Hospitals are notoriously poor places for patients trying to sleep. Not only can they be noisy, but staffers taking vital signs or giving medications around the clock can make a good night’s sleep seem like a dream.
After Dr. Melissa Bartick of Cambridge Health Alliance experienced this firsthand as a patient in her own hospital, she and her colleagues tested a possible solution called the “Somerville Protocol,’’ named after Alliance member Somerville Hospital. Under the experimental regime, an eight-hour quiet period started at 10 p.m., announced with a Brahms lullaby and lights out. Patients’ medication and vital sign times were adjusted to avoid overnight interruptions and staffers made sure noise was kept down. Seriously ill patients were excluded.
The researchers compared patients before and after adopting the protocol, tracking how many patients needed sleeping pills at night (staff and patients didn’t know sedative use was being monitored), and how well patients slept. Before the protocol was tried, 32 percent of patients got as-needed sedatives, compared with 16 percent after. Both groups of patients said hospital staff’s interruptions disturbed their sleep the most, even more than discomfort from their illness. But the proportion who said staff bothered them the most fell from 42 percent before the protocol to 26 percent after.
BOTTOM LINE: Small adjustments to hospital routines for giving medications and taking vital signs can cut hospital patients’ sedative use.
CAUTIONS: Patients weren’t randomly assigned to get the protocol care or not, meaning there may be something different about individual patients that led to the results, rather than the protocol itself.
WHAT’S NEXT: Future research could determine whether improving sleep in the hospital affects recovery time, costs, or the prevalence of delirium and falls, two problems linked to taking sedatives.
WHERE TO FIND IT: Journal of Hospital Medicine, online, October
ELIZABETH COONEY 
