For the past few days, we have been deprived of 600 hospital beds in Quebec, the equivalent of two hospitals across the province. Lack of nursing staff, closure of designated beds: all the ingredients are currently in place to cause a bottleneck in hospital capacity. Failing to obtain a bed in a care unit, many patients will have to resign themselves to sleeping in the emergency room, in conditions not conducive to rest. Constant noise, bright light, absence of pillows, lack of privacy… To believe that sleeping in the emergency room is almost an inaccessible dream.
As a researcher, I am interested in the benefits of sleep, and more specifically its role in recovery during and after health problems requiring critical or specialized care. I have collaborated on several book chapters and professional articles on this subject. An important part of my research program focuses on sleep after traumatic brain injury or in the context of chronic illness — two conditions well represented among emergency room stretcher patients.
The results of my work, combined with evidence emerging internationally, corroborate the observations made by health professionals, namely that emergency patients sleep poorly. Indeed, patients who spend the night in the emergency room have a much lower quality sleep than patients who sleep in hospital beds, and even less than those who sleep at home the days preceding hospitalization. Unfortunately, this lack of sleep is not without consequences for the patient and his family.
Sleep, a necessity to prepare for an operation and for the elderly
Because sleep is essential for our ability to tolerate stress, lack of rest in the ER directly impairs recovery in the hospital. For people awaiting surgery, insufficient sleep promotes high anxiety, lowers pain tolerance and increases daytime sleepiness. These elements combined lead to a loss of function and complicate the resumption of postoperative activities.
In the elderly, a stay of more than 12 hours in the emergency room is an independent risk factor for the development of an acute confusional state. Although several factors can cause this condition, sleep fragmentation in the emergency room, even for a short period of time, plays an important role in its onset. The occurrence of a confusional state in the elderly predisposes to intra-hospital mortality, doubles the length of hospital stay and increases the risk of developing dementia in the 48 months following hospitalization.
Given the importance of sleep in the first hours of hospital admission, we no longer have the luxury of overriding this fundamental need in our emergency care practices. Just as it would not come to the idea of not providing meals to people waiting for a bed, the implementation of measures to promote sleep in this sensitive sector must become automatic.
Valuable findings and an opportunity to seize
In the coming months, when we take stock of the lessons learned during the pandemic and when we will be busy rebuilding practices, more emphasis will have to be placed on the promotion of sleep in the provision of care. Although this may require organizational changes, solutions exist and are within our reach.
For example, on April 13, the Jewish General Hospital announced the deployment of a home hospitalization program. As part of this pilot project, patients requiring acute care for a known health problem (diabetes, heart failure, etc.) and requiring few new investigations, will be able to recover completely, and thereby sleep, in the comfort of their home. Here is a concrete example of how technology can be used to optimize rest and recovery for patients admitted to the emergency department.
Until our healthcare system is better equipped technologically, very simple measures can be taken on a smaller scale. Indeed, noise, light and the discomfort of the stretcher are the main barriers to obtaining quality sleep in the emergency room. In Spain, settings that have implemented systematic protocols to reduce noise and light at night have reported a significant improvement in sleep quality among patients waiting for a bed in the emergency room.
Until this type of protocol is more common in Quebec, it would not be a bad idea to bring earplugs, an eye mask and a pillow if you or your loved one have to spend the night in the emergency room. If you can’t dream in color, you will at least have the comfort of doing something to optimize your return to health.