Background: While sleep is critical for health and healing, the hospital setting is not conducive to sleep and few efforts have been made to improve the sleeping environment. To date, there have been no efforts to describe the current practices to improve the sleep of hospitalized patients at highly-ranked hospitals.
Methods: A multicenter mixed-methods study of the Section Chiefs of Hospital Medicine at the 2020 US News and World Report (USNWR) Honor Roll pediatric and adult hospitals was conducted to understand current practices and attitudes towards patient sleep during hospitalization. Using an iterative process with a group of physician high-value care experts, an anonymous, 20-item REDCap survey was developed, piloted, and disseminated to all section chiefs at USNWR top pediatric and adult hospitals. Hospitalist leaders were contacted via email and follow up emails were disseminated three times between June 2021 and August 2021. Survey participants were invited to share their institutions’ current efforts to promote inpatient sleep and their perspectives on ways to improve future sleep-friendly standards in a brief structured qualitative interview. Interviews were conducted via Zoom and transcribed using Atlas.TI. Three authors coded interviews until thematic saturation was achieved.
Results: Pediatric (n=10) and adult (n=20) section chiefs were queried using surveys and interviews. The total survey response rate was 77% (n=23/30; pediatric response rate = 80%, n=8/10; adult response rate = 75%, n=15/20). While 96% (n= 22) of hospitalist leaders rated sleep as important, only 43% (n=10) were satisfied with their institution’s efforts to improve patient sleep. Furthermore, although 91% (n=21) of hospitalist leaders identified hospital sleep as a health equity issue for patients with pre-existing medical risk factors, communication barriers, or limited familiarity with hospital services, only one institution (4%) had practices in place to address this disparity. Surveys revealed that 48% (n=11) of participating institutions had practices in place to improve patient sleep. Fifty-two percent of institutions (n=12) reported having no sleep-friendly practices in place. Among the 11 institutions with sleep-friendly practices in place, the most common practices included: reducing overnight vital sign monitoring (43%, n=10), decreasing ambient light in the wards (43%, n=10), adjusting lab and medication schedules (35%, n=8), and implementing quiet hours (30%, n=7) (Figure 1). Twenty-seven percent of the queried hospitalist leaders (n=8/30; pediatric interviews = 3/10, 30%; adult interviews = 5/20, 25%) participated in qualitative interviews. Their responses revealed a number of key concepts for establishing a sleep-friendly hospital environment (Table 1). Major themes from the interviews included: the importance of having a universal sleep-friendly culture, environmental changes, modified hospital practices, and external incentives to improve patient sleep.
Conclusions: Hospitalist leaders recognize the importance of improving patient sleep, but few have sleep-friendly institutionalized practices currently in place. Most institutions have no sleep health equity practices in place even though hospitalist leaders agree on the importance of sleep equity in the hospital setting. Building sleep-friendly hospital cultures and instituting best practices for patient sleep should be a priority for clinicians and hospital leaders moving forward.