The objective of this study was to understand the existing practices and attitudes regarding inpatient sleep at the 2020 US News and World Report (USNWR) Honor Roll pediatric (n = 10) and adult (n = 20) hospitals. Section chiefs of Hospital Medicine from these institutions were surveyed and interviewed between June and August 2021. Among 23 of 30 surveyed physician leaders (response rate = 77%), 96% (n = 22) rated patient sleep as important, but only 43% (n = 10) were satisfied with their institutions' efforts. A total of 96% (n = 22) of institutions lack sleep equity practices. Fewer than half (48%) of top hospitals have sleep-friendly practices, with the most common practices including reducing overnight vital sign monitoring (43%), decreasing ambient light in the wards (43%), adjusting lab and medication schedules (35%), and implementing quiet hours (30%). Major themes from qualitative interviews included: importance of universal sleep-friendly cultures, environmental changes, and external incentives to improve patient sleep.

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Sickle cell trait (SCT) has historically been considered a benign condition, but SCT-positive patients have increased baseline risk of venous thromboembolism and chronic kidney disease, as well as increased risk of sickled erythrocytes in settings of hypoxia, acidosis, and hypovolemia. Multisystem traumatic injuries are a common clinical scenario, in which hypoxia, acidosis, and hypovolemia occur; however, little is known about how SCT-positive status impacts outcomes in multisystem trauma. We conducted a scoping literature review to investigate what was known about SCT in the setting of multisystem trauma. In the 110+ years that sickle cell hemoglobinopathies have been known, only three studies have ever examined the relationship between SCT and multisystem traumas. All three articles were case reports. None of the articles intentionally measured the association between SCT and multisystem trauma outcomes; they only incidentally captured information on SCT. Our article then examines historical reasons why so little research has studied the pathophysiology of the multisystem trauma in patients with SCT. Among the reasons is that historical and logistical factors have long prevented patients from knowing their SCT-status: historical discriminations against SCT-positive patients in the 1960s and 1970s delayed federal mandating of SCT newborn screening until 2006, whereas difficulties communicating known SCT-status to afflicted children also contributed to lack of patient knowledge. In light of our findings, we offer specific calls to action for the trauma surgery research community: (1) consider testing for SCT in trauma patients that have unexpected complications, particularly venous thromboembolism, rhabdomyolysis, or renal failure and (2) support research to understand how SCT impacts multisystem trauma outcomes. We also offer specific guidelines about how to ‘proceed with caution’ in implementation of these goals in light of the troubled history of SCT testing and policy in the USA.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patient perceptions of hospital experience to determine the annual Center for Medicare and Medicaid Services (CMS) reimbursement. This study focuses on the “Quiet at Night” variable and identifies institutions with the highest scores to determine characteristics that facilitate patient sleep. The key findings were as follows: CMS Top Rated Hospitals have a mean score of 5 on the “Quiet at Night” variable. US News Honor Roll Hospitals have a mean score of 2.67, with a statistically significant difference of P < .001 between the groups. The key characteristics of the CMS Hospitals are that they are predominantly privately owned, specialized, surgical facilities with few total hospital beds. Knowing that HCAHPS scores directly impact and reflect patient experience, the objective of this study was to better understand the hospital practices that facilitate a high score on the “Quiet at Night” question to empower low scoring hospitals to improve their sleep practices at night and to score higher on the HCAHPS survey.

Introduction While sleep is critical for health, the hospital is not conducive to patient sleep and few efforts have been made to improve. The current practices to promote hospitalized inpatient sleep at highly-ranked hospitals are unknown. Methods A mixed-methods study of Hospital Medicine Section Chiefs at the 2020 US News and World Report Honor Roll pediatric and adult hospitals was conducted to understand the current practices and attitudes towards inpatient sleep between June and August 2021. An anonymous, quantitative survey was disseminated to quantify current practices and satisfaction with sleep-friendly institutional efforts. Survey participants were invited to share their institutions’ progress and potential ways to further improve inpatient sleep during structured, qualitative interviews. Results Pediatric (n=10) and adult (n=20) section chiefs were queried. Survey response rate was 77% (n=23/30; pediatric n=8/10; adult n=15/20). While 96% (n=22) of hospitalist leaders rated sleep as important, only 43% (n=10) were satisfied with their institution’s efforts to improve patient sleep. Although 91% (n=21) of hospitalist leaders rated sleep equity as important, one institution (4%) had practices in place to address the issue. Less than half (n=11) of institutions reported having sleep-friendly practices. Among these institutions, the most common practices included: reducing overnight vital sign monitoring (91%, n=10), decreasing ambient light in the wards (91%, n=10), adjusting lab and medication schedules (73%, n=8), and implementing quiet hours (64%, n=7). Twenty-seven percent of hospitalist leaders (n=8/30; pediatric interviews=3/10; adult interviews=5/20) participated in interviews. Themes included: the importance of having a sleep-friendly culture, environmental changes, modified hospital practices, and external incentives to improve patient sleep. Conclusion Hospitalists recognize the importance of improving patient sleep, but few institutions have sleep-friendly practices in place. Most institutions have no sleep health equity practices in place in their hospital. Building sleep-friendly hospital cultures and establishing best practices should be a priority for clinicians. Support (If Any) The authors thank the Society of Hospital Medicine and the Pritzker School of Medicine for funding support.