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University of Chicago Medicine study shows need to enhance patient rest, evaluate overnight interruptions for better patient experience

The program used electronic "nudges" to clinical staff to forgo overnight vitals and medications as well as clinical staff education.

Beth Jones Sanborn, Managing Editor

A new study published in the Journal of Hospital Medicine shows a hospital program designed to help patients get more rest for a better recovery process called SIESTA, or Sleep for Inpatients: Empowering Staff to Act, proved successful in cutting the number of times a patient was disturbed overnight and improved their experience.

The program utilized electronic "nudges" to clinical staff to forgo overnight vitals and medications as well as holding clinical staff education on improving patient sleep.

Two, 18-room University of Chicago Medicine general-medicine units were used: one "SIESTA-enhanced unit" experienced a full intervention of nursing education and empowerment/collaboration with physicians to implement sleep-friendly measures such as foregoing overnight interruptions, physician education, and EHR changes. Overnight interruptions were evaluated for necessity and skipped. The standard unit did not receive nursing interventions but received all other forms of intervention.

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Six months pre- and post-SIESTA, sleep-friendly orders rose in both units, like foregoing vital signs which rose from 4 percent to 34 percent in the SIESTA unit and from 3 to 22 percent in the standard unit. Also, nighttime room entries dropped by 44 percent in the SIESTA unit and patients were more likely to report no disruptions for nighttime vital signs than those in the standard unit. The standard unit was not changed.

Between March 2015 and March 2016, the study period, 1,083 general-medicine patients were admitted to the SIESTA-enhanced and standard units.


The study results show that with changes in EHR notifications, education and collaboration among clinical staff, it is possible to identify stable patients that need not be interrupted multiple times in an evening and can be allowed to rest. The results also show the difference that buy-in from your nursing staff can make on such a program.

"Although sleep-friendly orders were adopted in both units, a unit-based nursing empowerment approach was associated with fewer nighttime room entries and improved patient experience," the study said.


Patient experience in the age of consumerism is vital. It can dictate everything from patient loyalty to their provider to whether they fully pay their medical bill. So making sure that a patient has a positive experience is crucial. When a patient is not well-rested, not only can it affect their recovery and outcome, but it can leave a negative overall impression of the care they received.


"This study presents several implications for hospital initiatives aiming to improve patient sleep. Our study is consistent with other research highlighting the hypothesis that altering the default settings of EHR systems can influence physician behavior in a sustainable manner. However, our study also finds that, even when sleep-friendly orders are present, creating a sleep-friendly environment likely depends on the unit-based nurses championing the cause. While the initial decrease in nocturnal room entries post-SIESTA eventually faded, sustainable changes were observed only after SIESTA was added to nursing huddles, which illustrates the importance of using multiple methods to nudge staff," the study said.

Twitter: @BethJSanborn
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