749 - Promoting a sleep-friendly environment by minimizing overnight room entries

Poster Number: 749
Publication Number: 749.119

Lauren M. McDaniel, Seattle Children's, Seattle, WA, United States; Nilesh Seshadri, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Elizabeth Harkins, Johns Hopkins Children's Center, Baltimore, MD, United States; Megan Keydash, JHH, Baltimore, MD, United States; Alice Pan, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Laura Sterni, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Shawn Ralston, University of Washington, Seattle, WA, United States

Background: Despite its importance in illness recovery, the sleep of hospitalized children is frequently interrupted.

Objective: This quality improvement intervention aimed to reduce overnight room entries by minimizing unnecessary overnight interventions.

Design/Methods: This study was conducted at a university-affiliated children’s hospital on the hospital medicine services from March 2021 through April 2022. The intervention included order set changes and the implementation of a rounding checklist designed to address factors most closely associated with sleep disruption and overnight room entries. The outcome measure was overnight (10pm to 6am) room entries, which were counted utilizing room entry sensors. Process measures reflected the intervention targets [overnight vital sign orders, medication administration, and intravenous fluid (IVF) use]. The method of analysis was statistical process control charting.

Results: After the identification of special cause variation, the average number of overnight room entries decreased from 8.2 to 6.5, a 21% decrease (Figure 1). This decrease tracked with the implementation of a rounding checklist. However, there continued to be variability in average room entries, suggestive of a process lacking ongoing stability. The only process measure with consistent evidence of uptake was avoidance of overnight IVF use with 31 patient-nights between orders for overnight IVF (Figure 2). 

Conclusion(s): The implementation of a rounding checklist applied to a broad patient population was effective at decreasing overnight room entries. However, future work is needed to better understand factors associated with reliably sustaining such an improvement.