Why Do Hospitals Hate Sleep So Much? • Hacker News Board

Re: Why Do Hospitals Hate Sleep So Much?

#161

Post by lojack » Wed, Dec 05, 2018, 10:39 AM UTC

During my daughters first year of life we had multiple hospital stays at multiple hospitals for surgeries. What we found was that your experience can vary a lot depending on the hospital.

Our worst experience was at a hospital that was #1 in the nation for its specialty. The staffing leaned heavily on STNAs, and they had a lot of patients to look after. Their nurses were similarly rushed. Once in the step down unit we were placed in a pod with three other families. Of course not all of them were respectful of recovery, with one of them staying up late into the night having boisterous conversations. We ended up advocating for leaving the hospital sooner than they were originally planning. We also found ways to get them to line up vitals and medicine a little better. All of this took significant advocating and considerable effort.

Our best experience was a complete flip. This was at a top 5 hospital in the nation for pediatric care. Nursing staff seemed top of their class. They took their jobs seriously, seemed to be extremely knowledgeable, and were attentive to both my daughter as well as the family. Similarly the doctors seemed to respect the nurses a bit more as they were the ones in closer contact with the patients and more capable of identifying things. We were often assigned a night nurse that only had a couple families to attend to, sometimes we were the only one. I don’t remember ever seeing an STNA. They probably existed, but our care was overwhelmingly done through nurses. The step down unit was like a mini hotel, we had our own private room with a cot and pull out bed, private bathroom with shower, etc. The nurses seemed to actually give thought to their schedule and when to do vitals and meds. They also leaned on technology a bit more and had remote o2 and heart rate sensors, so they didn’t need to take as many vitals.

The facilities made a bit of a difference in our experiences, but above all the nursing staff had the biggest impact. Highly skilled nurses that aren’t over staffed seemed to be key.

Re: Why Do Hospitals Hate Sleep So Much?

#162

Post by kalmi10 » Wed, Dec 05, 2018, 10:41 AM UTC

dotancohen wrote: post #159

thaumasiotes wrote: post #106

Earlier quoted context omitted.

My mother is a doctor (in a different specialty), and this came up when we watched 10 Things I Hate About You , which repeats the myth. You're correct; as far as the patient is concerned, it's better for them if you let them sleep. But it's easier for everyone else if the patient isn't allowed to sleep, as sleeping and dying look exactly the same.

> sleeping and dying look exactly the same. I do not know how many dead people you've attended to, but the ones that I have seen generally lack pulse or breathing. Both of those vitals are monitored for inpatients. And if one of those goes, the other goes too in short order. Sleeping patients, on the other hand, usually pulse at least once per second, and breathe every six seconds or so.

there is a difference between dead and dying

Re: Why Do Hospitals Hate Sleep So Much?

#163

Post by Markoff » Wed, Dec 05, 2018, 10:41 AM UTC

more than sleep I've found bigger issue with excessive paperwork, while giving birth in China there was no need to measure your baby prior and after each feeding, this was not the case in EU hospital

you would say it helps to decrease newborn mortality but loss of weight it's completely natural and i don't see reason why bother mother and baby measuring weight every two hours, that's just insane harassment

can't really compare sleep since in China we landed in private room (public hospital, not that busy in smaller town) while in EU room for three which was extremely overheated that in winter you had to open window, in China you had to pay astronomic fee around 1.5€ per day for AC remote control and AC to be switched...

Re: Why Do Hospitals Hate Sleep So Much?

#164

Post by maccard » Wed, Dec 05, 2018, 10:43 AM UTC

nemesisj wrote: post #89

This is a problem that a startup I’m involved with (www.snap40.com) is tangentially aiming to solve. The prime goal isn’t really to help patients sleep better, but to help healthcare professionals monitor them better and be proactively alerted when things are deteriorating. It’s an iPhone sized (but lighter) device that’s worn on the upper arm and once you’re wearing it, you forget about it. Instead of reading vital…

I realise this is slightly off for this thread but I'm really interested in this topic. A cursory glance at your website (You're in Edinburgh, Hi!) doesn't mention anything about how you use/keep the data.

I'm also curious how staff would interact with the data. Your website shows lots of iPhones, but I'm assuming Doctors/nursers/clinical staff aren't accessing patient data through their own iPhones?

This is really cool though!

Re: Why Do Hospitals Hate Sleep So Much?

#165

Post by __david__ » Wed, Dec 05, 2018, 10:44 AM UTC

devereaux wrote: post #113

ad_hominem wrote: post #109

I asked my doctor relative about this once and IIRC they basically said because hospitals are not hotels - if you're inpatient in America you're pretty sick and more than likely need periodic monitoring for your condition. As soon as you're well enough to be sleeping for long periods of time without observation you'll get bounced.

You can be a patient and be so sick of the noise that you decide you want to opt out of the monitoring - or you DIY anyway, as most hospital do not take requests kindly. I was once in ICU. The cardiac monitor was beeping loudly whenever I was starting to sleep. After the first few time woke me up in pain, I bent over and pushed the button to power off the cardiac monitor. Problem solved! I fully admitted all the risk…

I did that with my IV machine the one time I was in the hospital. It would start incessantly beeping when the fluids needed changing, so I learned how to silence the alarm (by watching the nurses do it the first time). When the alarm went off, I'd call the nurse and then silence the machine.

When it went off at 3am I did that and by the time the nurse came by I was already asleep. She saw what I did and got angry at me. Re-awakened me responded badly to that and words were exchanged. She didn't bother me for the rest of the night at least (and we made up in the morning, when I was awake enough to be rational).

Re: Why Do Hospitals Hate Sleep So Much?

#166

Post by trashtester » Wed, Dec 05, 2018, 10:52 AM UTC

flippyhead wrote: post #158

trashtester wrote: post #149

People die or suffer serious harm in hospitals all the time. This often happens during sleep, and in many cases it could have been prevented if the patient had been checked on more frequently. It is much easier to confirm that the patient is ok if they are awake. When the nurse softly asks "do you feel ok?" when drawing blood in the night, it is not just meant as soothing, but just as much to check if further treatme…

This is interesting and not something I'd considered. I wonder though if they've got the balance right. These protocols were developed no doubt before it was really understood how incredibly dangerous poor sleep is to our health most especially during recovery from illness.

Its a mix of protocols, procedures, habits and personal biases, as are most such things in most workplaces.

But most of all, I think it is an attention thing. For the staff, a patient being sleep depraved for a couple nights is very low on their list of concerns. They see people die almost every day.

For the patient, the emphasis is different, especially for the ones that are there for minor issues.

Medically, a few nights with reduced sleep quality is unlikely to make a big difference.

Now, if it goes on for weeks or months, that is another matter. Still, more people are probably seriously injured or die from bedsores sleep depravation. Not to mention those that die from fall injuries caused by trying to walk to the bathroom unassisted. (The latter is the most frequent case of preventable fatal injuries aquired in most hospitals, at least in my country)

From my point of view, most complaints about loss of sleep in hospital are in the same category as complaining about the food. 1st world problems.

Re: Why Do Hospitals Hate Sleep So Much?

#167

Post by mschuster91 » Wed, Dec 05, 2018, 10:53 AM UTC

blattimwind wrote: post #160

benj111 wrote: post #132

Earlier quoted context omitted.

Yes. Having a different person coming in every 5 minutes to check something else. Somewhat tempered by having to go back in a week later, so all these things aren't useless. Child birth isn't the risk free thing we like to think it is.

> Child birth isn't the risk free thing we like to think it is. For almost all mammals it is, just not for humans, where gestation and partum are uniquely difficult and dangerous.

> For almost all mammals it is, just not for humans,

No, childbirth in nature is incredibly risky. But loss of life is expected in nature and disabilities, malformings etc. simply die whereas humans try to avoid life loss or any disadvantage for the offspring at any cost.

Re: Why Do Hospitals Hate Sleep So Much?

#168

Post by michaelt » Wed, Dec 05, 2018, 10:59 AM UTC

dijit wrote: post #92

philliphaydon wrote: post #88

I’ve been hospitalised 7 times. In New Zealand, Australia, Thailand, and Singapore. Aside from the first day/night after surgery, I’ve never felt like Hospitals are against slept?!? My Wife had a c-section in October. Again, other than first day/night after surgery, never felt like we were interrupted all the time. Is this article about America or something?

Agree. I’ve been overnight hospitalised in Estonia, Sweden and the UK- and I feel like every measure is taken to avoid disturbing sleep. Even heart rate monitor alarms are turned off/down locally;

I spent two nights in hospital in the UK after surgery for a broken arm. They were pretty good about not interrupting my sleep.... except for putting me in a ward with a bunch of sick people who were coughing and wheezing and groaning all the time.

Re: Why Do Hospitals Hate Sleep So Much?

#169

Post by maccard » Wed, Dec 05, 2018, 11:02 AM UTC

torstenvl wrote: post #62

yen223 wrote: post #22

Earlier quoted context omitted.

It's because doctor handovers are surprisingly dangerous.

That's an interesting angle, and I'm sure you're right. I'd like to read more. Do you have a source for that?

[0] says: > Handover is clearly a time when errors or omissions in key information can have critical consequences. Statistics from the National Confidential Enquiry into Patient Outcome and Death showed that in 13.5 per cent of cases where patients died within four days of admission, poor communication − between and within clinical teams − was an important issue contributing to the adverse outcomes.

Might be a starting point at least.

[0] https://www.hsj.co.uk/technology-and-innovation/taking-the-r...

Re: Why Do Hospitals Hate Sleep So Much?

#170

Post by dotancohen » Wed, Dec 05, 2018, 11:09 AM UTC

kalmi10 wrote: post #162

dotancohen wrote: post #159

Earlier quoted context omitted.

> sleeping and dying look exactly the same. I do not know how many dead people you've attended to, but the ones that I have seen generally lack pulse or breathing. Both of those vitals are monitored for inpatients. And if one of those goes, the other goes too in short order. Sleeping patients, on the other hand, usually pulse at least once per second, and breathe every six seconds or so.

there is a difference between dead and dying

What do you think "dying" means, or looks like? What signs would such a "dying" awake person display, that a "dying" sleeping person wouldn't?

Choking? Pulse goes up and breathing becomes shallow.

Cardiac arrest? Aneurysm? Torn blood vessel? Shot in the head? Stabbed in the chest? Poisoned? Spider/Snake bite? Fell off bed and broke hip? All these "dyings" are easily detected by pulse and breathing monitors.