Sleep ImprovementImproving Sleep for Older Adults in the Emergency Department

This quality improvement project aims to improve sleep for older adults during overnight stays in the Emergency Department. Older adults in the ED may experience prolonged stays while awaiting inpatient admission, and this period can involve sleep disruption, immobility, delirium risk, and physiologic stress. The first phase of the project will measure baseline sleep duration and related physiologic patterns among adults aged 70 years or older who are staying overnight in the ED and are admitted, or likely to be admitted, to Medicine.

Participants will be invited to wear a Fitbit Sense 2 device for approximately 24 hours. The device will collect sleep, heart rate, and activity data. Additional information will be collected through patient questionnaires and Epic chart review, including clinical and environmental factors that may affect sleep, such as ED location, overnight vital signs, bloodwork, imaging, medications, interventions, and delirium documentation. Fitbit data will be analyzed in aggregate and will not be used to guide real-time clinical care or flow into Epic.

After baseline sleep patterns and associated factors are better understood, the project will use quality improvement methods, including Plan-Do-Study-Act cycles, to introduce and evaluate practical sleep-improvement strategies through the Seniors Emergency Medicine Centre. Potential interventions may include reducing noise and lighting when clinically appropriate, providing sleep-support items such as earplugs and eye masks, using white noise, improving equipment and alarm management where safe, and considering sleep-promoting medications such as melatonin when appropriate. The primary outcome is total sleep time during the overnight ED stay, measured using Fitbit data. Secondary and balancing measures include patient satisfaction with wearing the Fitbit, delirium episodes, care delays related to sleep interventions, and staff feedback about workflow or device-related disruptions.

This project is intended to inform local improvements in care processes for older adults in the UHN Emergency Department and to support safer, more patient-centered overnight ED care. The QIRC submission identifies the project as a UHN quality improvement project focused on process change, information gathering, and evaluation, with an aim to improve overnight total sleep time for older adults by approximately one hour over six months after baseline measurement.