Effectiveness of SIESTA on Objective and Subjective Metrics of Nighttime Hospital Sleep Disruptors
We created Sleep for Inpatients: Empowering Staff to Act (SIESTA), which combines electronic “nudges” to forgo nocturnal vitals and medications with interprofessional education on improving patient sleep. In one “SIESTA-enhanced unit,” nurses received coaching and integrated SIESTA into daily huddles; a standard unit did not. Six months pre- and post-SIESTA, sleep-friendly orders rose in both units (foregoing vital signs: SIESTA unit, 4% to 34%; standard, 3% to 22%, P < .001 both; sleep-promoting VTE prophylaxis: SIESTA, 15% to 42%; standard, 12% to 28%, P < .001 both). In the SIESTA-enhanced unit, nighttime room entries dropped by 44% (−6.3 disruptions/room, P < .001), and patients were more likely to report no disruptions for nighttime vital signs (70% vs 41%, P = .05) or medications (84% vs 57%, P = .031) than those in the standard unit. The standard unit was not changed. 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.
© 2019 Society of Hospital Medicine
SIESTA-Enhanced Unit
In the SIESTA-enhanced unit, nurses received education using pocket cards and were coached to collaborate with physicians to implement sleep-friendly orders. Customized signage depicting empowered nurses advocating for patients was posted near the huddle board. Because these nurses suggested adding SIESTA to the nurses’ ongoing daily huddles at 4:00
Data Collection
Objectively Measured Sleep Disruptors
Adoption of SIESTA orders from March 2015 to March 2016 was assessed with a monthly EpicTM Clarity report. From August 1, 2015 to April 1, 2016, nocturnal room entries were recorded using the GOJO SMARTLINKTM Hand Hygiene system (GOJO Industries Inc., 2017, Akron, Ohio). This system includes two components: the hand-sanitizer dispensers, which track dispenses (numerator), and door-mounted Activity Counters, which use heat sensors that react to body heat emitted by a person passing through the doorway (denominator for hand-hygiene compliance). For our analysis, we only used Activity Counter data, which count room entries and exits, regardless of whether sanitizer was dispensed.
Patient-Reported Nighttime Sleep Disruptions
From June 2015 to March 2016, research assistants administered a 10-item Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ) to patients in both units. Responses to this questionnaire correlate with actigraphy-based sleep measurements.9,12,13 Surveys were administered every other weekday to patients available to participate (eg, willing to participate, on the unit, awake). Survey data were stored on the REDCap Database (Version 6.14.0; Vanderbilt University, 2016, Nashville, Tennessee). Pre- and post-intervention Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) “top-box ratings” for percent quiet at night and percent pain well controlled were also compared.
Data Analysis
Objectively Measured Potential Sleep Disruptors
The proportion of sleep-friendly orders was analyzed using a two-sample test for proportions pre-post for the SIESTA-enhanced and standard units. The difference in use of SIESTA orders between units was analyzed via multivariable logistic regression, testing for independent associations between post-period, SIESTA-enhanced unit, and an interaction term (post-period × SIESTA unit) on use of sleep-friendly orders.
Room entries per night (11:00
Patient-Reported Nighttime Sleep Disruptions
Per prior studies, we defined a score 2 or higher as “sleep disruption.”9 Differences between units were evaluated via multivariable logistic regression to examine the association between the interaction of post-period × SIESTA-enhanced unit and odds of not reporting a sleep disruption. Significance was denoted as P = .05.
