Change in EHR default orders helps reduce inpatient sleep interruptions

A tweak to default orders in the University of Chicago Medical Center’s electronic health records system is letting patients sleep more soundly at night.

Inpatient sleep deprivation is a serious problem at hospitals because of frequent nighttime awakenings by clinicians to measure vital signs or administer medications.

However, researchers at the University of Chicago Medicine conducted a prospective study—called Sleep for Inpatients: Empowering Staff to Act (SIESTA)—combining electronic “nudges” in the EHR to forgo nocturnal vitals and medications, as well as physician education on how to use the sleep-friendly tools in the Epic EHR system.

Results of the one-year study, which involved two 18-room general medicine units at the medical center, were published this month in the Journal of Hospital Medicine.

“The present SIESTA intervention demonstrated that physician education coupled with EHR default changes are associated with a significant reduction in orders for overnight vital signs and medication administration in both units,” according to the authors. “This study presents several implications for hospital initiatives aiming to improve patient sleep.”

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“Efforts to improve patients’ sleep are not new, but they do not often stick because they rely on staff to remember to implement the changes,” said Vineet Arora, MD, lead author and professor of medicine at the University of Chicago.

Part of the problem was that physicians did not know how to change the default vital signs order requiring them to be taken “every 4 hours” or how to batch-order morning phlebotomy at a time other than 4 a.m. Working with clinical informaticists as part of the study, researchers changed the EHR system’s default orders.

“Our study is consistent with other research highlighting the hypothesis that altering the default settings of EHR systems can influence physician behavior in a sustainable manner,” according to the authors. “However, our study also finds that, even when sleep-friendly orders are present, creating a sleep-friendly environment likely depends on the unit-based nurses championing the cause.”

“This illustrates the importance of engaging both nurses and physicians to create sleep-friendly environments in hospitals,” added Arora.