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Quasi-experimental, Nonrandomized Initiative to Minimize Sleep Disruptions among Hospitalized Children

Brianna Glover1, Leonid Bederman2, Evan Orenstein1,3,4

  • 1From the Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.

Pediatric Quality & Safety
|July 12, 2023
PubMed

Insights

Hospitalized children experienced fewer sleep disruptions after implementing a new vital signs (VS) protocol. This change reduced overnight blood pressure checks and improved patient rest.

Area of Science:

  • Pediatric Hospital Medicine
  • Sleep Science
  • Healthcare Quality Improvement

Background:

  • Hospitalized children frequently experience sleep disruptions.
  • Caregivers identify overnight vital signs (VS) as a major cause of these disruptions.
  • A need exists to improve pediatric sleep quality during hospitalization.

Purpose of the Study:

  • To decrease caregiver-reported sleep disruptions in hospitalized children by 10% over 12 months.
  • To implement and evaluate a modified VS frequency order.
  • To assess the impact of the new VS protocol on patient sleep and safety.

Main Methods:

  • Introduced a new VS order: 'every 4 hours (unless asleep between 2300 and 0500)'.
  • Utilized an electronic health record (EHR) to track adherence to the new VS order.
  • Measured caregiver-reported sleep disruptions as the primary outcome.
  • Monitored adherence and rapid responses as process and balancing measures.

Main Results:

  • Caregiver-reported sleep disruptions decreased significantly from 24% pre-intervention to 8% post-intervention (P < 0.001).
  • Overnight blood pressure readings were substantially reduced with the new VS frequency (36% vs. 87%, P < 0.001).
  • No adverse safety events were associated with the intervention.

Conclusions:

  • A new vital signs frequency protocol was safely implemented in a pediatric hospital setting.
  • The intervention successfully reduced overnight blood pressure monitoring.
  • The study demonstrated a significant reduction in sleep disruptions for hospitalized children.

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