title: The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU.
abstract: OBJECTIVE
  To determine if a quality improvement intervention improves sleep and delirium/cognition.
  
  
  METHODS
  Observational, pre-post design.
  
  
  METHODS
  A tertiary academic hospital in the United States.
  
  
  METHODS
  300 medical ICU patients.
  
  
  METHODS
  This medical ICU-wide project involved a "usual care" baseline stage, followed by a quality improvement stage incorporating multifaceted sleep-promoting interventions implemented with the aid of daily reminder checklists for ICU staff.
  
  
  RESULTS
  Primary ICU outcomes were perceived sleep quality and noise ratings (measured on a 0-100 scale using the valid and reliable Richards-Campbell Sleep Questionnaire) and delirium/coma-free days. Secondary outcomes included ICU and hospital length of stay and mortality. Post-ICU measures of cognition and perceived sleep quality were evaluated in an ICU patient subset. During the baseline and sleep quality improvement stages, there were 122 and 178 patients, respectively, with more than one night in the ICU, accounting for 634 and 826 patient-days. Within the groups, 78 (63.9%) and 83 (46.6%) patients received mechanical ventilation. Over the 826 patient-day quality improvement period, checklist item completion rates ranged from 86% to 94%. In multivariable regression analysis of the quality improvement vs. baseline stages, improvements in overall Richards-Campbell Sleep Questionnaire sleep quality ratings did not reach statistical significance, but there were significant improvements in daily noise ratings (mean ± SD: 65.9±26.6 vs. 60.5±26.3, p = 0.001), incidence of delirium/coma (odds ratio: 0.46; 95% confidence interval, 0.23-0.89; p = 0.02), and daily delirium/coma-free status (odds ratio: 1.64; 95% confidence interval, 1.04-2.58; p = 0.03). Improvements in secondary ICU outcomes and post-ICU outcomes did not reach statistical significance.
  
  
  CONCLUSIONS
  An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.
authors: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.
authors: Biren B
authors: BB
authors: Kamdar
authors: Lauren M
authors: LM
authors: King
authors: Nancy A
authors: NA
authors: Collop
authors: Sruthi
authors: S
authors: Sakamuri
authors: Elizabeth
authors: E
authors: Colantuoni
authors: Karin J
authors: KJ
authors: Neufeld
authors: O Joseph
authors: OJ
authors: Bienvenu
authors: Annette M
authors: AM
authors: Rowden
authors: Pegah
authors: P
authors: Touradji
authors: Roy G
authors: RG
authors: Brower
authors: Dale M
authors: DM
authors: Needham
mesh_terms: D000328:Adult; D000368:Aged; D015142:Baltimore; D003071:Cognition; D003693:Delirium / Q000503:physiopathology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009623:Noise, Occupational; D017063:Outcome Assessment, Health Care / Q000379:methods; D036301:Qualitative Research; D058996:Quality Improvement; D012890:Sleep