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

Re: Why Do Hospitals Hate Sleep So Much?

#271

Post by pc86 » Wed, Dec 05, 2018, 2:45 PM UTC

jyounker wrote: post #255

culot wrote: post #193

Earlier quoted context omitted.

I think it is absolutely standard in that situation to at least take vitals every couple/few hours, no way around it. It's annoying to be woken up so often, but it's done for good reasons.

So, my partner had the option of either going home directly after surgery or spending the night in the hospital. The hospital staff wanted her to go home. She wanted to stay. (She has issues with post-surgical pain.) If the hospital staff had sent her home, she would not be woken every two hours. The medical staff were fine with that. It would have been perfectly reasonable for them to let her sleep; it would have be…

> Clearly it was optional.

Unless there was some regulatory, legal, or hospital requirement that she receive a certain standard of care. They may have been fine with her sleeping through the night at home, but if she's in the hospital they need to take care of her.

It would not be an easy sell in a courtroom to explain that while you checked everyone except her every 3 hours, you let her sleep through the night and there was an issue that cost her life.

Not that the physicians and nurses should have been taking that into account but the folks crafting the regulations or hospital policy very well may have.

Re: Why Do Hospitals Hate Sleep So Much?

#272

Post by antidesitter » Wed, Dec 05, 2018, 2:45 PM UTC

pc86 wrote: post #260

ineedasername wrote: post #240

Earlier quoted context omitted.

Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really neces…

You would likely have to extend residency based on everything that you need to learn for a given specialty. Med school graduates have an average of over $180k in student loan debt - from med school alone - and resident salaries in the 2-4 year programs are mid five figures. Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to…

I believe the GP is talking about increasing the number of doctors, not their years in residency.

Re: Why Do Hospitals Hate Sleep So Much?

#273

Post by tomohawk » Wed, Dec 05, 2018, 2:46 PM UTC

Some of this stems from simple things. For example, most doctors are never trained in what nurses do, or what the implications of their orders may be. If a doctor waits til the end of a shift (when it is convenient) to write out a bunch of prescriptions and there is a frequency of dosage, then the start time is dictated by the time of the prescription, unless the doctor puts a specific time on it. This means that patients will be woken up at an inopportune time for the dose (end of a shift change), and usually a time when people would be asleep.

I learned about this by watching a video put out by a hospitalist who was showing the results of requiring new doctors to be paired up with nurses for a week or two to see how hospitals actually worked. The new doctors were very surprised that their mental model of things just wasn't grounded in reality.

This all stems from institution centric care rather than patient centric care.

Re: Why Do Hospitals Hate Sleep So Much?

#274

Post by bpyne » Wed, Dec 05, 2018, 2:46 PM UTC

This article brought back memories. When I was 9 something went through my eye. One night after surgery, the nurse came to check on my IV. She broke it. Her next mistake was getting a resident to put a new one in. Five tries in one hand and four in the other, they finally decided I could live without it for the night.

My wife and I still recoil at the memory of trying to rest the night after my daughter's birth. We were woken up every two hours for different tests. Keep in mind that it was a no complications birth. The fourth time they came in to run a test I begged them to leave us alone.

Re: Why Do Hospitals Hate Sleep So Much?

#275

Post by billmalarky » Wed, Dec 05, 2018, 2:47 PM UTC

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…

Anyone who claims making changes in healthcare is "trivial" doesn't know what they are talking about. Period.

The political forces that oppose change in an industry that is incredibly rigid and risk averse (for obvious, albeit frustrating, reasons - "move slow break nothing" is the rule when the risk of failure is death) are the actual challenge. The technicals are the easy part.

Re: Why Do Hospitals Hate Sleep So Much?

#276

Post by TallGuyShort » Wed, Dec 05, 2018, 2:47 PM UTC

We experienced the same thing after the birth of our first 2 children, and after our 3rd 2 months ago we were actually left alone all night. I commented to a nurse how nice it was and apparently protocol had recently changed for this reason.

Re: Why Do Hospitals Hate Sleep So Much?

#277

Post by m_mueller » Wed, Dec 05, 2018, 2:48 PM UTC

glenneroo wrote: post #216

m_mueller wrote: post #63

Earlier quoted context omitted.

May I weigh in with an outside perspective? My impression is this is a cultural issue, i.e. Americans are very insensitive to noisy disturbances during sleep hours. Biggest examples for me are your freight trains. Deadly accidents? Sure, the only solution is to disturb sveryone in a 5 mile radius around each crossing. In my home country this is unthinkable. People get chewed up, sometimes called the police on, for ev…

Since someone already guessed that you live in Switzerland, may I also ask if you are in an apartment building with neighbors above/under/around you? We have similar neighborly complaints in Austria where (at least in cities) almost everyone lives in apartment buildings and thus when someone runs the washing machine, you not only hear it, you also feel it. In the USA, I think most people in cities are living in indiv…

We do, and yes, it's the most common form of housing, including upper scale units.

Re: Why Do Hospitals Hate Sleep So Much?

#278

Post by jac241 » Wed, Dec 05, 2018, 2:51 PM UTC

gerbilly wrote: post #246

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…

> during pre-med training: with on-call work hours up to 120 hours a week. Can someone please tell me why they still put medical students through this institutional hazing?

In medical school, 120 hour weeks really only exist for 4th year med students who are on sub-internships in surgical specialties like neurosurgery, orthopedic surgery, general surgery, etc. Students in those fields do 3 or so month long sub-i's at hospitals they want to do residency at. They basically function as month long interviews for those programs, and are also used to get letters of recommendation from prominent faculty in the field. People who are interested in those fields know about the hour requirements on sub-i's and in residency, and self-select in a way.

The reason resident physicians work so much is because residents make $60k working 80+ hour weeks, and the PAs or NPs who would be willing to cover the floors at night would make $150k+ working 40hrs/wk. Residents also have no collective bargaining power because of the residency match system. You can't easily leave one program and go to another because you don't like the working conditions, for example. If you want to leave, you're more or less blackballed unless you're switching fields. And you don't want to speak up about the conditions because you've got $300k in debt and a degree that's useless until you finish residency.

Re: Why Do Hospitals Hate Sleep So Much?

#279

Post by dahfizz » Wed, Dec 05, 2018, 2:51 PM UTC

ExBritNStuff wrote: post #238

shados wrote: post #228

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, a…

The Elementary school comment rings so true. We have to get my seven year old up at 6:15 to get to school at 7:30. That's if we take him, if he caught the bus he would have to be AT the stop by 6:15. Every day is a battle against exhaustion. On the days that school is delayed due to weather and he can get up naturally at maybe 7:30, he is so much better. He feels better, his attitude is more positive, and he does so…

Why does the school bus pick him up more than an hour before school starts? That seems ridiculous.

Re: Why Do Hospitals Hate Sleep So Much?

#280

Post by Konnstann » Wed, Dec 05, 2018, 2:54 PM UTC

pc86 wrote: post #239

darepublic wrote: post #232

Earlier quoted context omitted.

I guess on paper going without sleep gives you some kind of competitive advantage? A company that believes otherwise could bet on giving their workers more sleep and they should gain an advantage by doing so.

Most companies (not startups) don't have their employees work much more than 40 hours. Lack of sleep is very rarely an issue with your employer.

In which fields? Financial/Law firms are routinely scrutinized because they overwork their employees, just to name a few. Doctors, EMS personnel, Police, all work more than 40 hours. There may not be mandated work hours over 40, but the culture/workload creates that environment anyway.