Surgeons Urge a Culture Shift to Protect Sleep in the Hospital
The importance of sleep has been well studied, it’s necessary for healing. Yet fractured and broken sleep is expected, even normalized, in the hospital—the place where it’s needed most.
Recently, an article in the New York Times pondered the question: “What if sleep were considered a continuous infusion of a medication that helped patients heal faster?”
Studies have shown that sleep disruption affects wound healing. Sleep is critical to our health, to pain management, and our ability to retain important information. But how do hospitals improve current systems to prioritize restful sleep?
“Sleep should be prioritized over testing, when appropriate, but even better—testing can be changed to prioritize sleep,” says colorectal surgeon Debby Keller, MD. “It's absurd that we routinely wake up a recovering patient multiple times throughout the night for vital signs, scheduled medications, lab work, and multiple exams from the rounding team.”
“It’s a combination of coordination at the local level [the hospital], but also organizational changes nationally,” adds breast surgeon Michelle Azu, MD. “We definitely have an ‘order’ then ‘do’ culture, but it’s because typically we want to provide care as fast as possible. Triaging priorities is a good idea.”
With so many patients to care for, hospital wards can be noisy at all hours. The intense pace and volume of healthcare often disrupts quiet hours for individuals who require testing as well as others asleep nearby. Thoughtfulness from providers is crucial, but hospitals themselves lack noise protection.
“There needs to be a redesign in hospital wards, where the rooms and common facilities are soundproof, comfortable, and designed for recovery,” says Dr. Keller. “This culture change, with reducing activity and noise from staff and machines, as well as the times patients are woken up for testing and exams, would improve sleep.”
“If routine exams and testing can be saved until the morning then that would be ideal,” says Dr. Azu. “But there isn’t necessarily a simple solution.”
“Actual thought to if the activity will disturb the patient during peak sleep time really needs to be done,” adds Dr. Keller. “Protocols should be revised with a patient focus.”
Patient protocols are created to maximize clinical effectiveness and generate good outcomes, a critical pursuit, but running the checklist can skew the perspective of the provider on duty–particularly if they are chronically sleep deprived themselves.
“Normalization of sleep deprivation is not a good thing for patients or providers,” says Dr. Azu.
When researchers surveyed medical interns before and after their first year of residency in internal medicine in 2002, the prevalence of chronic sleep deprivation climbed from 9 percent to 43 percent. Emotional exhaustion soared from 8.5 percent to 68 percent. Empathic concern dropped, while moderate depression and burnout spiked.
Prioritizing restorative sleep requires a two-fold culture shift: thoughtful consideration of patients’ needs, and systemic support for providers to get quality sleep on a regular basis too.
Dr. Azu and Dr. Keller note that research around the impact of sleep, particularly the lack of it, is starting to evolve standards and practices on both sides of the healthcare system, albeit slowly.
“Sleep is a tenet of the prehabilitation program we use for elective colorectal surgery patients and the importance is stressed throughout the surgical process,” says Dr. Keller. “It does make a difference for patients and patient support to hear that sleep—where the patient can rest and reset—is essential for preparation and recovery.”
Given the evidence of the effects of sleep deprivation on humans’well-being and performance, like the ability to empathize and perform tasks with speed and accuracy, limits on work hours have been implemented during the grind of medical residency, but little beyond.
“There have been significant changes for resident work hour restrictions, but there are no work hour restrictions for attendings,” says Dr. Azu. “Perhaps there should be.”
“Pilots have limited work hours to allow for safety of passengers, flight crew, and themselves,” she adds. “Physicians have none.”
A good night’s sleep is no luxury; it’s the foundation of health and healing. Hospitals should lead the charge by making rest a priority.