A Comparison of Nurse-Driven and Combined Physician and Nurse-Driven Interventions for Improving Sleep Quality and...

Background Inpatient sleep disruption is prevalent and contributes to delirium, impaired recovery, and increased healthcare utilization. Causative factors include illness severity, unfamiliar surroundings, circadian disruption, and poorly timed clinical tasks. Non-pharmacologic, protocol-driven approaches to improving inpatient sleep remain underutilized despite evidence of their benefit. This study aimed to evaluate the effectiveness of nurse-driven and combined nurse-physician sleep interventions in subjective sleep quality, patient satisfaction, and hospital resource utilization among medical-surgical inpatients. Methods Three sequential cohorts of medical-surgical inpatients were enrolled: a control group receiving standard care; a nurse-intervention cohort receiving nightly nurse-led sleep rounds and a personalized Sleep Hygiene Menu encompassing environmental modifications, comfort measures, and relaxation aids; and a combined nurse-physician cohort in which hospitalists additionally modified overnight order sets to reduce non-urgent vital sign checks, laboratory draws, and medication administrations during a protected sleep window (10:00 PM-6:00 AM). Cohorts were compared on demographics, LACE index scores (an acronym for Length of stay, Acuity of admission, Comorbidity, and Emergency department visits), responses to a modified Richards-Campbell Sleep Questionnaire (RCSQ), and Delirium Observation Screening Scale (DOSS) scores. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and sitter hours were captured for the control and nurse-intervention cohorts. Results A total of 92 patients were enrolled (29 control, 31 nurse intervention, 32 nurse+physician intervention), generating 102 survey responses (38 control, 32 nurse intervention, 32 nurse+physician intervention). Both intervention cohorts reported significantly deeper sleep, shorter sleep latency, fewer nocturnal awakenings, faster return to sleep, and better overall sleep quality compared to controls (all p < 0.05). No significant differences were found between the two intervention groups (p > 0.05 for all values). HCAHPS data showed an 8.47% increase in patient satisfaction with nighttime quietness (p = 0.0007). Sitter hours were reduced by 896 hours over seven months, yielding $21,351.68 in cost savings. Conclusion Structured nurse-driven sleep interventions significantly improved inpatient sleep quality and patient satisfaction, and generated measurable cost savings. Adjunctive physician order modifications provided no additional benefit over nursing interventions alone. These findings support routine integration of sleep hygiene protocols into inpatient nursing care and highlight an opportunity for hospitalists to champion multidisciplinary sleep promotion as a quality and cost-reduction strategy. Future studies should incorporate objective sleep measurement using wearable actigraphy devices.