Improving Sleep by Minimizing Unnecessary Overnight Vital Signs in Hospitalized Patients

Area of Science:

• Pediatric Hospital Medicine
• Patient Safety
• Sleep Science

Background:

• Hospitalized children experience frequent sleep disruptions due to vital sign (VS) measurements.
• Overnight VS monitoring can negatively impact patient rest and recovery.

Purpose of the Study:

• To increase the proportion of patient-nights with one or fewer overnight vital sign measurements in a pediatric hospital.
• To evaluate the impact of iterative interventions on sleep quality and VS monitoring practices.

Main Methods:

• A pre-post study design was implemented at a children's hospital.
• Interventions included a rounding checklist and electronic health record order changes for VS.
• Statistical process control charting and generalized linear mixed-effects models were used for analysis, assessing disparities.

Main Results:

• Patient-nights with one or fewer blood pressure (BP) measurements significantly increased from 36% to 69%.
• The proportion of patient-nights with one or fewer composite VS measurements showed a transient increase but regressed to baseline.
• No significant increase in rapid responses or intensive care unit transfers was observed.

Conclusions:

• Iterative interventions successfully reduced overnight BP measurements but did not sustain improvements in the composite VS measure.
• Disparities in overnight VS measurements persist, particularly for non-Hispanic white patients and those with English as their primary language.
• Further attention is needed to address inequities in VS monitoring to improve pediatric patient sleep.