Do Fewer disturbances from nighttime checks translate into better sleep in hospitalised patients?
Sleep has major consequences for physical and emotional well-being. Insomnia in hospitalized adults is a common condition and a source of patient dissatisfaction.
A recent study suggests that a predictive algorithm, paired with targeted and informative clinical decision support (CDS), can assist physicians to identify stable hospitalized patients. They found no significant harm in reducing overnight vital sign checks in such patients. However, the predictive algorithm does not reduce the incidence of delirium. The study findings were published in the JAMA Internal Medicine on December 28, 2021.
Iatrogenic interruptions are a major cause of sleep deprivation in hospitalized patients. Whether CDS, including analytics to target sleep promotion interventions to appropriate patients, would be safe and effective is unclear. Therefore, Dr Nader Najafi ad his team conducted a study to determine whether a clinical decision support tool, powered by real-time patient data and a trained prediction algorithm, can help physicians identify clinically stable patients and safely discontinue their overnight vital signs checks.
They conducted a randomized clinical trial and noted 3,025 total encounters screened by the CDS tool. The researchers then randomized 966 patient encounters to the intervention arm and 964 to the usual care arm. They also included physicians serving the patients on the general medical service.
The CDS tool notified physicians to patients who were at low risk for abnormal nighttime vital signs and therefore candidates for a skipped nighttime vital sign check. CTS Tool was based on a logistic regression model that used real-time patient data as input.
The major outcome assessed was the incidence of delirium, determined by bedside nurse assessment of Nursing Delirium Screening Scale scores, a standardized delirium screening tool (delirium diagnosed with score ≥2). They also assessed the mean nighttime vital sign checks. Potential harms were determined as intensive care unit transfers and code blue alarms.
Key findings of the study:
- Upon analysis, the researchers found that the sleep promotion intervention was not associated with a reduction in delirium compared with usual care in the general medicine service (11% vs 13%).
- However, they noted a 31% reduction in vital sign checks per night in the intervention arm with no potential harms, suggesting that for some patients, overnight vital sign checks can be reduced with no adverse effects.
"It is not surprising that the intervention was not able to decrease the incidence of delirium. Hospital delirium has many contributors, and the reduction in vital signs checking, although statistically significant, was relatively small," according to the editorialists.
The authors concluded, "Results of this randomized clinical trial suggest that the model we have described herein, a predictive algorithm that identifies clinically stable patients for whom a hospital intervention can be safely discontinued, has potential applications beyond measurement of vital signs. Continuous cardiac monitoring, higher level of care, and routine daily blood tests are all scenarios that could benefit from a similar approach."
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