Abstract
Background
Circadian rhythms are endogenous 24-hour oscillations in biologic processes that drive
nearly all physiologic and behavioral functions. Disruption in circadian rhythms can
adversely impact short- and long-term health outcomes. Routine hospital care often
causes significant disruption in sleep-wake patterns that is further compounded by
loss of personal control of health information and health decisions. We wished to
evaluate measures directed at improving circadian rhythm and access to daily health
information on hospital outcomes.
Methods
We evaluated 3425 consecutive patients admitted to a medical-surgical unit comprised
of an intervention wing (n = 1185) or standard control wing (n = 2240) over a 2.5-year
period. Intervention patients received measures to improve sleep that included reduction
of nighttime noise, delay of routine morning phlebotomy, passive vital sign monitoring,
and use of red-enriched lighting after sunset, as well as access to daily health information
utilizing an inpatient portal.
Results
Intervention patients accessed the inpatient portal frequently during hospitalization
seeking personal health and care team information. Measures impacting the quality
and quantity of sleep were significantly improved. Length of stay was 8.6hours less
(P = .04), 30- and 90-day readmission rates were 16% and 12% lower, respectively (both
P ≤ .02), and self-rated emotional/mental health was higher (69.2% vs 52.4%; P = 0.03) in the intervention group compared with controls.
Conclusions
Modest changes in routine hospital care can improve the hospital environment impacting
sleep and access to health knowledge, leading to improvements in hospital outcomes.
Sleep-wake patterns of hospitalized patients represent a potential avenue for further
enhancing hospital quality and safety.
Keywords
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References
- Post-hospital syndrome—an acquired, transient condition of generalized risk.New Engl J Med. 2013; 368: 100-102
- Circadian clocks: regulators of endocrine and metabolic rhythms.J Endocrinol. 2007; 195: 187-198
- Circadian clock proteins and immunity.Immunity. 2014; 40: 178-186
- A circadian gene expression atlas in mammals: implications for biology and medicine.Natl Acad Sci USA. 2014; 111: 16219-16224
- Circadian actin dynamics drive rhythmic fibroblast mobilization during wound healing.Sci Transl Med. 2017; 9 (eaa12774)
- Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα antagonism: a single-centre propensity-matched cohort study and a randomised study.Lancet. 2017; 391: 59-69
- The missing link: bridging the patient-provider health information gap.Health Aff. 2005; 24: 1290-1295
- Patient engagement in the inpatient setting: a systematic review.J Am Med Inform Assoc. 2014; 21: 742-750
- Lack of patient knowledge regarding hospital medications.J Hosp Med. 2010; 5: 83-86
- Hospitalized patients' understanding of their plan of care.Mayo Clin Proc. 2010; 85: 47-52
- Effect of light on human circadian physiology.Sleep Med Clin. 2009; 4: 165-177
- Chronobiology: stepping out of time.Nature. 2013; 497: S10-S12
- Multi-parameter vital sign database to assist in alarm optimization for general care units.J Clin Monit Comput. 2016; 30: 895-900
Weller RS, Foard KL, Harwood TN. Evaluation of a wireless, portable, wearable multi-parameter vital signs monitor in hospitalized neurological and neurosurgical patients [e-pub ahead of print]. J Clin Monit Comput. doi: 10.1007/s10877-017-0085-0, accessed May 18, 2018.
- Validation of a combined comorbidity index.J Clin Epidemiol. 1994; 47: 1245-1251
- How to measure comorbidity: a critical review of available methods.J Clin Epidemiol. 2003; 56: 221-229
- Circadian chemotherapy for gynecological and genitourinary cancers.Chronobiol Int. 2002; 19: 237-251
- Implications of circadian clocks for the rhythmic delivery of cancer therapeutics.Adv Drug Deliv Rev. 2007; 59: 1015-1035
- Morning vaccination enhances antibody response over afternoon vaccination: a cluster-randomised trial.Vaccine. 2016; 34: 2679-2685
- Perspective: casting light on sleep deficiency.Nature. 2013; 497: S13
- The impact of shift and night work on health.Appl Ergon. 1996; 27: 9-16
- Prevalence of healthy sleep duration among adults–United States, 2014.MMWR. 2016; 65: 137-141
- Incidence of myocardial infarction with shifts to and from daylight savings time.Am J Cardiol. 2013; 111: 631-635
- Changes in ischemic stroke occurrence following daylight saving time transitions.Sleep Med. 2016; 27-28: 20-24
- Daylight savings time and traffic accidents.New Engl J Med. 1996; 334: 924
- Fatal accidents following changes in daylight savings time: the American experience.Sleep Med. 2001; 2: 31-36
- Intrinsically photosensitive retinal ganglion cells.Rev Physiol Biochem Pharmacol. 2012; 162: 59-90
- The circadian response of intrinsically photosensitive retinal ganglion cells.PloS One. 2011; 6: e17860
- Overview of circadian rhythms.Alcohol Res Health. 2001; 25: 85-93
- Attenuation of short wavelengths alters sleep and the ipRGC pupil response.Ophthalmic Physiol Opt. 2017; 37: 440-450
- Hospital noise—levels and potential health hazards.New Engl J Med. 1973; 289: 774-781
- Noise and sleep among adult medical inpatients: far from a quiet night.Arch Int Med. 2012; 172: 68-70
- Sleep disruption due to hospital noises: a prospective evaluation.Ann Int Medi. 2012; 157: 170-179
- Guidelines for community noise.World Health Organization, Geneva, Switzerland1999
- Sound control for improved outcomes in healthcare settings.Center for Health Design, Concord, CA2007
- The triple aim: care, health, and cost.Health Aff. 2008; 27: 759-769
- Enabling patient-centered care through health information technology.Evidence report/technology assessments no 206. Agency for Healthcare Research and Quality, Rockville, MD2012
- Patients' perception of hospital care in the United States.New Engl J Med. 2008; 359: 1921-1931
- The relationships between HCAHPS communication and discharge satisfaction items and hospital readmissions.Pat Exp J. 2014; 1: 71-77
Article info
Publication history
Published online: May 02, 2018
Accepted:
April 16,
2018
Received in revised form:
March 15,
2018
Received:
February 6,
2018
Footnotes
☆Funding: None.
✯✯Conflicts of Interest: None.
✯Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
