By Madeline Kennedy
October 22, 2015

NEW YORK (Reuters Health) - Interrupted sleep and withholding of food can make hospitalized patients sicker, according to three U.S. physicians who say patient safety in hospitals is not just a matter of preventing falls and infections.

In a Viewpoint paper online September 8 in BMJ Quality and Safety, they point out that adequate sleep and nutrition are key to keeping the immune system strong, but noisy hospital conditions and long wait times may be compromising the body's defenses.

The authors, all from Johns Hopkins Hospital in Baltimore, say poor nutrition, present in up to half of all hospital patients - can contribute to inflammation, muscle breakdown, and organ damage.

Sleep and nutrition have always been an issue in hospitals, but longer wait times make the problem worse, coauthor Dr. Martin Makary, a surgeon, health policy researcher, and author of "Unaccountable," a book about transparency in medicine, told Reuters Health by email.

Today, "hospitals are busier and as a result we are seeing longer wait-lists for procedures, diagnostic testing, and inpatient transfers such as from the ER," Dr. Makary said.

The authors give an example of a woman who comes to a hospital with pneumonia. Though she has not been eating well for a few days due to not feeling well, she is placed on a no-food plan in case anesthesia is needed. While she waits to be evaluated, she may spend many hours in a shared room with beeping noises and people talking, resulting in highly interrupted sleep.

She might wait up to 12 hours to get a procedure, only to continue without food in case another procedure is needed. She may not sleep well or receive food for multiple days, eventually breaking her fast with low-quality hospital food. After being discharged in a weakened state, she soon ends up back in the hospital with the same symptoms as before.

Dr. Makary said the standard practice of having patients abstain from eating for at least eight hours before surgery isn't based on facts.

He called this eight-hour timeline a "myth." He and his colleagues say current research suggests it's safe to drink a high-carbohydrate drink two hours before surgery.

"We and several other centers have begun to make this our routine practice as of this year," he said.

"As for sleep deprivation, there are alarms and devices that make constant noise, which makes sleeping difficult for even a healthy person," and patients can be woken many times during the night for urine samples or blood cultures, said Dr. Ken Lee, who also studies patient safety and quality of care at Johns Hopkins but wasn't an author on the paper.

The authors suggest giving patients noise-cancelling headphones and eye masks to reduce the effect of the jarring environment.

"We are so focused on providing the best treatment for our patients' illness that we often forget their human needs," added Dr. Lee.

Dr. Makary said patients should be allowed to bring food that they like so that they do not have to rely on hospital food.

He also urges patients: "Ask your hospital about participating in new ERAS (Enhanced Recovery After Surgery) protocols and if they can help make rest a goal during any medical recovery."


BMJ Qual Safety 2015.