by Monica Shah
When I first stepped onto patient floors, I noticed the amount of commotion, from alarms beeping to staff conversations to loud knocks on patient doors. I couldn’t help but think, I wish I had some ear plugs! That was when it hit me that if I was feeling jolted just by visiting patient floors, what were patients thinking, especially those trying to sleep through this chaos? What impact does this commotion have on patient outcomes and their recoveries?
I am excited that I am going to find out that answer through my research project at the University of Chicago Hospital investigating sleep and functional recovery for older patients during hospital stay and post discharge. This study uses a variety of initial evaluation sleep surveys to look at patient’s sleep quality over the past month. We then do daily follow ups to assess patient’s sleep quality each night at the hospital. Additionally, those who chose to participate wear an actiwatch, a device which measures sleep and daytime physical activity. We also place a sound meter in patient rooms to calculate noise level (in decibels) each night.
While this is an ongoing study with further analysis still in progress, I am already seeing patterns emerge in the patient interviews I conduct. One of the biggest complaints I kept hearing was that nightly vitals, medications, and blood draws caused severe noise and disruption to sleep. The main issue seemed to be the lack of timely synchronization between these three procedures. Many patients were woken up multiple times at night for each of these tests. Additionally, another major concern for patients was the loud talking at night from staff. Now, these two issues raised a red flag to me because they both seem preventable just with some minor changes. Mostly, what is needed is increased communication between staff to correlate times for nightly tests and even simpler than that, quieter talking voices at night!
A previous study shows how hospital noise is associated with poor sleep for patients and loud talking by staff is one of the top reasons for hospital noise. So why hasn’t change been made? The issue is that the value of proper sleep is often forgotten about in hospital settings. With the common emphasis of patient care being placed on physical procedures to treat imminent medical conditions, the impact of sleep on functional recovery is often overlooked. However, sleep deprivation is a very real problem we face today and is linked to a condition called “post-hospital” syndrome. This is a critical period of vulnerability after discharge where patients are at increased risk for acquiring various conditions including irregular metabolic and physical conditions, cognitive problems, cardiac issues, etc.
No study to date has characterized sleep and recovery in general medicine older patients after discharge from the hospital. With the assistance of the SHM student scholarship and the mentorship of Dr. Vineet Arora, I am excited to have the opportunity to learn more about conducting a quality improvement program in the hospital and discovering more about sleep and outcomes for patients. I ultimately hope to use our work to help inform hospital policy. Before change can occur, we must first raise awareness of what is causing patients to sleep poorly in the hospital. Interestingly, one study found that patients with a higher sleep self-efficacy had a greater quality of sleep and reported less noise complaints. Maybe an intervention empowering patients to improve their own sleeping conditions could be the next step! At the University of Chicago Medicine, we are piloting a program called SIESTA, which stands for Sleep for Inpatients: Empowering Staff to Act. This is an educational intervention for healthcare staff to understand how patients can obtain better sleep and to learn more about proper screening for sleeping disorders. More interventions like this could be useful. So it’s time to wake up and realize that hospital noise is a serious problem and patients need their sleep to recover!
Monica Shah is a second year medical student at Wayne State University School of Medicine in Detroit, Michigan. She received her B.S from the University of Michigan in 2014, with a major in Neuroscience. She has been very active in the research community for the past 5 years, assisting in projects in the fields of child behavioral pediatrics, gastroenterology, and psychiatry. Currently, she is one of the three medical students who received the SHM Student Hospitalist Scholar Grant with which she is conducting research related to quality of care for patients.
Read Monica’s first blog post, “Improving Patient Care As a Trainee“.
When I was hospitalized at Mass General Hospital 11 years ago, the noise level was unbelievable. I had just had a complete hysterectomy (plus ovary removal and 33 lymph nodes). I didn’t know about the last two things, because I didn’t know what had been found when they opened me up. I was in a morphine induced reverie when the lights were turned on at 5AM the following morning. A doctor who I’d never seen before, but who had — it seemed later — been in the operating room, strode toward me, told me to lift up my gown, and took off my bandage. He then told me the news. Later, with no one to help me digest that my cancer had spread, I tried to dose. But the woman in the next bed had lots of wires attached to her and they beeped constantly. After that, I was aware of being woken up many times a night, sometimes calling the nurse myself to adjust her equipment. I continued to stay in the room for a few days, as the noise of her “equpment” let me sleep fitfully. There was also noise in the hall all night. To keep myself from becoming overwhelmed, I walked the halls with my walker (I needed a walker then) at 3AM until I felt tired enough to go back to bed and rest. I was given ativan around the clock, and that knocked me out, until my room was changed. This time I was in a room with a snorer and even the ativan wasn’t enough to block her out. And I was now closer to the nurse’s station. They didn’t seem to care what time it was — they chatted away and called out to each other as if they were in the supermarket in the middle of the afternoon. This was normal to them. There was absolutely no respect for the patients’ need to sleep or have a restful atmosphere. I got great care there, and I did love some of the nurses who were wonderful to me, but the overall experience was not positive and I was very happy when — even with all my pain and discomfort — I was discharged home.