Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Catching Zzzs


Many traditional practices, like pre-dawn pre-rounding, disrupt patient sleep. Prioritizing patient comfort can be a form of compassion and contribute to healing. 

As a resident physician and a parent to two young children, I’ve had my fair share of abrupt awakenings over the past few years. The piercing sound of a pager on a 24-hour call shift. The cries of my newborn, begging to be held and fed for the umpteenth time that night. My preschooler wordlessly standing at the side of the bed, waiting for me to wake up to the sound of her sniffles, to ask for her blankets to be straightened. With each sleep interruption, I can almost feel the frown lines on my face deepening and DNA strands shortening.  


I’m not my best, most patient and receptive self when frequent wakings punctate a much-needed period of sleep, and science agrees: even in healthy individuals, the short-term consequences of sleep disruption include a heightened stress response, increased pain levels, depression and anxiety symptoms, and deficits in cognition, memory, and problem-solving. So, why does our approach to routine patient care in the hospital necessitate so much unrelenting disruption to our patients and their families’ sleep?  


Of course, nighttime medication administration, scheduled vital checks, and early morning lab draws are essential for providing safe and effective medical care. I also understand that OR suites appropriately operate in the early morning hours. However, the culture of medicine has normalized pre-dawn pre-rounds to maximize the efficiency of medical team rounds. Eager, well-intentioned medical students are sent to conduct full physical exams and earnestly ask, “What questions do you have?” before the patient has even rubbed the sleep from their eyes. New interns follow suit and then the upper-level resident comes in to ensure that everyone has the same story to present to the attending physician. Pre-rounds were essential when lab values were stored on paper records within the lab and intake/output flowsheets were kept in the patient’s room. Now that this information lives within the EMR and on smart phone apps, I wonder why we insist on maintaining a ritual that reinforces unfiltered access to patients at the expense of their comfort and healing. 


I think the answer lies in the expanding complexity and logistics of modern medicine. However, the focus on efficiency and immediacy diverts from our true purpose of facilitating healing, comfort, and human connection. Allowing patients to sleep unperturbed, amid the frequent vitals and nursing assessments, shouldn’t be admonished as a failure to perform pre-rounding duties. Instead, it should be hailed as a small act of compassion and adaptability, and a rebuttal towards our ever-growing focus on “efficient” medical care.  


Maybe we could utilize EMR-based event logs and MARs to study when PRN analgesics were administered to speak toward level of pain control. We could ask all patients and loved ones at the time of admission their personal preferences on being woken up for a few early morning questions about illness progression, or if they would prefer to sleep until full morning rounds. It’s not the patient’s job to make our day-to-day routine easier or more comfortable for us. Instead, we have all taken an oath to do so for them.  


Several attending physicians have warned me of the dangers of making the hospital environment too comfortable because patients will never want to leave. I acknowledge that feelings of safety are natural consequences of kindness and hospitality. Perhaps our field should consider that the linguistic roots of “hospital” and “hospitality” are the same: to house and care for guests.  


By prioritizing sleep for patients, we can create a healthcare environment that fosters healing, reduces stress, and improves overall health outcomes. Implementing pilot programs to test alternative information gathering methods and incorporating patient preferences into sleep routines are crucial steps towards this goal. Ultimately, a shift in perspective—from efficiency to compassionate care—can revolutionize the way we approach patient well-being in hospitals. 








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.