Promoting Sleep for Neurology Inpatients

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Abstract
Sleep is a critical component of health and recovery. Awakening sleeping patients for routine vital sign monitoring overnight is a common inpatient practice, but its benefits are uncertain. This study asked 3 questions: (1) How often are routine overnight vital signs abnormal? (2) How often are those abnormal vital signs clinically actionable? (3) Are there patients who may not need routine overnight vital sign monitoring? We analyzed observational retrospective data extracted from electronic health records of patients admitted to inpatient neurology floors at our institution between 2017 and 2024. We defined routine vital signs as collected by nursing assistants at least 3 hours apart. The outcome measure was an urgent clinical action (stat orders, rapid responses, or transfers to a higher level of care) within 1 hour of vital sign events. We compared the rate of urgent clinical actions after abnormal vital signs with the base rate of those events after normal vital signs. Statistical analysis used generalized estimating equations to account for repeated measures. We analyzed 102,184 routine vital sign events from 5,569 neurology admissions. In total, 9% of vital sign events were abnormal. The likelihood of urgent clinical actions increased after abnormal vital sign events, compared with after normal vital sign events during the day (4.3% vs 2.4%, odds ratio (OR) 1.8 [1.6-2.1]); at night (2.4% vs 0.9%, OR 2.8 [2.2-3.7]); during the night in low-risk patients with normal daytime vitals (2.0% vs 0.7%, OR 3.0 [1.8-4.9]); and at night in high-risk patients with abnormal daytime vitals (2.6% vs 1.1%, OR 2.5 [1.7-3.6]). The number needed to treat (NNT), i.e., the number of vital sign events needed to initiate 1 extra urgent clinical action above the base rate, was 1,856 [943; 4,598] in low-risk patients. The NNT for low-risk stroke patients was 1,570 [679; 4,707] and for general neurology patients was 2,231 [797; 5,423]. Urgent clinical actions attributable to abnormal routine vital signs were uncommon in neurology inpatients, especially overnight in patients with normal daytime vital signs. Determining the risks and benefits of routine overnight vital sign monitoring will help hospitals and health care providers move toward more patient-centered inpatient neurologic care.

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