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Improving Sleep by Minimizing Unnecessary Overnight Vital Signs in Hospitalized Patients

Lauren M McDaniel1,2, Hannah Benjamin1,2, Kristy Carlin1,2

  • 1Seattle Children's Hospital, Seattle, Washington.

Hospital Pediatrics
|April 17, 2025
PubMed

Insights

Hospitalized children’s sleep is often disrupted by vital sign (VS) measurements. Interventions reduced blood pressure (BP) checks but not overall VS, highlighting persistent disparities.

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.
Abstract

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