Related Experiment Video
Updated: Jan 4, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Modeling Safe Infant Sleep in the Hospital
Emily Frey1, Nicole Hamp2, Nicola Orlov3
1Pritzker School of Medicine, University of Chicago, Chicago, IL, United States of America.
Insights
Healthcare providers received education to improve safe sleep practices (SSP) for infants in hospitals. While knowledge was high, adherence improved by 12.5% post-intervention, highlighting the need for ongoing training.
Area of Science:
- Pediatrics
- Public Health
- Healthcare Quality Improvement
Background:
- Over 3000 US infant deaths annually are sleep-related, despite SIDS reduction.
- Safe sleep practices (SSP) are crucial for infant safety in healthcare settings.
Purpose of the Study:
- To enhance healthcare provider adherence to five core SSP in an urban academic pediatric unit.
- To improve compliance with supine positioning, crib alone, no objects, appropriate bundling, and flat cribs.
Main Methods:
- A Quality Improvement project utilized a pre- and post-intervention design.
- Staff education on SSP was implemented.
- Provider knowledge was surveyed, and infant sleep environments were audited pre- and post-education (100 pre, 123 post).
Main Results:
- Baseline audits revealed no patients met all SSP criteria.
- Post-intervention, significant improvements (p < .05) were observed in flat cribs, object removal, and avoiding over-bundling.
- Overall SSP adherence increased by 12.5%.
Conclusions:
- Inpatient settings offer opportunities to model SSP, but provider adherence is often lacking.
- Continued education is vital for improving SSP adherence and ensuring hospitals model safe sleep for families.
- Behavioral modification for SSP adherence is complex and may require formal policy alongside education.
Purpose:
Despite reductions in the rate of sudden infant death syndrome (SIDS) over the last 25 years, over 3000 infant deaths annually in the US are attributable to sleep-related causes. We aimed to improve safe sleep practice (SSP) adherence by healthcare providers working with infants admitted to an inpatient pediatric unit in an urban academic center specifically increasing compliance on five core SSP (supine, alone in the crib, no objects in crib, appropriate bundling, and flat crib).
Design And Methods:
This Quality Improvement project evaluated a staff education intervention using a pre- and post-design. Surveys of providers determined baseline SSP knowledge. Adherence to SSP in the hospital was audited before and after education. One hundred pre-intervention infant sleep placement observations were recorded and 123 were collected post-intervention.
Results:
Surveyed providers had appropriate knowledge of SSP; however, baseline audits indicated that no patients met all SSP practices in the hospital. Post-intervention adherence to SSP showed significant (p < .05) improvements in keeping the crib flat, removing objects from the crib, and avoiding over-bundling. Overall, SSP adherence increased by 12.5% post-intervention.
Conclusions:
This quality improvement project suggests that the inpatient setting provides opportunities for providers to demonstrate SSP but that healthcare providers often do not follow SSP in practice. Continued education can lead to improvements in SSP adherence ensuring that hospitals are modeling SSP for the families of infants.
Practice Implications:
Limited improvements to SSP adherence illustrate the complexities of modifying provider behaviors in the absence of formal policy.
