Becker's Clinical Quality & Infection Control

13 QUALITY IMPROVEMENT & MEASUREMENT Nurse-led sleep protocol raises HCAHPS measure 8%, cuts 896 sitter hours By Paige Twenter A nurse-driven inpatient sleep protocol raised Hospital Consumer Assessment of Healthcare Providers and Systems nighttime quietness scores 8.47% and reduced sitter hours by 896 over seven months, according to a study published June 23 in Cureus. Researchers at UC San Diego Health and UC San Diego School of Medicine enrolled 92 medical-surgical inpatients across three sequential cohorts: standard care, a nurse-only intervention and a combined nurse-physician intervention. The nurse-led protocol paired nightly sleep rounds with a personalized sleep hygiene menu covering environmental adjustments, comfort measures and relaxation aids. Hospitalists in the combined cohort additionally modified overnight order sets to limit nonurgent vital sign checks, lab draws and medication administrations during a protected sleep window from 10 p.m. to 6 a.m. The experiment yielded more than $21,000 in cost savings over that seven-month period, according to the study. Both intervention groups significantly outperformed controls across all sleep quality metrics — depth, onset time, overnight awakenings and return to sleep — with no statistically meaningful difference between the two intervention arms. The authors concluded that physician order modifications provided no incremental benefit beyond nursing-led protocols alone, positioning inpatient sleep hygiene as a high-value, nurse-driven lever for patient experience scores and unit-level cost reduction on medical-surgical floors. n 2 health systems build new call coverage models By Paige Twenter H ospitals across the country are finding that traditional call coverage models are no longer enough. Clearwater, Fla.-based BayCare Health System and Midland-based MyMichigan Health are reworking the formula. e two health systems are deploying different models to keep specialty access intact: one building a network of specialty hospitalists, and another pooling call responsibilities across a rural footprint. Splitting the work: e specialty hospitalist BayCare Health System has extended the hospitalist concept, once reserved for internal medicine, to other specialties including OB-GYN, neurology and palliative care. GI, orthopedics and oncology are currently under development. e driving force, according to Sowmya Viswanathan, MD, executive vice president and chief physician executive for BayCare Health System, was call coverage strain. A generational shi has kept the momentum going. "We are hearing from many of the new graduates who are coming out who are looking for that work-life balance," Dr. Viswanathan told Becker's in January. "ey're saying, 'We don't want to take call coverage anymore for the hospital. I like to be an ENT, but I really don't want to come into the hospital.'" BayCare's approach is specialty-specific. An obstetrics hospitalist needs surge staffing for unpredictable overnight deliveries, while a neurology hospitalist can generally follow a one-week-on, one-week-off rotation. Compensation structures differ accordingly, and BayCare is still calibrating pay models for newer programs like GI. "We don't have a cookie-cutter model that works for every specialty," Dr. Viswanathan said. One early concern — that hospitalists themselves would burn out — has been addressed through flexible scheduling. Obstetric hospitalists who once lasted two years in the role are now staying five to seven. Dr. Viswanathan noted other systems are pursuing a similar expansion, and described the broader trend as a quiet transformation already underway across specialties. "Every specialty is moving in that direction, one way or the other," she said. Stretching coverage across geography: e pooled call model MyMichigan Health takes a different approach suited to its geography. e system serves 26 counties across Michigan and built a pooled call model that redistributes specialist availability across hospitals using a hub-and- spoke structure. Under the model, hospital specialists field aer-hours telehealth consults for surrounding community facilities. Hospitalists manage and stabilize patients overnight, and the local specialist resumes care the next morning. e system has run the model for 18 to 24 months across cardiology, orthopedics and medical oncology, with GI and urology in development. e new call structure has aided recruitment. Going from a 1-to-2 or 1-to-3 call ratio to 1-to-5 or 1-to-6 through pooled coverage has proven a meaningful differentiator in a competitive market, according to Sunita Vadakath, MD, senior vice president and chief strategy officer at MyMichigan Health. "If you're doing a 1-in-2 or 1-in-3 call, and you have the option to slip into a community call model that could potentially take that up to 1-in-5 or 1-in-6 … that is something that is very attractive to specialists," Dr. Vadakath said. Initial physician skepticism, which Dr. Vadakath likened to pre-COVID resistance to telehealth, has largely flipped. Some physicians now actively seek entry into the model. Hard constraints are trauma regulations and ST- segment elevation myocardial infarction care protocols, which require in- person presence and limit which specialties can participate. For systems considering the approach, Dr. Vadakath's core advice is to involve physicians before the model is built, not aer. n

• Cover