Authors (including presenting author) :
Cheung HY E (1), Chan NY (1), Hui TM (2), Lam KY (3), Yeung WS (1), Yue NT (1), Ho YY (1), Chen KK (1), Choy KL F (1), Wong YF B (1)
Affiliation :
(1) Department of Medicine and Geriatrics, North Lantau Hospital (2) Department of Accident and Emergency, North Lantau Hospital (3) Department of Ambulatory Surgery and Endoscopy Centre, North Lantau Hospital
Introduction :
Circadian Lighting System (CLS) is an indoor artificial light source system that can imitate the natural light of outdoor sunlight, provide corresponding colour temperatures with different sunlight hours and adjust the brightness of the light source according to different indoor activities. Many clinical studies had shown that the CLS could enhance patients’ sleep quality and safety. In mid of 2024, the Kowloon West Cluster Planning and Commissioning Team collaborated with North Lantau Hospital (NLTH) to establish the first clinical trial test at 6B Extended Care Ward (ECW). The evaluation on patients’ sleep quality and use experience of staff were conducted. It aims to investigate the beneficial effects and practicality of the Circadian Lighting System in local hospital.
Objectives :
1. To evaluate the beneficial effects of CLS in regarding to patients’ sleep quality in ECW
2. To evaluate the use experience of staff related to work environment and workflow efficiency after implementation of CLS in ECW.
Methodology :
Circadian Lighting System (CLS) completed the installation and began trial in 6B ECW of NLTH in July 2024. A paper form 8 questions questionnaire was used as a measurement tool on rating sleep quality during hospitalization which was based on the Insomnia Severity Index (ISI). The first 5 questions were using ISI to explore patient’s sleep quality during hospitalization, while the other 3 questions were exploring more in-depth about the perception of lighting in ward. Patient was interviewed by ward nurse and was asked to rate each element of the questionnaire using Likert-type scales among 8 questions. Patient could range from 0 to 4, where higher scores indicate more acute symptoms of insomnia. ISI total score of 0–7 indicates “no clinically significant insomnia,” 8–14 means “subthreshold insomnia,” 15–21 is “clinical insomnia (moderate severity),” and 22–28 means “clinical insomnia (severe).”
Result & Outcome :
There were 74 patients completed ISI survey before implementation of CLS from 5 June 2024 to 16 July June. 51 patients completed ISI survey after implementation of CLS from 21 July 2024 to 18 August 2024, while there were totally 59 patients excluded due to refusal, cognitive impairment, discharged and non-communicable during the survey period. 5 patients had experienced both before and after CLS implementation. 33 staff completed the staff survey on use experience of CLS by using the 10 questions questionnaire from 11 September 2024 to 8 October 2024 to explore the satisfaction and practicality of CLS in the working environment.
Patients’ sleep quality had improved with ISI average score from 10.27 to 9.25 which lower in severity insomnia after the implementation of CLS. On the other hand, the mean score of ISI among patients who experienced both original lighting and circadian lighting was 8.6 and 7.0 respectively. It showed an improving trend of ISI. On the other hand, the satisfaction of lighting appropriateness was enhanced from 66% to 77 %. Also, 29% of patients had found it easier to differentiate the daytime and night time compared to only 4% of patients before the CLS implementation. The staff survey overall showed a positive perception of CLS and 70% of staff agreed that CLS had beneficial effects to delivery patient care in daily basis. As changes in ward lighting enhanced staff’s alertness to patients’ night activities and patient safety where motion sensors were installed.
Conclusion:
The installation of circadian lighting system in the Extended Care Ward demonstrated promising outcomes in improving sleep quality and enhancing staff satisfaction in the working environment. Circadian lighting system may be the future trend in hospital settings, yet larger population studies are suggested to explore the sustainability and enhancement of the system.
