Things We Do For No Reason™: Routine Overnight Vital Sign Checks
© 2020 Society of Hospital Medicine
RECOMMENDATIONS
- Use clinical judgment or an existing risk stratification system, such as MEWS or PEWS, to identify patients who may benefit from more or less monitoring.
- Forgo overnight vital sign checks for low-risk patients.
- Check overnight vitals for low-risk patients at 10
pm and 6am. - Use pulse oximetry or regular nurse checks as a balancing measure, especially in the pediatric population.
CONCLUSION
Minimizing unnecessary sleep disruptors for hospitalized patients is essential for healing and health. The patient in the clinical scenario had iatrogenic comorbidities added during his hospitalization and an increase in length of stay that resulted from sleep-associated delirium. Hospitalists should take the lead in developing sleep protocols that can leverage current technology to “nudge” clinicians to improve patient sleep. We can modify the frequency of checking vital signs for low-acuity patients and alter environmental factors that may impair sleep, such as noise, light, and temperature, for high-risk patients who cannot forgo overnight vital sign checks. In addition to clinical judgment, artificial intelligence can enable hospitalists and nurses to determine which patients may benefit least from overnight vital sign checks. Finally, if we stop disrupting low-risk patients’ sleep, we can better target resources to patients at high risk for clinical deterioration. Let’s start improving inpatient sleep by eliminating the disruptive things we do for no reason.
Do you think this is a low-value practice? Is this truly a “Thing We Do for No Reason™”? Share what you do in your practice and join in the conversation online by retweeting it on Twitter (#TWDFNR) and liking it on Facebook. We invite you to propose ideas for other “Things We Do for No Reason” topics by emailing TWDFNR@hospitalmedicine.org.
