LHSON Participates in National Study Comparing ICU Care Bundles to Improve Sleep and Reduce Delirium

The Baylor University Louise Herrington School of Nursing (LHSON) is pleased to announce that Baylor University is participating in a national research project approved for funding by the Patient-Centered Outcomes Research Institute (PCORI) to study new approaches to improving sleep and reducing delirium in critically ill adults.

The project is led by Biren Kamdar, MD, MBA, MS, MHS, Associate Professor of Medicine at the University of California San Diego, an ICU physician, pulmonologist, and clinical researcher specializing in sleep and delirium in critically ill patients. At Baylor University Medical Center, the study is led by Nicole Gorecki, DNP, APRN, AGACNP-BC, CCRN, Clinical Assistant Professor at Baylor University Louise Herrington School of Nursing. Dr. Gorecki is also revered as an acute care nurse practitioner, nurse researcher, and implementation scientist with expertise in sleep and delirium in critical illness.

This patient-centered comparative clinical effectiveness research (CER) project will compare two structured ICU care bundles—one focused on non-medication strategies and the other combining non-medication and medication-based approaches—to determine which more effectively improves patient sleep and reduces delirium. Conducted in real-world ICU settings, the project aims to generate evidence that helps patients, families, and clinicians make better-informed care decisions. This multi-site project includes eight US hospitals: University of California San Diego (San Diego, CA), University of California San Francisco (San Francisco, CA), Vanderbilt University Medical Center (Nashville, TN), University of Utah (Salt Lake City, UT), Baylor University Medical Center (Dallas, TX), AdventHealth Orlando (Orlando, FL), Massachusetts General Hospital (Boston, MA), and the University of Puerto Rico (San Juan, PR). Together, these sites include 16 ICUs representing a wide range of patient populations and care settings. A Data Coordinating Center at Johns Hopkins University (Baltimore, MD) will oversee data collection, quality, and analysis.

Sleep disruption is one of the most common and distressing experiences for ICU patients and is closely linked to delirium, a serious condition associated with longer hospital stays and worse recovery. Despite existing guidelines, hospitals vary widely in how they promote sleep, and it remains unclear which strategies are most effective and sustainable.

In this project, Bundle A focuses on non-medication strategies such as reducing nighttime noise and light, clustering care to minimize sleep interruptions, and promoting daytime wakefulness. Bundle B includes these same strategies plus carefully targeted medication approaches, in which clinicians and pharmacists work together to review medications, adjust timing, and use sleep-promoting medications only when needed.

By comparing these two approaches, the study seeks to answer a key question: is optimizing the ICU environment enough to improve sleep, or do selected medication strategies provide additional benefit?

“This study represents an important opportunity to improve the experience and recovery of critically ill patients,” said Nicole Gorecki. “In the ICU, sleep is often overlooked, yet it plays a critical role in healing and recovery. Through this study, we aim to identify which strategies meaningfully improve patient outcomes and which can be reliably implemented and sustained across diverse ICU settings.”

Importantly, this research was designed with input from ICU survivors, caregivers, nurses, pharmacists, and critical care providers, and will incorporate caregiver perspectives throughout the project.

“This research project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other health care stakeholders, but also for its conduct in real-world settings,” said PCORI Executive Director Nakela L. Cook, M.D., MPH. “It has the potential to answer an important question about ICU sleep promotion strategies and fill a crucial evidence gap to help patients and those who care for them make better-informed health care decisions that reflect their needs and preferences. We look forward to following the study’s progress.”

The funding award has been approved pending completion of PCORI’s business and programmatic review and issuance of a formal award contract.

PCORI is a nonprofit organization with a mission to fund patient-centered CER designed to provide patients and those who care for them with evidence to make better-informed health care decisions.