Deep sleep and beeps II: Sleep quality improvement project in general surgery patients

Robert W Allen; Robert D Shaw; Charles P Burney; Laura E Newton; Andrew Y Lee; Brooke G Judd; Srinivas Joga Ivatury

doi:10.1016/j.surg.2022.09.013

Deep sleep and beeps II: Sleep quality improvement project in general surgery patients

Surgery. 2022 Dec;172(6):1697-1703. doi: 10.1016/j.surg.2022.09.013. Epub 2022 Oct 28.

Authors

Robert W Allen¹, Robert D Shaw², Charles P Burney², Laura E Newton³, Andrew Y Lee³, Brooke G Judd⁴, Srinivas Joga Ivatury⁵

Affiliations

¹ Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: robertwaldoallen@gmail.com.
² Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
³ Geisel School of Medicine, Dartmouth College, Lebanon, NH.
⁴ Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Dartmouth College, Lebanon, NH; Sleep Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
⁵ Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin TX.

PMID: 38375787
DOI: 10.1016/j.surg.2022.09.013

Abstract

Background: Poor sleep leads to poor health outcomes. Phase I of our sleep quality improvement project showed severe sleep disturbance in the ward setting. We implemented a novel PostOp Pack to improve sleep quality.

Methods: Patients underwent elective, general surgery procedures. Fitbit trackers measured total sleep time. Patients completed the inpatient Richards-Campbell Sleep Questionnaire, which combines 5 domains into a cumulative score (0-100). Patients completed the outpatient Pittsburgh Sleep Quality Index preoperatively and postoperatively. Patients received the PostOp Pack, which included physical items and a sleep-protective order set to reduce nighttime awakenings. Patients from phase I served as the historical control. The primary outcome was the percentage of patients with Richards-Campbell Sleep Questionnaire total sleep score ≥50. The secondary outcomes included the mean Richards-Campbell Sleep Questionnaire domain scores and Fitbit total sleep time.

Results: A total of 49 patients were compared with 64 historical controls. The percentage of patients with a total sleep score ≥50 was significantly higher in patients receiving a PostOp Pack versus historical control (69% vs. 44%, difference 26%, 95% confidence interval 6.1-45%, P = .01). The mean Richards-Campbell Sleep Questionnaire Total Sleep Score was significantly higher in patients with a PostOp Pack (62 vs 49, mean difference 13, 95% confidence interval 6-21, P ≤ .01). The PostOp Pack Richards-Campbell Sleep Questionnaire domain scores were significantly higher in various areas: Sleep Latency (68 vs 49, P ≤ .01), Awakenings (56 vs 40, P = .01), Sleep Quality (61 vs 49, P = .02), and Noise Disturbance (70 vs 59, P = .04). Of all patients, 92% would use PostOp Pack again in a future hospitalization. No patients had a failure to rescue event with PostOp Pack. The mean total sleep time was significantly improved with PostOp Pack on night 1 (6.4 vs 4.7 hours, P = .03).

Conclusion: The PostOp Pack improves inpatient sleep quality and is safe.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Intensive Care Units
Quality Improvement
Sleep
Sleep Quality*
Sleep, Slow-Wave*
Surveys and Questionnaires