Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Why Do Hospitals Hate Sleep So Much?

motherjones.com

Post reply on HN
Print view View original

351–360 of 528 posts

Re: Why Do Hospitals Hate Sleep So Much?

#351

Post by technofiend »

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.

> Pilots don't have to ensure continuity of care for their passengers, and can accomplish their work in reasonable chunks.

Are you aware that on long haul international flights pilots do in fact rotate who is actively "flying" the plane? Flying is in quotes because most of the work is done by automation these days. I won't draw any analogies between the autopilot doing much of the work for pilots and nurses doing it for doctors because I can't actually support the statement with any data.

Re: Why Do Hospitals Hate Sleep So Much?

#352

Post by da_chicken »

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.

I used to work in hospital IT at a level 1 trauma center from 2004-2006. While I was there, an article was released which studied the relationship between time on shift and errors made by staff. As I recall (and it has been 10 years) the findings were:

* Through roughly 9 hours, the error rate was about the same. Say, x%

* In the 10th hour, the error rate increased. Say x + y%.

* In hours 11 and 12, the amount the error rate increase doubled the 10th hour's increase. So x + 2y%.

* In hours 13 and 14, the amount the error rate increase quadrupled the 10th hour's increase. So x + 4y%.

* In every subsequent hour studied, the error rate increase doubled again. x + 8y% in hour 15, x + 16y% in hour 16.

I want to say the study went to 18 hours, but I don't recall if it was 16 or 18 at this point. The paper made the recommendation that shift lengths should be limited to 10 hours maximum.

Every health care professional I spoke to about the article (resident doctors and nurses, maybe 10 overall, mostly in the ER) said the same three things:

1. They had personally witnessed someone make an error they could attribute to tiredness.

2. They themselves had never made a mistake due to tiredness.

3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem.

Re: Why Do Hospitals Hate Sleep So Much?

#353

Post by Verdex_3 »

mrhappyunhappy wrote: post #337
IB885588 wrote: post #231

Earlier quoted context omitted.

And it's a known biological fact that during teenager years the circadian rhythm is affected and normal sleep is pushed later in the night. Having teens wake up early is literally fighting biology and can't but have negative results on their health, education, socialization, etc.

Sure, I barely remember high school seeing how I was half asleep most of it. There was not a day when I did not fall asleep in class early in the morning. I remember having to fake like I was looking down to pick something up just so I could sleep.

I remember trying to sleep in between classes. Like, I would close my eyes and touch the wall in the hallway so that I could "sleep" while I was walking to my next class.

Re: Why Do Hospitals Hate Sleep So Much?

#354

Post by c2h5oh »

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…

Add time necessary to get to school when your commute isn't the best and it becomes even more fun.

I remember having to get up at 5:20 AM four days a week, to leave 20 minutes later to catch a bus at 5:58 AM to be get to high school in time for classes starting at 7:10 AM. And a teacher complaining to my parents that I often seem tired.

Re: Why Do Hospitals Hate Sleep So Much?

#355

Post by _7fvc »

I think the reason is simple. It has to do with money. If a medical worker doesn't come in and perform their job, he/she is not entitled to be paid.

When you step into a hospital, there's a process in place to make money out of you. If anyone misses their part, they'll have revenue shortfall. The pressure is on medical workers. Hospitals have admin staff to pay (CEO, managers.) They have bonds that come to due.

Hospitals are not there just to care for the sick. They're there primarily to make money. I think most of them are designed that way.

Re: Why Do Hospitals Hate Sleep So Much?

#356

Post by uxp100 »

ineedasername wrote: post #317
cstross wrote: post #291

Earlier quoted context omitted.

Here in the UK, the way I heard it from a friend who was doing their pre-med, is that there was a built-in cost incentive: hospitals paid doctors who were on-call at one third of their regular hourly rate for out-of-hours on-call coverage. (That's not regular hourly rate plus a third; that's one third of normal wages for hours after the first 40.) So the hospital administration had a solid reason to work their intern…

I wonder how much of it is financially motivated in this way and how much is the inertia of this hazing-style culture. From what you've said, I'm sure hospitals would object to a change out of financial self-interest, but it seems the ingrained culture stops the issue from getting a big push to begin with. I know labor unions (sometimes rightfully) get a bad rap, but it seems this is exactly the type of abuse they we…

But Doctors have a very strong labor union, which tends to advocate FOR this system. Probably even though the AMA represents residents, doctors who have succeeded in the residency system have more sway within it.

Re: Why Do Hospitals Hate Sleep So Much?

#357

Post by Lordarminius »

dahfizz wrote: post #279
ExBritNStuff wrote: post #238

Earlier quoted context omitted.

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.

For this and most questions regarding school schedules, consider the point that the timing is for the convenience of the adults who need to go l get to work / back home / other tasks, not the children. A school system that puts kids first would start by 9am but how would society cope with that ?

Re: Why Do Hospitals Hate Sleep So Much?

#358

Post by rocho »

mrhappyunhappy wrote: post #337
IB885588 wrote: post #231

Earlier quoted context omitted.

And it's a known biological fact that during teenager years the circadian rhythm is affected and normal sleep is pushed later in the night. Having teens wake up early is literally fighting biology and can't but have negative results on their health, education, socialization, etc.

Sure, I barely remember high school seeing how I was half asleep most of it. There was not a day when I did not fall asleep in class early in the morning. I remember having to fake like I was looking down to pick something up just so I could sleep.

I had the same problem in college. Classes started at 0830 but for me it was still too early. I was always falling asleep and after a while I just stopped attending.

Re: Why Do Hospitals Hate Sleep So Much?

#359

Post by AnthonyMouse »

Lordarminius wrote: post #357
dahfizz wrote: post #279

Earlier quoted context omitted.

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

For this and most questions regarding school schedules, consider the point that the timing is for the convenience of the adults who need to go l get to work / back home / other tasks, not the children. A school system that puts kids first would start by 9am but how would society cope with that ?

> A school system that puts kids first would start by 9am but how would society cope with that ?

Do it like daylight savings time. Have everything start two hours later, all year. The issue for the kids is time related to sunrise, not time related to when the parents go to work.

Post reply on HN