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Research Snapshot Theater: Quality and Patient Safety, Pediatric I

Nighttime Routine and Nonpharmacologic Interventions for Improved PICU Sleep

Sunday, March 22, 2026
2:30 PM - 3:30 PM Central Time
Location: Connections Central - RST 10

  • Laxmi M. Vemuri, DO

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • PC

    Poojita Chinmay, B.A.

    Medical Student
    Medical College of Georgia at Augusta University

    Disclosure information not submitted.

  • RV

    Robert M. VanBrackle, Jr., B.B.A.

    Medical Student
    Medical College of Georgia, Georgia

    Disclosure information not submitted.

  • PG

    Philippe Gaillard, Ph.D.

    Associate Professor
    Dept. of Biostatistics, Data Science and Epidemiology at Augusta University

    Disclosure information not submitted.

  • SR

    Seth Rozelle, B.S.

    Doctoral Candidate
    Dept. of Biostatistics, Data Science and Epidemiology at Augusta University

    Disclosure information not submitted.

  • AF

    Ashley D. Freeman, MD

    Associate Professor
    Medical College of Georgia at Augusta University

    Disclosure information not submitted.

Introduction: Sleep interruption has a significant effect on the recovery of patients in critical care; despite this, sleep is frequently disturbed due to clinical needs and environmental conditions. The objective of this study is to determine if the implementation of a quality improvement project in the PICU aimed at minimizing sleep disruptions with a protected sleep period, can reduce the number of labs drawn during this time frame by 50%.


Methods: A nighttime sleep protocol was initiated in the PICU in June 2024 with a protected sleep period from 2200 to 0500. As part of the protocol, overnight labs, defined as those drawn between 2200 to 1000, were to be done at 0500 or later for patients who qualified. Patients on titratable vasoactive medications, ECMO, or admitted for diabetic ketoacidosis (DKA) were excluded. We performed a retrospective cohort study of PICU patients, birth to 21 years old, from March 2024 to September 2024, encompassing pre- and post-protocol implementation periods. We analyzed the proportion of overnight labs taken within the protected sleep period over the first two 24-hour periods of patients’ admission. Secondarily, we analyzed if labs done in the protected sleep period were within 12 hours of admission.


Results: Analysis included 266 patients and 375 individual lab draws (159 pre-protocol implementation and 216 post-implementation). Pre-protocol, 92.5 % (147/159) of labs were obtained during the protected sleep period, with a significant reduction post-protocol implementation to 66.2% (143/216), p < 0.001 and 95% CI [0.188 – 0.338]. Of all first 24-hour labs done within the protected sleep period, 52.6% were within 12 hours of admission. However, when comparing the first and second 24 hours of data, the percentage of labs obtained within the protected sleep period did not significantly vary (p > 0.05) for either pre- or post-protocol.


Conclusions: Implementation of a PICU sleep protocol led to a statistically significant decrease in labs drawn within the protected sleep period. Proximity to admission did not significantly affect rates of obtaining labs in the protected sleep period. Next steps include continued education regarding the sleep protocol and exploring barriers to compliance, to see if we can further reduce the number of labs drawn in the protected sleep period.