To characterize baseline sleep data for neurology inpatients and to develop and assess a multi-pronged intervention targeted at key drivers of poor sleep in the hospital.

Patients sleep significantly fewer hours in the hospital compared to at home. Poor sleep negatively impacts patient experience and clinical outcomes. This QI project sought to elucidate and improve the state of sleep for an inpatient neurology population.

Using actigraphy devices, patient surveys, and direct observation, we collected baseline sleep data for patients admitted to the general neurology service. We identified key disruptors of inpatient sleep and developed interventions aimed at addressing each of these factors. Descriptive statistics compared pre- and post-intervention sleep patterns.

Baseline data (patient-nights; n=16 observation/survey, 12 actigraphy) revealed that major causes of poor inpatient sleep include provider-driven interruptions, patient discomfort and anxiety, and lack of provider awareness around sleep deprivation. Interventions (n=21) encompassed: (1) A sleep-friendly order set for patients deemed low risk for clinical deterioration; this order set retimed care (e.g., vitals, neuro checks, phlebotomy, medications) outside of protected sleeping hours, adjusted delivery of VTE prophylaxis, and included standing melatonin; (2) a patient-centric sleep menu that offered comfort items (e.g., aromatherapy) and interactions (e.g., guided meditation); and (3) individual sleep reports with actigraphy data and patient commentary on their sleep experience, distributed to clinicians each morning. For patients who received these interventions, on average, total sleep duration increased by 75% (7.30h vs 4.16h), overnight charted interruptions decreased by 51% (1.65 vs 3.38), and actigraphy sleep quality scores increased by 33% (78.18 vs 58.83). 71% of enrolled patients slept at least 6 hours each night, compared to 25% pre-intervention.

There are multiple causes for inpatient sleep deprivation for general neurology patients. Targeting each of these factors through a combined approach improves sleep duration and quality.