At Mount Sinai Hospital in New York, a group of medical students is learning about high-value care through a project intended to help patients in the hospital setting get quality sleep. The project is based on a Choosing Wisely recommendation from the American Academy of Nursing to avoid waking patients for routine care unless the patient’s condition or care specifically requires it.
Michael Herscher, MD, Assistant Professor of Hospital Medicine at Mount Sinai, is overseeing the quality-improvement project. He said the students did a literature review, looked at what interventions were plausible and addressed some of the limitations of stopping interruptions entirely.
“We wondered how we can get hospital staff and patients to focus on sleep during overnight shifts when we may not be present,” he said. “There can be some resistance with changing medication times or asking people to stop checking vital signs, so we focused on areas we would make an impact.”
The intervention starts at 9 p.m., when medical assistants complete rounds. During this final interaction of the night with the patients, the medical assistants ask questions based on an instruction card created by the students. Questions included whether their pain was controlled, if they wanted the blinds drawn and if they wanted the lights and the TV switched off.
The medical students also put together “sleep hygiene” bags for patients with items that were already on the hospital floor, including eye masks, lavender oil and other items to promote relaxation that the medical assistants could offer patients during this time as well.
To determine whether the intervention worked, the medical students surveyed patients using the Richards–Campbell Sleep Questionnaire, which includes grades for five sleep-related elements, and looked at Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which factor in quietness on the floor. They also talked to staff on the floors often to hear about any updates or improvements.
After the intervention, all five of the areas analyzed via the Campbell survey increased and there were statistically significant differences in three of the five areas, showing clear improvements in patients’ self-reported sleep. The HCAHPS score also indicated a 10 percent increase in how quiet the hospital was.
Dr. Herscher presented the results at a plenary session during the Society of Hospital Medicine annual meeting. Student Daniela Mikhailov also presented a poster about the project, which won a blue ribbon, at the Mount Sinai’s Institute for Medical Education event.
Dr. Herscher noted that other factors the group could consider studying in the future are whether the intervention reduced requests for and administration of sedatives and whether it reduced length of stay.