Division of Hospital Medicine Research and Educational Updates – November 2025

Message from Division Chief, Amber Inofuentes MD, Division of Hospital Medicine

Hospital Medicine’s inaugural year as a Division was marked by significant growth, innovation, and excellence in both clinical care and medical education. We led several quality improvement initiatives focused on streamlining patient progression, enhancing clinical documentation tools for frontline providers, and prioritizing advanced care planning for high-risk patients.

In education, our hospitalists earned numerous awards and honors and were appointed to leadership roles across undergraduate and graduate medical programs. We also celebrated a significant research milestone: Shri Gadrey received our Division’s first NIH R01 grant for his groundbreaking work using novel technology to analyze respiratory kinematics. I am proud to share two additional significant achievements: Paul Helgerson has been promoted to full Professor – our first faculty member to achieve this rank – and Andrew Parsons has become our first faculty member to earn tenure.

Today, our Division includes nearly 50 faculty members, six advanced practice providers (APPs), a Division Administrator, and three administrative staff. Our hospitalists care for well over 100 patients daily across 12 general medicine services and one hematology-oncology hospitalist service, and support patient care across numerous specialties through our Orthopedics Co-Management and General Medicine Consult service.

To sustain this growing team, we successfully recruited seven new faculty members and three APPs this year—many bringing valuable experience from academic and community hospitalist programs. We invite you to explore the profiles of our exceptional new team members. This year, Joe Kerley joined George Hoke in leading our robust recruitment program, bringing his insights and experience from residency and faculty recruitment at the University of Kansas and the Billings Institute. He and George will jointly lead our recruiting during a transitional year, after which Joe will assume full responsibility as the Director of Recruitment.

After several years as our Director of Quality, Jess Dreicer has stepped down from this role to focus on her work as an Associate Program Director and remediation coach for graduate medical education. During her tenure, she helped launch a Division M&M, led many successful QI/PS projects, and supported program evaluation through hospitalist quality metrics. Moving forward, Ryan Wiggins’ role will encapsulate both Quality & Clinical Operations, and he is joined in this work by Emily Richardson as our new Assistant Director of Quality & Clinical Operations.

Looking into 2026, the Division is excited to embrace new AI-focused strategies to reduce clinician workload, leverage geographic patient placement to improve care team efficiency and collaboration, and take on new initiatives to mitigate low-value VTE chemoprophylaxis and increase prescribing of evidence-based medications for patients with severe alcohol use disorder.

As a group, we’d like to extend our thanks to Dr. Taison Bell and the rest of the Department of Medicine for its collaboration and commitment to our shared success.

~ Amber Inofuentes MD

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QUALITY PROGRAM

Clinical Documentation Improvement Update: A Year of Innovation, Impact and Expansion
by Omar Alsamman, Director of Clinical Documentation Improvement

This past year has been a busy and exciting one for Clinical Documentation Improvement (CDI) in the Division of Hospital Medicine. We’ve rolled out streamlined note templates, launched a dedicated CDI team, and introduced new tools that make documentation clearer and more efficient. This work aligns with our strategic goal to support clinicians by reducing the cognitive burden of documentation while simultaneously improving how we capture the care we deliver.

To meet the needs of a growing Division of faculty and APPs, we launched the Hospital Medicine CDI team—led by Dr. Alsamman and including Drs. Brian Peterson, Tareq Arar, and Sam Florescu—which provides individualized feedback and coaching to early-career hospitalists as part of a comprehensive onboarding program. The team has introduced AI-powered tools to enhance documentation and is currently working on a quality improvement project that leverages these tools to support patient progression.

New note templates, released late 2024, removed several checklist items and added smartphrases to support billing accuracy and provider efficiency. Additionally, the CDI team expanded the implementation of AutoDx, a tool embedded within progress notes to enhance diagnostic capture without increasing clinician documentation burden. This program’s success in improving documentation capture of covered conditions while simultaneously reducing query volume was showcased earlier this year by Dr. Alsamman at NYU’s Annual Hospital Medicine Conference, Transforming Hospital Medicine Through the Care Continuum.

Earlier this year, Dr. Amy Moreno joined UVA Health as the CDI and Utilization Management (UM) Director, and the Hospital Medicine CDI team has begun developing a strong partnership with her in this new role. Major priorities for this year include implementing a new discharge summary template, spreading note templates to community partners, and collaborating with cardiovascular medicine to enhance documentation of congestive heart failure. These initiatives reflect our ongoing dedication to clinical excellence, operational efficiency, and health system alignment. We’re proud of the strides we’ve made, and excited for the year ahead!

 

Division Launches Workgroup to Enhance Frontline Clinicians’ Workflow Within Epic
by Tareq Arar and George Hoke

The Division of Hospital Medicine created the EIEIO (Epic and Integrated EHR informatics Optimization) workgroup, a hospitalist-led initiative formed in late 2024, starting with engaged hospitalists, division data scientist Jason Adams, and ACMIO Dr. David Ling. We are now also working in collaboration with our hospitalist colleagues from Community Health. As hospitalists, we engage with the EHR more intensively and in more complex ways than most inpatient providers. The EIEIO group was established to provide a structured, clinician-driven channel to identify, test, and escalate solutions that improve efficiency and reduce frustration for providers.

In just a few months, the group has already completed several impactful projects. These include elimination of ineffective BPAs (such as the OSA and VTE prophylaxis alerts), streamlining admission and discharge orders to reduce redundancy, eliminating the need to reconcile certain inpatient medications at discharge (such as intravenous flushes), and creation of shared favorite order sets for hospitalists. Other wins include improving safety and compliance by refining IV opioid PRN indications in alignment with the Joint Commission requirement, piloting DAX ambient scribe in the inpatient environment, and developing professional development sessions on “Epic Quick Wins.” Collectively, these projects have improved provider efficiency, reduced unnecessary interruptions, enhanced patient safety, and supported regulatory compliance.

Beyond individual fixes, the EIEIO group serves as a vital bridge between frontline clinicians and the IT teams implementing Epic changes. Leveraging the expertise of tech-inclined hospitalists, the group translates clinical frustrations into clear, actionable requests for Epic developers. Importantly, the group has also established a

formalized process for submitting, reviewing, escalating, and tracking suggestions, ensuring that provider feedback progresses through defined phases toward resolution. A provider scans one of the QR codes in the workroom, and the suggestion flows smoothly from there.

EIEIO recently hosted our CMIO, Dr. Markowski, at one of our meetings, where we shared ongoing projects and explored opportunities for collaboration to help navigate institutional prioritization processes. Through the group, several hospitalist members have also joined key institutional committees, including the Medication Orderset Governance Committee and the Inpatient Design Group. Their involvement ensures that frontline perspectives are represented in system-wide decision-making and that proposed changes remain grounded in both clinical practice and best evidence.

Our work group meets monthly and actively welcomes input from colleagues across disciplines. We are excited to build on this momentum, driving efficiency, enhancing provider satisfaction, and strengthening patient-centered care by shaping Epic to better serve both providers and patients. Contact Tareq Arar or George Hoke if you are interested in contributing to this work.

 

Hospital Medicine Group Quality Projects
by Amber Inofuentes, Division Chief

Each year, the Division of Hospital Medicine undertakes a portfolio of group quality projects aligned with departmental and medical center priorities. Last year, three of our key initiatives focused on improving advanced care planning (ACP), utilizing an evidence-based cirrhosis order set, and enhancing the timeliness of discharge medication orders. As you will see below, each of these was a successful project that remains a priority for this year.

Advanced Care Planning – Utilizing a validated ‘Surprise Question’ on admission, hospitalists focused on having serious illness conversations and completing ACP documentation within 72 hours of admission for high-risk patients. Notably, patients screened as high-risk with this question have a 3-fold higher 6-month mortality. To promote early ACP, we provided individualized performance feedback, implemented smartlinks to simplify documentation, and introduced a non-interruptive alert to assist clinicians in identifying high-risk patients. Last year, ACP completion within 72 hours rose from 15% to over 45% among hospitalist patients.

Cirrhosis Order Set – Chief resident Dr. Laura Lavette and hepatologist Dr. Zach Henry developed a comprehensive cirrhosis management panel embedded in the general medicine admission order set. The order panel supports evidence-based care for common complications, including acute kidney injury, GI bleeding, and hepatic encephalopathy, and promotes early diagnostic paracentesis for patients with ascites. The panel also includes tailored discharge instructions and patient education. Last year, hospitalists increased order panel utilization from 16% to 36% and this year have nearly doubled utilization to 67% of eligible patients, in a comparative analysis performed by Drs. Lavette and Henry, along with Dr. Andrew Barros, patients managed with the order set had a lower rate of 30-day ED visits and a faster time to diagnostic paracentesis.

Timely Discharge Medication Orders – Limited inpatient bed capacity continues to adversely impact patient care, especially when patients board in the Emergency Department (ED). Earlier discharges from inpatient units improve throughput, facilitating earlier arrival of admissions from the ED. In collaboration with the outpatient pharmacy, we found that placing discharge medication orders before the day of discharge sped up preparation and reduced delivery delays for patients utilizing UVA’s Meds to Beds program. Last year, we increased the percentage of medications ordered before the day of discharge from 13% to 27%. Patients with any prior-day orders were discharged on average 42 minutes earlier than those without, supporting this workflow as a strategy to improve patient progression.

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CLINICAL PROGRAM

Expanding Use of Clinical Pathways
by Paul Helgerson, Vice-Chair for Inpatient Services, ACMO for Acute Care

Clinical pathways have been used effectively in a breadth of care settings to reduce clinical variation and improve care. For example, substantial evidence exists that patients managed in ED observation units have better outcomes and shorter length of stay when managed via a clinical pathway. Experience with postoperative patients managed under ERAS (Early Recovery After Surgery) pathways has demonstrated a similar impact locally and nationally.

Over the past year, the Medical Center has adopted AgileMD as an EPIC-integrated clinical pathway platform. This was done initially to support the developing ED observation unit and was launched in January 2025. A set of evidence-based, accessible pathways has since grown to several dozen in number, covering a broad spectrum of clinical presentations and triage scenarios.

We hope that answers to the following Frequently Asked Questions may provide insight into the workings and value of the program:

What is the benefit of a clinical pathway?
Pathways can support care standardization in a variety of ways. Pathway authors incorporate best evidence into a stepwise flow of clinical decision points, and can also link out to important papers, calculators, and other tools. Branched logic can support complex algorithms in ways that simple order sets cannot. For example, our limb preservation pathway embeds a scoring tool to help clinicians characterize the severity of a diabetic foot infection and choose antibiotics appropriate for that severity using IDSA guidelines. In addition to supporting decision-making, pathways can also make care more efficient. Orders are embedded directly in the care pathways and can be bundled for ease of use. Finally, pathways are written or adapted at a local level, allowing for the embedding of links to Medical Center-specific resources, such as consult teams or triage algorithms.

How do I use AgileMD?
The AgileMD tool is accessible in the patient chart via an activity tab. Use the down-arrow (next to the wrench) in your activities bar to find AgileMD, and choose a pathway (note they are available in both inpatient and emergency domains). Consider “pinning” the activity for everyday use.

Is this just used in the ED?
The ED started first and has a rapidly expanding program of several dozen pathways. Inpatient medicine is just beginning to build a portfolio. Our gallstone disease pathway, for example, outlines initial treatment and service-based triage of common presentations. Other early inpatient pathways include hyponatremia, a flowchart supporting the triage of general medicine vs. family medicine admissions, and a process to support socially complex patients that present to the ED and may require admission. Notable in those early pathways is their diversity of use case – some support largely operational functions, others outline evidence behind complex clinical decision-making, and some provide efficient links to local resources.

How do we know if the pathways are having the desired impact on clinical care?
While early, we are building capability in monitoring outcomes. The ER limb preservation pathway appears to be associated with a 0.5-day reduction in length of stay for patients presenting with diabetic foot ulcers (a big thanks to DOM’s Josh Eby and Addison Hicks from Infectious Disease and Rob Becker from Hospital Medicine, who have partnered with physician leaders in the ED, Vascular Surgery, and Orthopedics on this work)! The platform supports regular reporting of use, with the ED chest pain pathway having been used almost 1000 times. If you have feedback on a given pathway, links exist within the tool to message the authors – they are happy to hear from you!

What if I want to suggest a pathway or build one in Agile?
Email Rhoda Shulaw (rs4cs@uvahealth.org), the Clinical Pathways Program Coordinator.

 

Improving Geographic Cohorting for General Medicine Patients
by Ryan Wiggins, Director of Quality & Clinical Operations

In preparation for the new academic year, the Medical Center undertook a major initiative to improve the geographic alignment of admitted patients with their primary provider teams. This realignment, implemented on July 1, resulted in an expanded inpatient bed footprint to better support our 16 general medicine teaching services and direct care hospitalist teams. We now care for an average of 150 patients across seven inpatient units, with 6 Central and 4 North newly designated as general medicine units.

This geographic restructuring is designed to enhance care coordination, with the ultimate goals of improving patient outcomes, reducing length of stay, and increasing provider satisfaction. While implementation is still in its early stages, geographic localization of patients has already improved to 90%, with the most significant gains seen among our general medicine resident teams.

Ryan Wiggins Named Medical Director for Patient Progression
by Amber Inofuentes, Division Chief

Effective October 1, Dr. Ryan Wiggins became Medical Director for Patient Progression at UVA Medical Center. Ryan joined the Hospital Medicine faculty in 2019 after completing his IM residency at Tufts Medical Center, and emerged as an operational thinker with an eye for streamlining processes early in his career. For the past several years, he has served as the 3 East unit medical director and the Director of Clinical Operations for Hospital Medicine. His recent work in those roles has focused on overseeing the geographic alignment of patients and care teams to support best practices in interprofessional care coordination, improving advanced care planning for hospitalized patients with advanced chronic illness, and addressing barriers to discharge for patients with prolonged hospitalization. Apart from his leadership roles, Ryan has also maintained a strong clinical practice, dividing his time between general medicine teaching wards, direct care hospitalist services, and the Orthopedics Co-management and Consult service. In his new role for patient progression, Ryan will partner with medical center leaders to optimize the patient’s journey from admission to discharge, supporting throughput to improve capacity.

 

Hospital Medicine APP Program Update
by Robert Becker, Director of Hospital Medicine APP Program

Our Hospital Medicine Advanced Practice Provider (APP) program continues to grow, now with six providers covering three distinct service lanes, including a dedicated consultative service. In addition to their clinical responsibilities, our APPs play a vital role in education, serving as preceptors and mentors for students in the UVA School of Nursing Acute Care Nurse Practitioner program. The team is also actively engaged in high-value care and quality improvement initiatives to support the implementation of evidence-based clinical practice.

We’re excited to welcome several outstanding providers to our growing team:

• Dominica Ko, NP – With over 20 years of experience as a nurse practitioner in Richmond, Dominica brings a wealth of clinical expertise. She is currently completing her Doctor of Nursing Practice (DNP) and is leading a significant quality improvement initiative aimed at reducing unnecessary VTE prophylaxis in low-risk patients.

• Lori Franssen, NP – Lori joins us with extensive experience as a transplant coordinator, bringing deep knowledge and specialized skills in managing this unique and high-acuity patient population.

• Kristin Long, DNP, NP – Kristin recently earned her Doctor of Nursing Practice degree and brings a strong background as a MICU nurse. She is spearheading the implementation of her doctoral project focused on a “Quiet at Night” protocol to improve rest and recovery in the acute care setting.

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RESEARCH

Shrirang Gadrey, MBBS, MPH, Awarded $4 Million to Study Physiological Signatures of Labored Breathing

Shrirang Gadrey, MBBS, MPH, an associate professor in the Department of Medicine, Division of Hospital Medicine, was awarded a $4 million NIH grant for a project titled “Novel physiomarkers of high-risk labored breathing for advanced warning of clinical deterioration.”

Labored breathing patterns (i.e., abnormal respiratory kinematics) are physical examination signs of respiratory instability. Contemporary patient monitoring systems do not measure respiratory kinematics beyond the average respiratory rate. Clinicians are forced to rely on qualitative visual inspections to monitor for labored breathing. Such assessments lack sensitivity and interrater reliability, and they are labor-intensive. Therefore, respiratory kinematic information cannot be used in early warning systems. The resulting delays and errors in the recognition of labored breathing can prove life-threatening.

The barriers to large-scale respiratory kinematic measurement were recently overcome when a UVA team led by Dr. Gadrey developed a simple and scalable new technology called ARK (Analysis of Respiratory Kinematics). ARK uses wearable motion sensors that are easy to apply in any setting. Yet, powered by original breakthroughs in inertial signal processing, it quantifies respiratory kinematics with high fidelity. In this project, the ARK team will pioneer the quantitative documentation of the human respiratory kinematic profile on an unprecedented scale. The kinematic properties of the mature respiratory system will be recorded in a large cohort of adults during emergency room visits for respiratory illness. Additionally, the properties of an immature respiratory system will be explored by establishing the safety, feasibility, and validity of ARK monitoring in a cohort of premature neonates in the neonatal intensive care unit.

The expected outcome is a comprehensive understanding of the diagnostic and prognostic significance of well-known breathing motion patterns and the discovery of novel breathing phenotypes. By enhancing the completeness of bedside physiological measurement, this work holds the promise for a far-reaching impact, including major leaps in predictive analytics that trigger timely treatment, reduce ventilator use, unburden ICUs, and save lives.

Collaborators on the project include William Ashe, PhD; Thomas Hartka, MD, MS, MSDS; Brynne Sullivan, MD; Sarah Ratcliffe, PhD; and J. Randall Moorman, MD, from the UVA School of Medicine.

 

Early Career Scholars Project Focuses on Improving Care of Patients with Heart Failure

As part of the Early Career Scholars (ECS) program, Dr. Tareq Arar is leading a project to reduce hospital readmissions among patients with heart failure. He is receiving mentorship from Dr. Shri Gadrey and collaborating with the Division of Cardiology and Dr. Soutik Ghosal from Public Health Sciences. Heart failure remains one of the leading causes of hospitalization and readmission nationally, and addressing this challenge is both a clinical and health system priority. Dr. Arar’s work aims to better understand the unique characteristics of our patient population at UVA, identify predictors of frequent readmissions, and ultimately build a predictive model to identify those at highest risk. Unlike most database-driven analyses that rely heavily on ICD codes or labs, this study incorporates granular electronic health record (EHR) data such as vital signs, providing a richer and more clinically meaningful understanding of risk.

In parallel, Dr. Arar is working with the Heart Failure Quality Group to translate these insights into standardized, evidence-based care across the medical center. Together, this team is developing shared admission and discharge order sets, diuresis protocols, GDMT clinical guidance pathways, as well as structured approaches for patient education and early post-discharge follow-up. These initiatives represent practical, data-driven interventions designed to enhance consistency in care delivery, reduce variation across service lines, and ensure our patients receive the most up-to-date therapies and support.

By combining predictive analytics with quality improvement initiatives, this work seeks to create a comprehensive framework for managing heart failure admissions. On one level, the project is about learning more about our own patient population and risk factors for readmission. On another, it is about embedding best practices into our workflows so that we can proactively identify vulnerable patients and provide tailored interventions.

The overarching goal is to reduce heart failure readmissions in alignment with CMS guidelines, preserve hospital resources, support providers and learners, and most importantly, improve the quality of life and outcomes for our patients. This work represents an exciting opportunity to advance both scholarship and clinical care in hospital medicine, while strengthening our Division’s impact across the institution.

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EDUCATION

Hospital Medicine Continues to Expand Educational Roles in UME and GME
by Alexander Millard, Director of Education and Faculty Development

Ian Crane was confirmed as the General Medicine Acting Internship Elective Director in July. He also joined as part of the formal medical student advising team, taking on the role of advising and writing Departmental Letters for 6 to 10 students applying to residency in Internal Medicine each year.

Meghan Geraghty also assumed the formal role of advisor for students applying to Med-Peds residency programs this past year.

Marcus Ellison joined Hospital Medicine in July after completing his Chief Resident Year at UVA. He joined Glenn Moulder and Alex Millard as an Associate Clerkship Director for the Internal Medicine (IM) Clerkship. The IM Residency Program also recruited him as Core Faculty this year, joining Rebecca Clemo, Jess Dreicer, Ian Crane, Alex Millard, Glenn Moulder, and Andrew Parsons, where he will formally advise a small cohort of residents.

Sam Florescu was recently appointed thread leader for Quality Improvement and Patient Safety (QIPS) for medical student education. He will work closely with course directors to embed QIPS content across the curriculum, with particular emphasis on workshops during Intersessions and the Clerkship Readiness Course.

Becky Kenner was appointed to a position of Designated Assessor this past year and is responsible for the EPA assessment of medical students across Phase 2 (clerkship rotations) and Phase 3 (post clerkship rotations) of the medical school curriculum, which aids in advancement decisions for medical students.

George Hoke joined the newly formed School of Medicine Competency Committee this year, given his extensive work as a Designated Assessor and knowledge of medical student advancement. In this role, he will help determine student progression through Phase 2 and Phase 3 of the Medical School curriculum to graduation. He is also the Medical Advisor for UVA’s Post-Bacc Pre-med program, where he serves on the admissions committee, teaches a seminar focused on the American healthcare system, and arranges clinical experiences for students.

Brian Peterson has been selected as a physician coach for the Foundations of Clinical Medicine course, through which he will work closely with students on clinical skills development and professional identity formation across all years of medical education. In addition, this year he became Co-director of the Internship Readiness Preparation Program.

 

New Hire Faculty Development

Every fall, the Division of Hospital Medicine hosts two half-day sessions for new hires to help orient them to clinical and educational practices and missions at the University of Virginia.

The first session in early September covered UVA Health System and IM Department structure, CME requirements, review of benefits, billing and coding requirements, transitions of care and quality improvement best practices, perioperative medicine, the APP-Physician team dynamic, and working with acting interns on the Hospitalist ACE.
The second session will cover the structure of the UVA IM residency, teaching student and resident teams, learner feedback and evaluation, working with struggling learners, and making the most of mentorship and exploring career opportunities at UVA. Faculty outside Hospital Medicine who are new to UVA are welcome to attend – don’t hesitate to get in touch with Alex Millard if interested.

This past year, Rebecca Clemo spearheaded a program to help orient new hires at UVA to the expectations and practices of UVA General Medicine teaching services. In this program, new hires shadow a faculty member with extensive teaching experience and stellar trainee evaluations to observe best practices for running rounds and educating the team. The new attending is then observed on rounds by an experienced faculty member during their first teaching block with a structured tool for bi-directional feedback. With very positive feedback on the program from both new hires and experienced faculty, this program will continue in the 2025-2026 academic year.

This program has also been extended to any Hospital Medicine faculty member who wants to improve their clinical teaching skills with observation and feedback from our more experienced Hospitalists.

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HIGHLIGHTS

AWARDS
Department of Medicine Excellence in Clinical Care
Miriam Gomez-Sanchez
Omar Alsamman

Department of Medicine Excellence in Mentorship
George Hoke

Department of Medicine Excellence in Teaching
Rebecca Clemo
Brian Peterson

Leonard Tow Humanism in Medicine Award
Rahul Mehta – The Arnold P. Gold Foundation presents the award. It recognizes individuals who demonstrate exceptional compassion and sensitivity in patient care, serving as role models for humanistic values in the medical field.

International Association for Health Professions Education (AMEE) Research Award
Andrew Parsons

Inpatient Attending of the Year
Glen Moulder – awarded by Internal Medicine residency

 

Getting ICU Patients the 40 Winks They Need
by Christine Phelan Kueter, originally published on the UVA School of Nursing website

By instituting a new policy to let patients sleep in the ICU between 12 and 4 a.m., acute care nurse practitioner and DNP graduate Kristin Long (DNP’ 24) not only improved patient satisfaction and well-being, but she also educated her peers on why high-quality, undisturbed sleep is a key part of getting the sickest patients back on their feet and headed home. Sleep “prescriptions” are now part of health record charting, and a new owl graphic — a hospital “Do Not Disturb” card — will soon make the rounds.

Hospitals can be difficult places to get good rest.
While illness, discomfort, and pain can all come in the way of 40 winks, so, too, can the constant barrage of interruptions from well-meaning care providers who come calling round the clock to draw blood, check vitals, request labs, and re-position. In some cases, sleep deprivation can prolong ICU stays, cause emotional and physiological distress, and even increase the risk of death.

Long, a School of Nursing DNP graduate and a UVA Health acute care nurse practitioner, focused her final scholarly project on re-instituting Quiet At Night, a 12:00 a.m. to 4 a.m. protocol that nurse practitioners and physicians can prescribe for eligible patients that gained traction in the medical ICU, and, now, beyond it. She answered questions about her scholarship, just published in the Journal of Critical Care, as well as the importance of sleep, how she went about promoting it, and her affection for a new owl graphic that offers a “Do Not Disturb” message for patients who get the sleep promotion protocol on their hospital room doors.

“Patients expect to get sleep in a hospital, and they’re shocked that they don’t,” said Long. “Something simple like sleep, though, goes a long way.”

Why study sleep in particular?
When I was doing this project, I worked in the Medical ICU doing both day and night shifts. After every day shift, I’d always ask my patients, “How did you sleep last night?” Over and over, they’d tell me, “Oh, it was terrible, this was beeping, the nurses came in 10 times, I didn’t get any rest at all.” Often, they felt physically bad.

Obviously, doing a project was a requirement for school, but I also knew there were a few projects going on but nothing that incorporated the patients’ voices. That’s hard in the ICU, because a lot of our patients are intubated and sedated. I’ve always thought, though, that patients know their bodies best and, when possible, should be listened to.

Also, I wanted to make a lasting difference. I didn’t want to do my project and then leave. My colleague, [faculty member] Cheri Blevins, told me that the Society of Critical Care Medicine’s clinical guidelines have us assess pain, agitation, delirium, immobility, and sleep — we call these the PADIS guidelines — but mentioned that sleep is usually lumped in with delirium in practice, rather than a separate factor in and of itself. That piqued my interest.

How’d you start the project?
I checked out what the guidelines specific to sleep promotion were and stumbled upon a document called the “Quiet at Night” initiative, which had been rolled out before COVID but not actualized or updated since. I started highlighting things it advised and found a structure that provided a time frame where care providers intentionally minimized interactions with patients. The six- to eight-hour time frame it mentioned wouldn’t be feasible for an ICU, where we’re constantly checking on and assessing patients, but a four-hour time frame seemed possible for certain patients.

First, I had to figure out what inclusion factors to consider when selecting patients for the new protocol, and, because I wanted to keep patients’ voices involved, looked for and found a validated survey for them to take so they could offer details about the quality of sleep they got. I started thinking, too, about how to educate my interdisciplinary colleagues through presentations about why sleep is so important for patients in general, and for ICU patients in particular, the sickest of the sick, and then figure out ways to help them imagine what small changes we could bring about to maximize patients’ sleep, emphasizing that it was all for the patients’ well-being and would incorporate their voices.

How did your colleagues react?
I think it was well received, and the fact that I was actually asking people do to less, I didn’t think anyone would say no. It encouraged all of us to think about how to clump our work together so we could avoid bothering patients during certain time frames — in this case, between 12 and 4 a.m. Physicians had to get involved, and fix their orders, pharmacists had to adjust the timing of certain medications, and nurses were truly the gatekeepers of the process. They’d have to say to the physicians, “This medication is timed for here; can it be moved up two hours?” Everyone participated, everyone helped out.

What did patients say?
After everything was in place, I interviewed patients myself. I heard, “I could tell nurses were invested in my getting a good night’s sleep,” or, “Nurses hung towels over computer screens.” I even had a patient that I visited after being discharged from the ICU to another unit who said, “I slept so much better on your unit!” It was heartwarming.
Patients expect to get sleep in a hospital, and they’re shocked that they don’t, because they don’t realize that when you’re hooked up to four different machines, you’re not going to get rest. They don’t realize how the hospital works. Something simple like sleep, though, goes a long way.

You said you wanted to make a lasting impact. What’s happened since?
The sleep protocol has started to get better known as a process both inside and beyond the MICU and become part of the rounding checklist of items in more spaces at UVA Health. We created an EPIC order set, so a physician can actually just type in “sleep” and it pops up and enables them to set an order, one of a series of a la carte options. They can change the duration of the sleep “prescription” based on acuity: it might be for four, six, or even eight hours. While it’s mostly still being used in the MICU, where it’s thriving, I’m seeing a lot of providers outside that unit who are selecting the sleep order, as well. It’s gaining traction.

A coworker of mine drew an owl for me, which we used as a graphic to indicate that a patient was on sleep precautions and had an official order that prescribed rest. I’ve been talking with UVA Health’s marketing department, and we’re planning on making it an official sign, now that it’s an official order. That will help raise awareness. So will talking about it, which I’m doing a lot of.

I also see more conversations with our local shared governance structure and hope I can meet with colleagues across the hospital to explain what the initiative was, how to implement it, what it looks like for providers to place “sleep orders,” and what it means for unit nurses.

What’s interesting is that, when I was a DNP student, I implemented the protocols and project as a nurse. Now that I’m a nurse practitioner, I see it from the provider perspective and consider it a strength of being an NP.

I’m also having conversations, too, about standardizing rounding checklists across all ICUs at UVA, so the sleep protocols and prescriptions are a standardized, routine part of our workflows. What I’d like to happen now is for EPIC to, if a provider said they wanted to do a sleep promoting plan, automatically change the other orders, rather than having the nurses scramble to make those adjustments.

Your work was just published in the Journal of Critical Care. What’s next?
Publishing was one of those things that I didn’t think would ever happen to me. As DNP students, we’re required to submit our projects for publication, and when I didn’t hear back for a long while, I assumed the journal had taken a pass. But publishing is such a long process.

I feel fortunate to have the publication, and thankful for the guidance I’ve had from Drs. Hundt and Wiencek, who kept giving me insight along the way. Since the paper came out in April, I’ve been getting emails, having conversations with medical directors and marketing. People are asking, “How can we bring this to my floor?”

It’s really re-sparked my interest. I really wanted to do this for the patients, and I did.

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View Full November 2025 Issue of Medicine Matters

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Filed Under: Basic Research, Clinical Research, DOM in the News, Education, In the Know, News and Notes, Notable Achievements, Publications, Research, Top News