ArticleJournal of general internal medicine2023
Reducing Nighttime Interruptions and Improving Sleep for Hospitalized Patients by Restructuring Nighttime Clinical Workflow.
Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- A randomized trial of I-SLEEP: A patient education and empowerment intervention on inpatient sleep duration and medical sleep disruptions.Journal of hospital medicine · 2026Trial
- Recent Evidence on Factors and Potential Interventions Affecting Patient Sleep in Inpatient and Hospital Settings.Current psychiatry reports · 2026Review
- Nursing champions to promote evidence-based in-hospital sleep: a qualitative descriptive study.Journal of research in nursing : JRN · 2026Article
- Evidence-based sleep promotion in acute care from the perspective of nursing staff: a cross-sectional study.BMC nursing · 2026Article
- Effect of a nighttime medical order adjustment protocol on objective and subjective sleep quality in hospitalized adults: a randomized controlled trial.Sleep advances : a journal of the Sleep Research Society · 2026Article
- Promoting Sleep for Neurology Inpatients: The Value of Routine Overnight Vital Signs.Neurology. Clinical practice · 2025Article
- Nudging towards Sleep-Friendly Health Care: A Multifaceted Approach on Reducing Unnecessary Overnight Interventions.Applied clinical informatics · 2024Article
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Authors and funding
7 authors.
Funding
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Abstract
backgroundNighttime sleep disruptions negatively impact the experience of hospitalized patients.
objectiveTo determine the impact of adopting a sleep-promoting nighttime clinical workflow for hospitalized patients on nocturnal disruptions and sleep.
designSurvey-based pre- and post-intervention cross-sectional study using convenience samples.
participantsHospitalized veterans on a 23-bed general medical ward at a tertiary Veterans Administration Hospital.
interventionsBaseline sleep surveys (N=149) identified two major sources of interruptions: blood pressure checks at 4 am for telemetry patients and subcutaneous (SQ) heparin injections between 4:30 and 6 am for venous thromboembolism prophylaxis. Clinical workflow was restructured to eliminate these disruptions: moving 4 am blood pressure checks to 6 am and providing daily SQ enoxaparin at 9 am as an alternative to Q 8-h SQ heparin, which had prompted an injection between 4:30 and 6 am. The impact of these changes was assessed in a second round of surveys (N=99). MAIN MEASURES: Frequency and sources for nighttime sleep disruptions; percentage of patients reporting longer time to fall asleep, more interruptions, and worse sleep quality (vs. home) before and after restructuring nighttime clinical workflow. KEY
resultsAfter restructuring nighttime clinical workflow, medication administration as a source of nighttime disruption decreased from 40% (59/149) to 4% (4/99) (p<0.001). Blood pressure checks as a source of disruption decreased from 56% (84/149) to 42% (42/99) (p=0.033). Fewer patients reported taking longer to fall asleep in the hospital vs. home (39% pre-intervention vs. 25% post-intervention, p=0.021). Similarly, fewer patients experienced waking up more frequently in the hospital vs. home (46% pre-intervention vs. 32% post-intervention, p=0.036). Fewer patients reported sleeping worse in the hospital (44% pre-intervention vs. 39% post-intervention), though this trend was not statistically significant (p=0.54).
conclusionsNighttime disruptions in hospitalized patients frequently interfere with sleep. Restructuring of the clinical workflow significantly reduced disruptions and improved sleep.
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