Robert Bober, MD: What is Optimal Hospital?

Blood draws in the early morning are a standard procedure at many hospitals that patients must endure, but investigators at Ochsner Medical Center in New Orleans have questioned the necessity of the practice and others like it.

In an interview with MD Magazine®, Robert Bober, MD, Director of Nuclear Cardiology at Ochsner Medical Center, shared about Optimal Hospital, a program introduced in one wing to evaluate the effect of innovative changes to hospital rooms and procedures. He described the 3am blood draw that has roots in residency programs where doctors wanted results ready for morning rounds.

Bober questioned the practice, “why are we actually doing that? It makes utterly no sense.” Instead, with Optimal Hospital, patients are allowed to sleep uninterrupted from 11pm to 6am each night.

MD Mag: What is the Optimal Hospital program?

What has driven the Optimal Hospital innovations?

Robert Bober, MD: Optimal Hospital is—it's a program that we started several years ago with the attempt to try to reduce hospital-acquired infections, reduce length of stay, reduce readmissions. So, to try to have a better patient experience and better outcomes. And if you just go back in time and say, well how do we design hospital rooms to begin with, it hasn't really been well thought out. It evolved from hospitals from the 1920s and we've never really had any type of major significant change. The technology may have gotten a little bit better, but we still kind of do the same things.One of the philosophies of the Ochsner innovation is: rethink what you're currently doing. So, the thought is, why do we wake patients up to get their blood at 3 o'clock in the morning? Well, that has its infancy in residency programs. When the doc comes around, they want the blood results already there, so we got to get it really early—forget about the patient they're already sick.

Okay, so we've asked the question: why are we actually doing that? It makes utterly no sense. Things that we do know which are factual: sleep is extremely important to health and to healing, and if you interrupt your circadian rhythm, outcomes are worse. So, what we try to do is leave the patient asleep during sleep hours—11:00pm to 6:00am—the goal is uninterrupted sleep, no blood draws, no waking the patient up for vital signs.