Background

Sleep is essential for a child’s growth, development and immune function. Disrupted sleep is associated with increased hyperactivity, behavioural challenges and impacts on both physical and mental development. Sleep difficulties are estimated to affect 8 in 10 children with neurodevelopmental conditions such as autism or ADHD.

The sleep service at Alder Hey Children’s Hospital supports children with neurodevelopmental diagnoses and their families. The team assesses the medical, developmental and behavioural factors contributing to sleep difficulties, enabling appropriate behavioural or pharmacological intervention to be considered.

A thorough assessment is the essential first step. Over a 14 day period, parents complete a detailed sleep diary, recording information such as sleep and waking times, daytime naps and night waking. This ensures clinical decisions are informed by structured data.

Challenge

While clinically valuable, paper diaries are vulnerable to the realities of daily life for families already managing complex care needs. Paper diaries could be misplaced, completed retrospectively, or partially filled in before being forgotten altogether. In some cases, parents would return incomplete records that failed to meet the minimum requirement of 10 days’ entries over a 14-day period, necessitating the diary to be restarted from the beginning.

For clinical teams, this created silos in data, delays in decision-making and extended time within the pathway. Incomplete data meant appointments could not always be progressed as planned, increasing administrative burden and impacting service productivity.

Clinicians were also required to review handwritten entries once completed, limiting opportunities to review sleep patterns in advance of consultations.

As Alder Hey was piloting the delivery of sleep assessment internally, it decided to include in its service a more reliable, efficient, and environmentally reliable method of collecting sleep data.

Solution

Working in partnership with Aire Innovate, Alder Hey built a digital sleep diary using the Aire Innovate platform. This enabled the solution to be tailored precisely to the needs of its developmental paediatrics sleep pathway, including:

• A pre-assessment questionnaire to identify potential medical concerns, such as snoring or breathing difficulties.
• Structured daily entries capturing sleep duration, routines and night waking.
• Automated delivery via SMS link to the parent or carer’s mobile phone.
• Daily reminders to prompt completion of entries.
• A consolidated view of all entries over the 14 day period

Once triggered within the clinical system, families receive a secure link each morning allowing them to record the previous night’s sleep from their own device, without the need for passwords or additional applications.

Crucially, submitted data flows automatically into Alder Hey’s Meditech Electronic Patient Record (EPR). This enables clinicians to review completed sleep diaries directly within the patient record, in the same location as other clinical documentation.

Because the solution is built around Alder Hey’s exact pathway requirements, the transition to digital was incorporated into existing workflows with no disruption for clinicians or families.

Results and Impact

Since implementing the digital sleep diary, Alder Hey has observed a number of improvements across both patient engagement and clinical workflow.

The programme has achieved a 66.66% reduction in time taken to process sleep diaries. From postage time saved to administrative workload to scan paper documents, the digital process has reduced the overall length of time taken to send, complete, and return sleep diaries. 

Thanks to automated reminders, families have also been less likely to miss diary entries, reducing the number of cases in which data collection must be restarted, which requires administrative effort to chase incomplete diaries, and delays treatment.

It has also made a real impact on clinicians, improving the availability of clinically usable data at the point of review, and less consultation time is spent reviewing diary entries, with more time spent discussing the findings and support with patients.

Commenting on the project, Vickie Furfie, CCIO said: “By replacing paper with a configurable, EPR-integrated digital solution from Aire Innovate, Alder Hey has demonstrated how targeted digital innovation can support families, streamline pathways and enable clinicians to focus on delivering the right intervention at the right time – ensuring that better sleep, and the developmental benefits it brings, are within reach for more children.”