Irma D'Antonio, MSN, RN and Daniel W. Pitch, MD, DMD
The VOICE of UPMC Shadyside Winter 2017

Do Not Disturb

Shadyside Hospital Foundation grants lead to first-ever "sleep protection" breakthrough.

Despite efforts to keep busy hospitals as quiet as possible, they can be unavoidably noisy places. Patients, unfortunately, rarely get the sustained sleep that is so crucial for healing. This is a critical problem that Daniel W. Pituch, MD , DMD , past president of the UPMC Shadyside Medical Staff and section chief of Maxillofacial Surgery/Dentistry, is determined to solve.

“Our goal is to protect each patient’s sleep,” says Dr. Pituch. “Lack of sleep is a stressor that affects your entire body’s physiologic function.”

Now, with grants from the Shadyside Hospital Foundation and the assistance of Foundation-supported improvement specialist Irma D’Antonio, MSN , RN , Dr. Pituch is leading the development of a “first of its kind, do not disturb system that’s linked to the patient.”

Tackling a complex problem Physicians and nurses have long recognized that disturbances of patient sleep by hospital personnel can adversely affect recovery, but no one anywhere has yet implemented an effective solution.

Dr. Pituch and Ms. D’Antonio began the challenge of tackling this problem by using decibel meters to measure sound levels in various patient rooms. They also enlisted the help of Daniel J. Buysse, MD, an internationally recognized sleep expert at Western Psychiatric Institute and Clinic.

“We learned that the ultimate decibel level is not what’s really important for sustained sleep,” says Dr. Pituch. “What is important are spikes in decibel levels — interruptions that occur because of care at night, which causes patients to awaken.”

The next step was to try to figure out how to protect patients from being awakened, while still providing the care they need. Dr. Pituch worked with engineers to develop a small prototype sensor that can accurately measure brain waves to indicate when a patient is awake or asleep. This “Z-machine” links by Bluetooth to a tablet mounted outside the patient’s room. The tablet turns green when a patient is awake and red when she falls asleep. Yellow indicates that the patient has successfully received a certain amount of sleep but is still asleep.

“For the first time, we have a real-time visual display of what the patient’s sleep status actually is,” says Ms. D’Antonio.

Now in development is a ranking of care that could be given when the tablet is green, when it is yellow, and when it turns red. When the tablet is red, only critical care interventions would be permitted. Yellow shows that the patient has received a prescribed amount of sleep and could be disturbed with less critical intervention, but would still be allowed to sleep when possible. A green screen would allow all patient care to be delivered.

In addition, physicians would be able to place orders for their patients to get a certain number of hours of sleep.

“Lack of sleep is a stressor that affects your entire body’s physiologic function.”

“These solutions are truly unique,” Dr. Pituch states. “Nowhere in the world has technology like this been used to notify personnel of a patient’s sleep status and stratify patient care interventions based on sleep status or even to generally protect patient sleep.

“Nursing staff, physicians, surgeons, and technicians are appreciating how important sleep protection is for patients,” Dr. Pituch adds. “They are all supporting our research efforts.”

Next steps are to begin using the Z-machines to measure and record how much sleep patients actually get. “The goal is to move care and interventions around the patient’s sleep rather than our convenience,” Ms. D’Antonio says. “We are looking to protect sleep, because we understand how valuable that is to patient health and satisfaction, especially when the length of stay is longer.”

According to Dr. Pituch, “a review of the literature worldwide shows that nobody anywhere in the world is doing anything like this. It’s really groundbreaking, and we believe it can lead to a host of new opportunities to improve hospital care. I’m grateful to the Shadyside Hospital Foundation for supporting this project, and for supporting two full-time improvement specialists who make care safer and more efficient throughout UPMC Shadyside.”

G. Nicholas Beckwith III, chairperson of the UPMC Board of Directors, describes the sleep team’s work so far as “truly compelling. This is a wonderful example of how we can start tackling a problem that needs to be tackled, and needs to be cured.”