Frequent disruptions are more than just annoying for
patients. They can also cause harm.
Dec. 3,
2018
By Austin
Frakt
If part of a hospital
stay is to recover from a procedure or illness, why is it so hard to get any
rest?
There is more noise
and light than is conducive for sleep. And nurses and others visit frequently
to give medications, take vitals, draw blood or perform tests and checkups — in
many cases waking patients to do so.
Some monitoring is
necessary, of course. Medication must be given; some vital signs do need to be
checked. And frequent monitoring is warranted for some patients — such as those
in intensive care units. But others are best left mostly alone. Yet many
hospitals don’t
distinguish between the two, disrupting everyone on a
predefined schedule.
Peter
Ubel understands the problem as both a physician and patient.
When he spent a night in the hospital recovering from surgery in 2013, he was
interrupted multiple times by blood draws, vital sign checks, other lab tests,
as well as by the beeping of machines. “Not an hour went by without some kind
of disruption,” said Dr. Ubel, a physician with Duke University. “It’s a
terrible way to start recovery.”
It’s more than
annoying — such disruptions can harm patients. Short sleep durations are
associated with reduced
immune function, delirium, hypertension and mood disorders.
Hospital conditions, including sleep disruptions,
may contribute to “posthospital
syndrome” — the period of vulnerability to a host of health problems
after hospitalization that are not related to the reason for that
hospitalization.
“In addressing a
patient’s acute illness, we may inadvertently be causing harm by ignoring the
important restorative powers of a healing environment,” said Harlan Krumholz, a
Yale University physician who has been calling attention to posthospital
syndrome for several years. “The key to a successful recovery after illness may
be a less stressful, more supportive, more humane experience during the
hospitalization.”
It’s an environment
that, all too often, seems set up for everyone else’s convenience but the
patient’s. To help patients deal with the stresses of
hospitalization, sedatives are often prescribed.
These medications, including opioids, carry their own risks, such as addiction.
“Instead, we could
make the environment more conducive to rest and reduce the use of sedatives,”
Dr. Ubel said.
Solutions aren’t hard
to fathom. Dr. Ubel listed
some in 2013. Hospital workers could coordinate so that one
disruption serves multiple needs: a blood draw and a vitals check at the same
time instead of two hours apart. Or they could allow patients’ needs to guide
schedules. If a patient is at low risk and can go six or eight hours without a
vitals check, for example, perhaps don’t do that check once every four hours.
Small changes in
hospital routines like these can go a long way. A clinical trial to
test them found that they significantly reduced the proportion of patients
reporting hospital-related sleep disruptions, and they cut sedative use in
half. These small changes can even increase patients’ ratings of hospitals,
which are now part of Medicare quality measures. The key insight seems to be to
prioritize patients over tests and other interruptions that can be deferred.
Some
hospitals are trying to allow patients to get more rest.
Yale-New Haven Hospital has empowered nurses to change medication schedules to
minimize sleep disruptions and to tick
off other tasks before patients go to bed.
Another example: To
reduce noise, Massachusetts
General Hospital in Boston has gone so far as to install rubber
floors in some areas.
The
University of Michigan Health System has taken steps to reduce
noise at night, including changing when floors are cleaned and installing
sound-absorbing tiles.
“Since the 1960s, the
noise level in hospitals has gone up,” said Mojtaba Navvab, associate professor
of architecture at the University of Michigan and an expert in reducing noise
level in buildings. He helped design acoustical changes to the university’s
hospital corridors. By adding acoustic tiles to hallway walls, “the sound level
was three times lower,” he said.
Being sick and
hospitalized is bad enough. Being subjected to sleep deprivation adds insult
(or more injury) to injury.
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