How to Promote Patient Restfulness in the Hospital Setting
By Christopher Cheney
Hospitals can be a poor environment for patient sleep and rest.
Hospital wards are often noisy, and patients can have their sleep and rest interrupted by medical care such as collection of vital signs and blood draws during sleep and rest time.
However, hospitals can launch interventions to promote patient restfulness, according to a new journal article published by JAMA Network Open. The researchers studied restfulness interventions conducted at Barnes-Jewish Hospital in St. Louis. Data was collected from nearly 700 patients.
“Inpatient wards are notoriously disruptive environments for patients,” the journal article’s co-authors wrote. “Nighttime disturbances are particularly common, reducing sleep by more than an hour per night for most patients. Overnight disturbances are often caused by pain, excessive light and noise, nursing assessments, and awakenings for blood draws and medication administration.”
Four primary interventions were examined. First, a one-page educational document on the benefits of restfulness and ways to promote restfulness was distributed at nursing stations.
Then, care teams reduced unnecessary nighttime interruptions by clustering care as well as limiting light and noise, including the use of red-wavelength flashlights by nurses instead of overhead lights in patient rooms.
Third, staff were encouraged to limit nighttime interruptions for patients who were stable.
Finally, an intervention emphasized personalization of the patient rest environment, including distribution of sleep kits and white noise machines to all patients.
“Sleep opportunity increased significantly during the project,” the journal article’s co-authors wrote.
Patient restfulness at Allegheny Health Network
Promoting sleep and rest in the hospital setting is crucial for patient experience, according to Donald Whiting, MD, CMO of Allegheny Health Network and president of Allegheny Clinic.
“If patients feel rested and feel they are in an environment where staff care about their time and rest, they have a better experience,” Whiting says. “A better patient experience helps to determine the patient’s outcome. If patients have a better experience, they tend to do better clinically.”
Research has shown that restfulness has several benefits for hospitalized patients, Whiting explains.
“There is a lot of evidence that shows that restfulness improves healing, improves anxiety, helps with concentration and orientation, and helps with participation in therapies,” Whiting says.
In the hospital setting, the patient’s body is working hard to recover from whatever injury it is experiencing, which can be a surgery or an infection, says Eugene Scioscia, MD, chief experience officer at Allegheny Health Network.
“The body is working overtime in terms of its metabolism and healing process,” Scioscia says, “so it is critical to allow the body to rest.”
“There are some easy things to do such as eliminating hallway conversations during rest hours,” Whiting says. “We have a certain period of time at our hospitals that is quiet time, where staff are educated and encouraged to limit loud conversations.”
Allegheny Health Network’s hospitals have also looked at intervening in patient care during the rest time, when patients should be resting or sleeping, according to Whiting.
“There are certain things that we must do for medical care such as collecting vital signs, but we can bundle these things together at one time to allow for patients to have time to get some rest and sleep,” Whiting says. “There can be periodic blood draws, periodic collection of vital signs, and periodic times where dietary staff or environmental staff do things. We try to coordinate those events to minimize interruptions in the patients’ rooms.”
A restfulness focal point for Allegheny Health Network hospitals is blood draws, according to Scioscia.
“We are trying to limit the drawing of bloodwork very early in the morning,” Scioscia says. “Most patients are sleeping at that time in the morning, when the phlebotomist comes into the room. We ask whether we need that bloodwork—is it really going to be critical for the day?”
Limiting disruptions from patient rounding is a priority at Allegheny Health Network hospitals, Scioscia explains.
“There can be more than one clinician rounding on patients,” Scioscia says. “There can be attending physicians, medical students, and residents. We ask these clinicians to try to avoid talking outside of the patient’s room to limit awakening the patient.”
Why should CMOs care?
Patient restfulness should be among the priorities of CMOs, according to Whiting.
“First and foremost, the CMO cares about everything patient-related and hospital-related,” Whiting says. “We help bring all of the components together to boost the ultimate outcome and ultimate experience.”
Promoting patient restfulness is part of a CMO’s responsibility to pursue the Quintuple Aim of healthcare, Whiting explains.
“It is the CMO’s job to ensure that we are doing our best to deliver on the Quintuple Aim, which is best patient experience, best clinician experience, equitable delivery of care, best clinical outcomes, and lowest cost per outcome,” Whiting says. “Restfulness and patients doing well in terms of healing as quickly and efficiently as possible is squarely in the CMO’s bailiwick.”
Christopher Cheney is the CMO editor at HealthLeaders.