Improving Sleep by Minimizing Unnecessary Overnight Vital Signs in Hospitalized Patients

BACKGROUND: The sleep of hospitalized children is frequently interrupted by vital sign (VS) measurements. We aimed to increase the proportion of patient-nights with 1 or fewer overnight VS measurements. METHODS: This study included all patients admitted to general medicine services at a university-affiliated free-standing children's hospital. Iterative interventions included rounding checklist and VS order changes within the electronic health record. Our primary outcome measures were a composite of all overnight VS measurements, as well as blood pressure (BP) measurements individually. Balancing measures included rapid responses and intensive care unit (ICU) transfers. We used statistical process control charting to analyze outcomes over time and assessed for inequities based on race, ethnicity, and language of care using a generalized linear mixed-effects model. RESULTS: Our preintervention period included 4292 patients and 15 721 patient-nights between January 1, 2022, and February 15, 2023, and our postintervention period included 4354 patients and 18 584 patient-nights between February 16, 2023, and March 15, 2024. Patient-nights with 1 or fewer composite VS measurements increased from 11% to 18% but ultimately regressed to baseline. Patient-nights with 1 or fewer BP measurements increased from 36% to 69%. There were no increases in rapid responses or ICU transfer postintervention. Non-Hispanic white patients had higher odds of 1 or fewer overnight VS measurements (odds ratio OR, 1.21; 95% CI, 1.07-1.37) as did patients with English as their language of care (OR, 1.28; 95% CI, 1.06-1.54). CONCLUSION: Iterative interventions resulted in fewer overnight BP measurements but changes in the composite VS measure were not sustained. The disparities noted in overnight VS measurements warrant attention.