Vineet Arora, MD, MAPP, on Improving Sleep Disturbances Among Inpatients

Sleep deprivation is a major concern for patients in hospitals. To determine how practitioners and the institutions at which they work can address this concern, a team of researchers implemented Sleep for Inpatients: Empowering Staff to Act (SIESTA) at two 18-room University of Chicago Medicine general-medicine units.

The results showed that adjusting the EHR system may help hospitalists and nurses avoid waking inpatients throughout the night, in turn avoiding patient grogginess and falls the following day.

We asked lead author Vineet Arora, MD, MAPP—who is professor of medicine at University of Chicago Medicine and associate chief medical officer-clinical learning environment—about these findings.

Pulmonology Consultant: How long did it take for all of the involved health care providers to fully be on board with SIESTA? What were some of the challenges practitioners faced during the transition?

Vineet Arora: It took some time to develop the intervention actually. Getting clinicians on board was easier because we asked for champions to work with us to coach their peers. We had a resident champion, a hospitalist champion, and 2 nurse champions, and lots of leaders from these groups, too. We also had used focus groups early on to help ask staff what they thought the problem was and how we should fix it, which primed them to thinking they could change. We also used techniques to promote learning on the job. We met people where they were (i.e. during a shift change or a huddle) to give a quick few minutes on why this was important and what they could do. So, it was not a message of work harder and do better, but work smarter with these tools.

PULM CON: Part of your study included having doctors and nurses view a 20-minute presentation on the consequences of in-hospital sleep deprivation. What were the key takeaways from that presentation?

VA: The main points were that sleep loss in the hospital does have adverse health effects, that patients do care a lot about sleep disruptions, and that most of the disruptions patients report are modifiable and under a clinician’s purview.

PULM CON: You have said that “efforts to improve patients’ sleep are not new, but they do not often stick because they rely on staff to remember to implement the changes.” What can practitioners, or their institutions, do to ensure the efforts stick?

VA: Make sure to include a sustainable systems change, whether it be an IT one that is hardwired into the electronic health record to nudge clinicians to promote sleep, or hardwire it into an ongoing highly reliable activity, such part of a checklist or a huddle so that clinicians can pause to consider how to help patients sleep.

PULM CON: Are there any other barriers that would prevent a clinic from successfully implementing a program like SIESTA?

VA: Culture and burnout are the 2 big ones. If your clinicians do not have it in them to try this approach, since they are either too burned out or this is not inherently a priority, then it will be an uphill battle no matter how small the task is. Both of these can be overcome but require investments to improve engagement of the staff. Having the patient voice is helpful. We often use patient experience data to set the stage for why this is needed and highlight that this will help staff connect with their patients.

PULM CON: What has your team learned from this study for implementing similar changes to other centers in the future? And what should practicing pulmonologists, who might be interested in making similar changes at their clinic, keep in mind?

VA: The EHR may be a great tool to help patients sleep, but an interprofessional team championing the cause is equally important.

Reference:

Arora VM, Machado N, Anderson SL, et al. Effectiveness of SIESTA on objective and subjective metrics of nighttime hospital sleep disruptors. J Hosp Med. 2019;14(1):38-41. doi:10.12788/jhm.3091.