sectional study using convenience samples.
PARTICIPANTS
Hospitalized veterans on a 23-bed general medical ward at a tertiary Veterans Administration Hospital.
INTERVENTIONS
Baseline sleep surveys (N=149) identified two major sources of interruptions: blood pressure checks at 4 am for telemetry patients and subcutaneous (SQ) heparin injections between 4:30 and 6 am for venous thromboembolism prophylaxis. Clinical workflow was restructured to eliminate these disruptions: moving 4 am blood pressure checks to 6 am and providing daily SQ enoxaparin at 9 am as an alternative to Q 8-h SQ heparin, which had prompted an injection between 4:30 and 6 am. The impact of these changes was assessed in a second round of surveys (N=99).
MAIN MEASURES
Frequency and sources for nighttime sleep disruptions; percentage of patients reporting longer time to fall asleep, more interruptions, and worse sleep quality (vs. home) before and after restructuring nighttime clinical workflow.
KEY RESULTS
After restructuring nighttime clinical workflow, medication administration as a source of nighttime disruption decreased from 40% (59/149) to 4% (4/99) (p<0.001). Blood pressure checks as a source of disruption decreased from 56% (84/149) to 42% (42/99) (p=0.033). Fewer patients reported taking longer to fall asleep in the hospital vs. home (39% pre-intervention vs. 25% post-intervention, p=0.021). Similarly, fewer patients experienced waking up more frequently in the hospital vs. home (46% pre-intervention vs. 32% post-intervention, p=0.036). Fewer patients reported sleeping worse in the hospital (44% pre-intervention vs. 39% post-intervention), though this trend was not statistically significant (p=0.54).
CONCLUSIONS
Nighttime disruptions in hospitalized patients frequently interfere with sleep. Restructuring of the clinical workflow significantly reduced disruptions and improved sleep.
背景
夜间睡眠中断会对住院患者的体验产生负面影响。
目的
确定为住院患者采用促进睡眠的夜间临床工作流程对夜间中断和睡眠的影响。
设计
使用便利样本进行基于调查的干预前后横断面研究。
参与者
退伍军人事务部退伍军人事务部的一家三级退伍军人事务医院的 23 张普通医疗病房住院患者。
干预措施
基线睡眠调查（N=149）确定了两个主要的中断源：遥测患者的凌晨 4 点血压检查和静脉血栓栓塞预防的凌晨 4:30 至 6 点之间的皮下（SQ）肝素注射。临床工作流程进行了重组，以消除这些干扰：将凌晨 4 点的血压检查推迟到早上 6 点，并提供每天早上 9 点的 SQ 依诺肝素，作为 Q 8-h SQ 肝素的替代方案，后者在凌晨 4:30 至 6 点之间引发了注射。第二轮调查（N=99）评估了这些变化的影响。
主要措施
夜间睡眠中断的频率和来源；报告入睡时间更长、中断更多和睡眠质量更差（与在家相比）的患者百分比，在重组夜间临床工作流程前后。
主要结果
重组夜间临床工作流程后，作为夜间中断源的药物管理从 40%（59/149）降至 4%（4/99）（p<0.001）。作为中断源的血压检查从 56%（84/149）降至 42%（42/99）（p=0.033）。与在家相比，报告在医院入睡时间更长的患者人数减少（39% 干预前 vs. 25% 干预后，p=0.021）。同样，与在家相比，在医院更频繁醒来的患者人数减少（46% 干预前 vs. 32% 干预后，p=0.036）。与在家相比，更多的患者报告在医院睡眠质量更差（44% 干预前 vs. 39% 干预后），但这一趋势没有统计学意义（p=0.54）。
结论
住院患者夜间的中断经常干扰睡眠。临床工作流程的重组显著减少了中断并改善了睡眠。
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