Piloting I-SLEEP: A Patient-Centered Education & Empowerment Intervention to Improve Patients’ In-Hospital Sleep

From the 2021 HVPAA National Conference

Noah Mason (University of Chicago Pritzker School of Medicine), Samantha Anderson, Max Byron, Christine Mozer, Nicola Orlov, Vineet Arora

Background

During hospital stays, patients experience a myriad of sleep disturbances that are linked to poor outcomes and are often preventable. To improve in-hospital patient experience and care, the American Academy of Nursing recommends avoiding unnecessary sleep disruptions through the Choosing Wisely campaign. While prior work has focused on staff training, engaging patients may help.

Objective

This study evaluated a multicomponent intervention (Inpatient Sleep Loss: Education & Empowering Patients (I-SLEEP)) that aims to empower patients to advocate for fewer nighttime disruptions and get better sleep.

Methods

This study was conducted among hospitalized general medicine patients, 18 years of age and older, at an urban, academic medical center, from June to December 2019. For eligible inpatients, I-SLEEP was delivered at patients’ bedsides and included a short educational video and brochure adapted from the NIH, and a sleep kit with an eye mask, ear plugs, and a notecard that reinforced three questions patients should ask their care teams to reduce nighttime disruptions that were reviewed in the video and brochure [(1) Can I get my blood drawn during waking hours? (2) Do I need overnight vitals? (3) If I have to be woken up during the night can I get everything done all at once?]. Following I-SLEEP, patients reported satisfaction and understanding using 5-point Likert scale and “teach- back” questions. On subsequent nights, we asked patients if they asked their care team any of the questions and reviewed patient charts to collect data on nighttime disruptions (vitals, lab tests).

Results

For the 36 patients who received I-SLEEP, 88% (23) were satisfied with the brochure and 86% (25) with the video. Nearly all patients (97%, 35) felt empowered to ask their care teams to improve sleep and 72% (26) reported intent to alter their sleep habits post-discharge. Just over half (53%, 16) of patients asked at least one of the questions and 30% (9) used the eye mask. Patients who asked at least one question were significantly more likely to have the lowest average nighttime vital signs interruptions across their stay (once per night 27.3% vs 4.3%, p=0.03). While not significant, more patients who asked at least one question had no lab draws at night (30% vs 9.5%, p=0.07).

Conclusions

I-SLEEP was well-accepted and resulted in patients asking their care teams questions to improve their sleep. Future directions include examining I-SLEEP’s effect on objective measures of sleep (i.e. actigraphy), evaluating I-SLEEP’s effect on sleep duration and quality post-discharge as well as in hospital, and evaluating I-SLEEP’s effectiveness vs. standard care in a future randomized trial.

Clinical Implications

Empowering and educating patients to advocate for reducing unnecessary nighttime disruptions and improving sleep in the hospital is a patient-centered, low-cost strategy to improve patients’ care and in-hospital experience.

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