Implementation of a Quiet-Time Protocol on a Post-Surgical Spine Unit

BACKGROUND: Rest is essential for healing the body, especially after spine surgery. While in the hospital, the patient’s sleep is interrupted by noise and staff coming in and out of the room throughout the day and night. These sleep disturbances can negatively affect the patient.

LOCAL PROBLEM: The project setting is a 23-bed post-surgical spine unit at a level-one trauma hospital, which is recognized for providing high-quality spine surgery care and an outstanding patient experience. The quiet score on the spine unit is 52%, lower than the national average of 62.0%.

METHODS: The Evidence-based Practice Improvement Model (EBPI) is valuable in helping achieve quality improvement goals and was used as the framework for this project. This allowed the use of plan-do-study-act (PDSA) cycles to improve clinical implementation. Pre and post-implementation data of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were collected to evaluate the effectiveness of a quiet time protocol on quiet scores in the spine unit.

INTERVENTIONS: A quiet time protocol was implemented for patients that fit the stakeholders' criteria. The protocol involved fewer interruptions throughout the night, reducing environmental stimuli, and keeping voices and noises low.

RESULTS: The quiet time protocol was implemented on 37% of patients seen for spine surgery. Quiet HCAHPS scores increased by 10% following implementation, improving to 61.54%.

CONCLUSIONS: Implementing a quiet time protocol on patients following spine surgery was not statistically significant; however, scores for quiet time increased between pre- and post-implementation, which indicates clinical significance. The sustainability of a quiet time protocol involves more stakeholder involvement and continuing staff education.