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

Re: Why Do Hospitals Hate Sleep So Much?

#221

Post by GavinMcG » Wed, Dec 05, 2018, 1:52 PM UTC

verelo wrote: post #204

mfe5003 wrote: post #198

Earlier quoted context omitted.

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,…

Medicine has different concerns than piloting, though. Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks. Doubling the number of patient handoffs, on the other hand, significantly increases the risk of one of the more common sources of error.

Re: Why Do Hospitals Hate Sleep So Much?

#222

Post by athenot » Wed, Dec 05, 2018, 1:53 PM UTC

arkades wrote: post #180

mattjaynes wrote: post #137

I recently had a family member in the intensive care unit (ICU) for over a month in Austin, Texas. I quickly learned my main contribution would be protecting her sleep when I saw she hadn't slept in days because of the constant interruptions. She went from reasonable and compliant in taking her medication, to extremely irritated and noncompliant with the doctors. Of course I could see this was due to sleep deprivatio…

> intensive care unit (ICU) There are only two reasons for someone to be in an ICU: they require a therapy no other floor will administer, or their condition/therapy requires very frequent administration/titration/observation. These two reasons frequently overlap. Sleep isn’t optional in general. It’s optional in the ICU, because the premise is “if you don’t need this level of attention to survive, you absolutely sho…

Yes and there is an added benefit to frequent interruptions: despite all the monitoring equipement, a human assessment can go a LONG way in detecting trouble. My wife used to be an ICU nurse and her first code (CPR) in her career was when she was doing some routine stuff for the patient and noticed the color of their skin "looked different". When the patient's heart stopped beating, she was already there to get it back going, saving some precious delay.

For non-ICU stuff, yes there could be some better coordination around sleeping time, but again there's so much non-verbal stuff going on in just a physical assessment.

What would really be useful is having cleaning services and admin/billing services come at the same time (well, right after) a nurse comes, to take advantage of that interruption.

Re: Why Do Hospitals Hate Sleep So Much?

#223

Post by Nasrudith » Wed, Dec 05, 2018, 1:53 PM UTC

anticensor wrote: post #102

ajmurmann wrote: post #38

Earlier quoted context omitted.

To me the beeping also seemed like a quality backwards solution where much better, seemingly obvious solutions exist. Reality is probably much more complicated though. In a solution like you described and I had in my head we'd need a agreed upon protocol between IV drip and monitoring device. Probably the same standard should be used by other, similar devices. If that doesn't happen we get vendor lock in. In addition…

Can we not repurpose CAN for medical purposes?

Technically yes but seriously just don't. CAN is a horror show for security that can't handle a radio without being a security liability and medical privacy violations are expensive let alone wrongful deaths.

Re: Why Do Hospitals Hate Sleep So Much?

#224

Post by km3k » Wed, Dec 05, 2018, 2:01 PM UTC

DisruptiveDave wrote: post #218

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…

To be clear, you're saying that people whose job is to - quite literally - understand, diagnose, and treat hundreds (thousands?) of medical issues that they personally haven't experienced, don't have the capacity to understand that not everyone is on their same sleep schedule?

Yes.

Re: Why Do Hospitals Hate Sleep So Much?

#225

Post by mindcrime » Wed, Dec 05, 2018, 2:01 PM UTC

chasd00 wrote: post #220

mindcrime wrote: post #211

OMG, so glad to hear somebody else saying this. The last time I was hospitalized, the recovery was a complete nightmare for exactly this reason. If there wasn't somebody coming by to poke or prod me, there was somebody coming by to do something to the other patient in the room, or if it wasn't that, the door was open and the click-clack of heels on the tile floor kept me awake, or there was too much light coming in f…

"If there wasn't somebody coming by to poke or prod me, there was somebody coming by to do something to the other patient in the room, or if it wasn't that, the door was open and the click-clack of heels on the tile floor kept me awake, or there was too much light coming in from the hallway, not to mention how uncomfortable those beds are, etc., etc. Sleep was damn near impossible." surely you realize there's more to…

surely you realize there's more to hospital than just you?

Of course I do. What does that have to do with anything?

As the article says, there are simple changes they could make that would maintain the same quality of care, while still allowing patients to get more sleep. Considering how important sleep is to our health, not doing those things is borderline malpractice, IMO.

Re: Why Do Hospitals Hate Sleep So Much?

#226

Post by yellowbuilding » Wed, Dec 05, 2018, 2:03 PM UTC

kiriakasis wrote: post #96

Zhenya wrote: post #37

Earlier quoted context omitted.

Can you please elaborate on "it's stupid...?"

I think the parent refer to its own solution as stupid "it is stupid that they would use a pill if possible"

Yeah, that’s what she meant

Re: Why Do Hospitals Hate Sleep So Much?

#227

Post by km3k » Wed, Dec 05, 2018, 2:05 PM UTC

GavinMcG wrote: post #221

verelo wrote: post #204

Earlier quoted context omitted.

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,…

Medicine has different concerns than piloting, though. Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks. Doubling the number of patient handoffs, on the other hand, significantly increases the risk of one of the more common sources of error.

But could the increase in errors from increased hand-offs be smaller than the increase in errors from sleep-deprived doctors, nurses and patients combined with the increase in disease spread and disease progression from the effect of sleep deprivation on the immune systems of doctors, nurses and patients? Additionally, could there be benefits from getting more eyes on a patient's condition?

Re: Why Do Hospitals Hate Sleep So Much?

#228

Post by shados » Wed, Dec 05, 2018, 2:05 PM UTC

I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter?

- Elementary school starting so early all the kids are half asleep in class.

- College + Sleep? Not gonna happen.

- 24 hour construction in certain part of NYC, check!

- Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, and all your neighbors do the same!

- Having attention deficit? Lets start with ADHD medecine, not with a sleep study, no sir.

- Bazillion jobs requiring on call, waking people up at all manner of time, as a standard thing.

- Neighbors woke you up? Toughen up bro!

- Myth around how so many people apparently can do just fine on 5 hours of sleep.

The hospital thing is just a symptom of a society built around lack of respect for sleep. No one seems to consider it an important thing. If you're drowsy because you couldn't sleep, it's considered a minor inconvenience and little more.

Re: Why Do Hospitals Hate Sleep So Much?

#229

Post by Nasrudith » Wed, Dec 05, 2018, 2:07 PM UTC

perlgeek wrote: post #91

rifung wrote: post #49

Earlier quoted context omitted.

That was my first thought too. However, the downside of that solution is that the failure signal relies on correctness of the machine. In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate.

Monitoring over the network exists, and should be the preferred way to detect failure. > In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate. I can easily imagine software bugs that make the machine continue beeping even if the normal function doesn't work anymore. Somehow, this sounds like an excuse for lazy design.

It sounds like an excuse for not networking at all really. Or upgrading equipment. Just a primitive cables to a data station on a cart outside the room would handle it better on every level than trying to figure out which thing isn't beeping when it should. Have it beep if it loses a signal. Better yet it can handle triaging far better when networked. Signal lost and "patient definetly not breathing" are two very different triage levels for one. You want to restore signal as soon as able but it isn't a mobilize a crash team to resuscitate situation. Nearly everything else has abandoned beeps as the sole indicator with good reason.

Re: Why Do Hospitals Hate Sleep So Much?

#230

Post by IB885588 » Wed, Dec 05, 2018, 2:07 PM UTC

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.

Peter Attia (MD) had a podcast episode where he talked about being a resident and how it almost killed him (asleep while driving) and was bad for patient.

Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..