McDaniel Lauren M, Benjamin Hannah, Carlin Kristy, Desai Arti D, Ralston Shawn L
Seattle Children's Hospital, Seattle, Washington.
University of Washington, Seattle, Washington.
Hosp Pediatr. 2025 May 1;15(5):387-397. doi: 10.1542/hpeds.2024-008105.
The sleep of hospitalized children is frequently interrupted by vital sign (VS) measurements. We aimed to increase the proportion of patient-nights with 1 or fewer overnight VS measurements.
This study included all patients admitted to general medicine services at a university-affiliated free-standing children's hospital. Iterative interventions included rounding checklist and VS order changes within the electronic health record. Our primary outcome measures were a composite of all overnight VS measurements, as well as blood pressure (BP) measurements individually. Balancing measures included rapid responses and intensive care unit (ICU) transfers. We used statistical process control charting to analyze outcomes over time and assessed for inequities based on race, ethnicity, and language of care using a generalized linear mixed-effects model.
Our preintervention period included 4292 patients and 15 721 patient-nights between January 1, 2022, and February 15, 2023, and our postintervention period included 4354 patients and 18 584 patient-nights between February 16, 2023, and March 15, 2024. Patient-nights with 1 or fewer composite VS measurements increased from 11% to 18% but ultimately regressed to baseline. Patient-nights with 1 or fewer BP measurements increased from 36% to 69%. There were no increases in rapid responses or ICU transfer postintervention. Non-Hispanic white patients had higher odds of 1 or fewer overnight VS measurements (odds ratio [OR], 1.21; 95% CI, 1.07-1.37) as did patients with English as their language of care (OR, 1.28; 95% CI, 1.06-1.54).
Iterative interventions resulted in fewer overnight BP measurements but changes in the composite VS measure were not sustained. The disparities noted in overnight VS measurements warrant attention.
住院儿童的睡眠经常被生命体征（VS）测量打断。我们旨在提高夜间VS测量次数为1次或更少的患者夜数的比例。
本研究纳入了一家大学附属独立儿童医院普通内科服务收治的所有患者。迭代干预措施包括电子健康记录中的查房清单和VS医嘱变更。我们的主要结局指标是所有夜间VS测量的综合指标，以及单独的血压（BP）测量指标。平衡指标包括快速反应和重症监护病房（ICU）转诊。我们使用统计过程控制图来分析随时间变化的结局，并使用广义线性混合效应模型评估基于种族、族裔和护理语言的不平等情况。
我们的干预前期包括2022年1月1日至2023年2月15日期间的4292名患者和15721个患者夜数，干预后期包括2023年2月16日至2024年3月15日期间的4354名患者和18584个患者夜数。夜间VS综合测量次数为1次或更少的患者夜数从11%增加到18%，但最终又回到了基线水平。夜间BP测量次数为1次或更少的患者夜数从36%增加到69%。干预后快速反应或ICU转诊次数没有增加。非西班牙裔白人患者夜间VS测量次数为1次或更少的几率更高（优势比[OR]，1.21；95%置信区间[CI]，1.07 - 1.37），以英语为护理语言的患者也是如此（OR，1.28；95% CI，1.06 - 1.54）。
迭代干预减少了夜间BP测量次数，但综合VS测量指标的变化未能持续。夜间VS测量中存在的差异值得关注。
