Improving Sleep Quality in Emergency Department Patients: A Multimodal Nonpharmacological Quality Improvement Initiative

ABSTRACT Background: Sleep disruption is common in emergency department (ED) patients, and those boarding in hallway beds face compounded barriers including persistent overhead lighting, ambient noise, staff activity, and thermal discomfort. Purpose: To improve patient-reported sleep quality among hallway patients at a community ED through a multimodal, nonpharmacological quality improvement (QI) intervention. Methods: This QI study was conducted in phases. Phase 1 (September-December 2025) established baseline sleep quality through a questionnaire in 44 ED patients: 32 hallway and 12 room-bed patients. A sleep bundle including a Bluetooth sleep mask, heating pad, and a multilingual patient education display was developed through iterative Plan-Do-Study-Act cycles. Phase 2 (January-April 2026) assessed outcomes in 22 hallway patients who received the bundle. Results: Postintervention hallway patients reported improvements across all measured domains. Cold discomfort decreased from 66% to 41%, light disturbance from 91% to 50%, and noise disturbance from 69% to 46%. Poor or very poor sleep decreased from 59% to 18%. Exploratory analyses showed significant improvement in sleep quality using a significance threshold of p < .05. Conclusions: A multimodal, nonpharmacological sleep bundle was feasible to implement in an ED hallway setting and was associated with improvements in patient-reported sleep quality. Sleep disturbance in this environment is modifiable through targeted environmental intervention. Implications: Simple comfort measures improve patient experience in overcrowded acute care settings. This project focused on hallway patients, but the same interventions may be adaptable for patients in ED beds. These findings support broader adoption of nonpharmacological sleep bundles in ED environments.