When was the last time you spent the night in the hospital, either as a patient or with family? What are your most sustained memories of the experience? A few months back, my wife and I spent a couple of bad nights in the hospital with my daughter. Things eventually resolved well, but my strongest memory of the incident (besides the stress) was being woken up every few hours for the nurses to check my daughter’s vital signs, change the IV bag, or check some other aspect of care. The constant interruptions prevented my sick kid from getting her much needed rest, and managed to make the nighttime seem so much longer.

It seems that when patients are in the hospital, the one thing they lack is peace. Poked and prodded, awoken at all hours, displaced for imaging and other testing, and interrupted by all manner of noises and strangers (including the doctors) – it’s no wonder patients dislike and fear hospitals. Despite the need to recover and deal with a serious illness, despite the anxiety, the one thing patients need and don’t receive, is a restful environment. Does it have to be this way?

I don’t think so. Many, if not most of our hospitals, are still living in the past with linoleum-lined institutional halls, multi-bed rooms, and constant interruptions. In some locations throughout the country, hospitals are progressively changing their appearance and protocols to better suit the needs of their patients. Let’s take a look at a few examples of changes that can improve our patients’ hospital stays.

Since I brought up vitals at the beginning, let’s start with that. How about simply holding vitals during a portion of the night to let the patient obtain a full night’s sleep? The vast majority of hospitals still have the every four hour vitals protocol. Would it be safe to stop vitals during the night? Yoder and colleagues performed a prospective cohort study of 54,096 consecutive in-patients to see if they could identify low-risk patients that might safely avoid nighttime vitals.¹

These researchers tracked the Modified Early Warning Score (MEWS), a guide to rapidly determine the degree of illness of a patient using several physiologic factors such as vital signs. A score of four or greater correlated with an increased need for interventions.² Lower scores, then, correlated with less need for interventions. They also examined the number of vital signs taken between 11 PM and 6 AM and the number of adverse events (ICU transfers or cardiac arrests) with an attempt to correlate these two factors. They found that almost half (45%) of all nighttime vital sign disruptions occurred in patients with a MEWS score of ≤1.¹ This study demonstrates that a significant number of patients could be left alone overnight without untoward consequences. It’s important to note that this study’s definition of complications were very severe (transfers to the ICU or cardiac arrests). Thus, it is likely that the number of patients that could be safely left alone overnight may actually be much higher.

A study by Pellicane found a similar conclusion. In this study, 50 patient charts in an inpatient rehabilitation ward were retrospectively reviewed for unanticipated transfer to acute care wards. In these patients in which vital signs were taken several times overnight, seven of them possessed vital sign abnormalities. The author concluded that checking vital signs overnight was not a legitimate screening tool for patient stability.³ There appears to be reasonable evidence that many of our patients do not need to be awoken overnight for vitals.

Similarly, if hospitals created protocols for other aspects, such as no overnight nonemergent blood draws, we could significantly improve the hospital experience. Another issue that often occurs is an alarm when an intravenous fluid bag is completed or the IV line becomes occluded. I suggest we convert all of these alarms to a telemetry-like system that would inform the nursing staff of these types of alarms instead of the patient hearing them. A slight improvement in technology could also add pre-alarm notifications similar to the gasoline level in your car. Instead of the patient having to listen to the alarm and wait for their busy nurse to come, that same nurse would be able to preemptively change the bag or unkink the IV line. In fact, with newer technology on the horizon, including wearable applications for vital signs and other data, we could continue to monitor important patient statistics overnight, and leave the patient in peace.

Imagine what the hospital experience will be like in the future when all patient information, including blood work, will be monitored from afar without bothering the patient. Perhaps then hospitalization will be a more restful and healthy experience than it is now.