# Improving Sleep Quality on the First Postoperative Night in the Intensive Care Unit: A Quality Improvement Initiative

## TL;DR

This study tested a low-cost bundle of interventions to improve sleep quality for ICU patients on their first postoperative night, finding modest improvements without increasing staff workload.

## Contribution

A multimodal, low-cost sleep bundle was developed and tested in the ICU setting with real-time adaptation using data analysis.

## Key findings

- Patient-reported sleep quality increased from 5.0 to 5.4/10 after implementing the sleep bundle.
- Nurse-perceived sleep quality showed favorable variation after streamlined surveillance protocols.
- No increase in staff workload or adverse events was observed with the interventions.

## Abstract

Background

Sleep disruption in critically ill patients is common and associated with delirium, immune dysfunction, and reduced quality of life. The first postoperative night in the intensive care unit (ICU) is particularly challenging due to pain, anxiety, and frequent care. No intervention has yet reliably improved sleep for this population.

Methodology

We conducted a quality improvement project with six Plan-Do-Study-Act cycles over seven months. Postoperative adult patients admitted before 21:00 were eligible, with exclusions for instability or factors precluding reliable self-report. The primary outcome was patient-reported sleep quality (1-10 scale) the morning after ICU admission. Secondary outcomes included nurse-perceived sleep quality, sleep quantity, and patient satisfaction. Balancing measures included nurse workload and adverse events. Control charts were used to assess variation. Interventions included staff engagement, earplugs/eye masks, standardized door closure, pain management review, noise monitoring, simplified surveillance protocols, and melatonin.

Results

A total of 69 patients were recruited (23 pre-interventions, 46 during interventions). Patient-reported sleep quality increased from 5.0 to 5.4/10 after culture shift promotion. Nurse-perceived sleep quality had a favorable special cause variation after streamlined surveillance protocols. No increase in workload or adverse events occurred. The initial survey identified intermittent pneumatic compression devices as sleep disruptors, and the interim analysis showed that an epidural was associated with poorer sleep.

Conclusions

A multimodal, low-cost sleep bundle modestly improved sleep without increasing staff burden. Periodic data analysis supported real-time adaptation and may benefit similar initiatives. Future work should explore sustainability and impact on recovery.