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Why Do Hospitals Hate Sleep So Much?

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Re: Why Do Hospitals Hate Sleep So Much?

#201

Post by jessriedel »

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…

Source? I've asked nurses why they constantly wake up patients and they always say it is because they are supposed to get X data ever Y hours. None of them have ever said they purposefully wake a patient to just ask how they're doing.

If they wake you up while they're checking something, obviously they are likely to ask is you need anything. But that is not the topic of the discussion.

Also, its usually phlebotomist, not nurses, who are drawing blood at night.

Re: Why Do Hospitals Hate Sleep So Much?

#202

Post by mattkrause »

mfe5003 wrote: post #198
technofiend wrote: post #190

Earlier quoted context omitted.

>One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.

I've always assumed that the failure rate for handing off care to another person and the rate because of long hours must go in favor of long hours. I don't have anything to back this up except the MCAT being designed to check how you perform when tired. Now with electronic records I've been wondering if long hours are still be necessary, assuming I'm right about the failure rates. I'm sorry about your mother in law r…

This is the claim, but if you look at the experiments supporting it, they’re all bonkers. For example, care is no worse from doctors on 28 hr shifts vs 24. I would argue that both of these are so far from a well-rested baseline that they’re meaningless.

We know from lab experiments that performance craters way, way before that, which is why pilots, truck drivers, cops, and every other profession work shorter shifts.

Re: Why Do Hospitals Hate Sleep So Much?

#203

Post by peterwwillis »

> As Frakt says, solutions aren’t hard to fathom. In fact, they’re trivially easy to figure out.

Lots of things are "easy to figure out", and also "really hard to implement correctly".

Managing the care of a lot of different people with different conditions over long periods of time is complex and error-prone. You can't stand around all day in a hospital trying to figure out if you missed an edge case in a patient's customized care plan. Not only are you tremendously busy, but making a mistake in that customized plan could mean life or death. Routine is much safer and more reliable.

It's not impossible to improve patient care, but it is tremendously more difficult than a layman can observe just by sitting in a hospital bed.

Re: Why Do Hospitals Hate Sleep So Much?

#204

Post by verelo »

mfe5003 wrote: post #198
technofiend wrote: post #190

Earlier quoted context omitted.

>One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.

I've always assumed that the failure rate for handing off care to another person and the rate because of long hours must go in favor of long hours. I don't have anything to back this up except the MCAT being designed to check how you perform when tired. Now with electronic records I've been wondering if long hours are still be necessary, assuming I'm right about the failure rates. I'm sorry about your mother in law r…

Super intersting to see people discussing this! As someone that holds a pilots license and talks with a lot of commercial pilots about their jobs, sleep is often a hot topic of discussion. It would be illegal, not just irresponsible, for a pilot to try pull off a 120 hour work week. Why do we treat doctors differently? Their macho behaviour in my opinion is unacceptable, and likely reduces positive patient outcomes, yet it goes on?

Re: Why Do Hospitals Hate Sleep So Much?

#205

Post by nnq »

Hospitals worldwide should be optimized for increased patient comfort even at the cast of marginally lowering survival (let's say 1%) and increasing cost (again 1%)! Almost all patients would prefer it.

But it's hard to convince people that often in life paying slightly more for a statistically slightly worse outcome increases you comfort ~10x and is 1000% worth it! After all, we live to feel good, and living is only worth it as long as we feel good doing it!

...but no, we just have to insist that we want the absolutely best things (as customers) and that we need to be as efficient as possible (as service providers). This combination of constraints makes life a living hell that I'm not sure why we can still stand. Also there's those maniacs that absolutely hate being or making others COMFORTABLE, but making life worse for them would be sooo enjoyable.

Re: Why Do Hospitals Hate Sleep So Much?

#206

Post by duxup »

swsieber wrote: post #28
duxup wrote: post #4

When my wife was in the hospital after the birth of both our two kids (premature so they weren't in the room with her to care for, they were in the NICU).... I chose to go home to sleep as the nurses just came and went endlessly. Someone had to get sleep. Then my oldest son was in the hospital for a while. He was sick so I wasn't too surprised he was napping all the time until spent a few nights sleeping at the hospi…

There are preliminary results showing that when the NICU dims it's lights during the day and goes even darker at night babies recover faster. 5 weeks faster on average. (That's from "Why We Sleep")

Yeah the NICU for my second child had a sort of day night light cycle. It was pretty nice... for parents too ;)

Re: Why Do Hospitals Hate Sleep So Much?

#207

Post by Nasrudith »

technofiend wrote: post #190
cstross wrote: post #182

Earlier quoted context omitted.

You were dealing with doctors and nurses, right? One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted. I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting…

>One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.

Medicine is a conservative field - unfortunately that also includes ignoring anything harmful to their cult aspects even if it is trivially obvious like "wash your hands" after doing a damn autopsy before delivering a baby. Or yes infants can feel pain - not using anesthesia because the control isn't fine enough to not have a better chance of killing them is a grim but justifiable thing initially but inexcusable once it becomes possible to do so safely.

And the sleep deprivation and hazing "I did it so everbody else must too!" is definitely a cultic thing.

I use cult very deliberately to point at the reasoning being entirely irrational and social as opposed to underlying value. And also because actual cults use slerp deprivation.

Re: Why Do Hospitals Hate Sleep So Much?

#208

Post by winchling »

marcojx wrote: post #118

For having spent a long time in hospital (France), I can tell that the beeps of the machines are completely useless. It is maybe very ok for someone spending 2 or 3 days in the hospital, but for people spending 3 to 6 or even more months in hospital (this was the case here), it is completely terrible and the sleep deprivation goes against any good care practice. Situation is the following: - First you have beeps ever…

Reminds me of the 'too many road signs' problem:

https://www.safetysign.com/blog/too-many-traffic-signs/

It's hard to get staff working within a bureacracy to acknowledge this sort of thing, however. Only bureacratic procedures are real. Attempts to reform merely add to the bureacracy.

Re: Why Do Hospitals Hate Sleep So Much?

#210

Post by lbriner »

peterwwillis wrote: post #203

> As Frakt says, solutions aren’t hard to fathom. In fact, they’re trivially easy to figure out. Lots of things are "easy to figure out", and also "really hard to implement correctly". Managing the care of a lot of different people with different conditions over long periods of time is complex and error-prone. You can't stand around all day in a hospital trying to figure out if you missed an edge case in a patient's…

Absoutely! My mum used to work as a Senior Nurse and there were numerous "simple things" that could save time and money but there were various reasons why they didn't happen:

* You don't have the authority to change it * The person who does have authority is too far removed to care * There is simply too much work to do to think about leaving the patients alone * There are frustrating restrictions on e.g. approved suppliers so that you can't simply change something that would seem to make sense * Although things like beeping IV machines are annoying, they also prove they are running correctly - no sound might mean nothing or it might mean broken!

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