Clinical question: Can a clinical-decision-support tool enable physicians to identify hospitalized patients who are stable enough to have their nighttime vital-sign checks discontinued?
Background: Sleep disturbance is a common and unwelcome aspect of hospitalization. Previous studies show that iatrogenic sleep disruption is common in hospitalized patients. Prior evidence suggests that nighttime vital-sign checks could safely be eliminated in lower-risk medical patients.
Study design: Randomized controlled trial
Setting: Single-center academic hospital
Synopsis: The study group developed a clinical-decision-support tool to identify patients at low risk of developing abnormal vital signs overnight. Clinicians randomized to the intervention arm received an electronic health record (EHR) order prompt for low-risk patients to potentially receive “sleep promotion vitals.” Although the intervention did not lead to a difference in the primary outcome of incidence of delirium, it did lead to a difference in nighttime vital-sign checks and a clinically significant increase in sleep opportunity (4.95 hours versus 4.57 hours). There was no increase in ICU transfers (49 [5%] versus 47 [5%]) or code blues (2 [0.2%] versus 9 [0.9%]) in the intervention group.
Bottom line: A prediction algorithm embedded in a clinical-decision-support tool can be used to help physicians identify low-risk patients who can safely have nighttime vital-sign checks discontinued.
Citation: Najafi N, et al. Effectiveness of an analytics-based intervention for reducing sleep interruption in hospitalized patients: a randomized clinical trial. JAMA Intern Med. 2022;182(2):172-177. doi: 10.1001/jamainternmed.2021.7387. PMID: 34962506; PMCID: PMC8715385.
Dr. Scaletta is a hospitalist at Denver Health, Denver, and an assistant professor in the division of internal medicine, at the University of Colorado School of Medicine.