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

Re: Why Do Hospitals Hate Sleep So Much?

#371

Post by krrrh » Wed, Dec 05, 2018, 5:07 PM UTC

hedora wrote: post #319

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…

You forgot my favorite. In California (and probably other states), the building codes for apartment sound proofing are much weaker than for condos. If you wanted to sleep, you shouldn’t have chosen to rent. Your landlord couldn’t be expected to pay $1000’s [1] extra to build your apartment, after all. (1) https://www.remodelingexpense.com/costs/cost-soundproof-insu...

Counterpoint: regulations like these are part of what leads to an affordability crisis. It all adds up.

Re: Why Do Hospitals Hate Sleep So Much?

#372

Post by verelo » Wed, Dec 05, 2018, 5:10 PM UTC

foobarchu wrote: post #236

GavinMcG wrote: post #221

Earlier quoted context omitted.

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.

I've always wondered if the problem might be in the handoff procedures. Those studies about mortality in the event of a handoff always make it sound like obviously handoffs are an inherently dangerous thing, but perhaps the modern way of doing them is just poorly implemented? It feels extremely unlikely to me that absurdly long hours are the only solution.

I think this is a rational question to ask! Often people will jump to conclusions "handoffs cause errors", and while errors are a symptom of handoffs executed poorly, it seems uncommon for people to often ask for improvements to these processes.

Re: Why Do Hospitals Hate Sleep So Much?

#373

Post by GavinMcG » Wed, Dec 05, 2018, 5:13 PM UTC

technofiend wrote: post #351

GavinMcG wrote: post #221

Earlier quoted context omitted.

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…

Yes, but that's the whole point: there's little risk in rotating pilots, whereas rotating members of the care team carries a substantial risk of key information falling by the wayside.

Re: Why Do Hospitals Hate Sleep So Much?

#374

Post by rpedela » Wed, Dec 05, 2018, 5:16 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.

As others have said, sleep deprivation is the norm in certain fields like healthcare. There are also jobs where you work 40 hours but the schedules are so random that they can also screw with your sleep such as retail. And a lot of top performing companies in a variety of fields expect people to always be on.

Re: Why Do Hospitals Hate Sleep So Much?

#375

Post by tstrimple » Wed, Dec 05, 2018, 5:17 PM UTC

AnthonyMouse wrote: post #362

BigChiefSmokem wrote: post #283

Earlier quoted context omitted.

To pick up the other kids on a long route.

> To pick up the other kids on a long route. The obvious problem then being that the routes are too long. You have to wonder if there isn't some kind of carpool incentive the school could give to parents to get rid of 90-100% of buses. How many stay at home parents with 9-passenger vehicles would be willing to make $500/month by filling their minivan with other kids when they deliver their own kid as they were going…

All kinds of liability problems with that. School bus drivers are presumably vetted and trained to deal with not just getting from point A to point B, but dealing with students along the way.

Re: Why Do Hospitals Hate Sleep So Much?

#376

Post by snowwrestler » Wed, Dec 05, 2018, 5:22 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,…

Flying a plane is way less complex than medicine. A pilot can hand off a flying plane way, way, way more easily than a doctor can hand off a patient with a complex set of symptoms and treatments.

I should also point out that the vast majority of doctors don't work 120 hours a week continuously, rather, they experience higher-than-usual clusters of working time vs. not working time. That is, they might be on rotation for 36 hours straight but then off for 36 hours or more. And some of their shifts might only be 8 hours. Residents work longer hours, but are supervised by doctors.

I know several ER docs and they all cite the dangers of patient hand-off as the main reason they continue to support long shifts.

Re: Why Do Hospitals Hate Sleep So Much?

#377

Post by irrational » Wed, Dec 05, 2018, 5:22 PM UTC

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…

Tell me about it. We have to get our high school kids up at 5am to get to school on time while the middle schoolers don't have to get up till 8am or so (school starts at 9:15).

Re: Why Do Hospitals Hate Sleep So Much?

#378

Post by topkai22 » Wed, Dec 05, 2018, 5:22 PM UTC

AnthonyMouse wrote: post #362

BigChiefSmokem wrote: post #283

Earlier quoted context omitted.

To pick up the other kids on a long route.

> To pick up the other kids on a long route. The obvious problem then being that the routes are too long. You have to wonder if there isn't some kind of carpool incentive the school could give to parents to get rid of 90-100% of buses. How many stay at home parents with 9-passenger vehicles would be willing to make $500/month by filling their minivan with other kids when they deliver their own kid as they were going…

I actually did the math on this in my district. Based on the cost data they published, it costs (roughly) $1.5-2/ride on our school bus system. Allowing 20 minutes for pick up and drop off, no current ride-sharing system I know about would be cost competitive, but its a relatively close thing.

RE carpooling, this probably cost competitive but their are other factors that make this harder than you think. Buses are allowed exemptions to booster seat rules, minivans aren't- do you leave the van full of car of booster seats all day? Do kids carry their own? My kindergartener still has issues buckling their self in in a crowded car, that really pushes up pickup/drop off time spent. How do you get kids to school if the primary driver is sick or has car trouble? Who is liable for accidents? Do you randomly drug/alcohol test your parents?

None of these are insolvable, but they also aren't easy.

School busing in the era of autonomous vehicles gets a lot more interesting- you could have much smaller and efficient pick up routes. However, I think it will take (US at least) society a while before they are willing to leave 4-8 children alone in a car for 30 minutes a day. It just takes a couple 5th graders fighting in a car before the district decides supervision is needed.

Re: Why Do Hospitals Hate Sleep So Much?

#379

Post by cortesoft » Wed, Dec 05, 2018, 5:25 PM UTC

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…

> College + Sleep? Not gonna happen.

Wait, what? I slept so much in college. Way more than at any other point in my life. You schedule your own classes and aren't actually in class that much, gives you plenty of time to sleep.

Re: Why Do Hospitals Hate Sleep So Much?

#380

Post by topkai22 » Wed, Dec 05, 2018, 5:25 PM UTC

rocho wrote: post #358

mrhappyunhappy wrote: post #337

Earlier quoted context omitted.

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.

I just started attending the sections of the same class that started at 930, except on test days. The professors knew I was doing it, but didn't seem to mind.