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Protecting Sleep in the Hospital, for Both Patients and Doctors

nytimes.com

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Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#21

Post by reitanqild »

darkerside wrote: post #4

I had an infuriating experience with a young child in the hospital, where routine checks were being performed at the worst possible times for his sleep cycles. Sleeping is so critical to healing. Could it be that hospitals are being counterproductive, sacrificing effectiveness for efficiency?

FWIW my experience was totally different less than 9 months ago when I visited the hospital with my youngest and had to stay a few days for what ended up as a minor surgery (but still with anesthesia):

I woke up once in the night and saw a shadow with a tiny led light, carefully taking a look at the sleeping child before disappearing just as quitely.

(FWIW the nurse was there every night, but this was the only time I observed it.)

My daughter slept very well during those days, as did I.

IIRC they'd also plan with me in advance to know when the best time would be for checks and blood works, at least it came across as very thoughtful.

This was Norway, not one of the major hospitals, so not so relevant for many others except as proof that it isn't like that everywhere in the world.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#23

Post by dzink »

In the US Hospital reimbursements from insurers and medicare are per procedure, not duration of stay. Hospitals have a strong vested interest in both keeping patients alive and reducing length of stay. Food quality and sleep interruptions for non-critical patients both help the latter metric, even if that is likely not their sole reason.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#24

Post by Ayesh »

dzink wrote: post #23

In the US Hospital reimbursements from insurers and medicare are per procedure, not duration of stay. Hospitals have a strong vested interest in both keeping patients alive and reducing length of stay. Food quality and sleep interruptions for non-critical patients both help the latter metric, even if that is likely not their sole reason.

From what I see in Asia and Europe, hospitals charge per night stayed in the hospital, plus the cost for any procedures.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#25

Post by musicale »

Theodores wrote: post #15

There are a lot of exemptions in healthcare, sleep is part of this exceptional world, I was told bluntly 'we are not operating a hotel here' last time I spent a sleepless night in a hospital. Food is another area of concern. You can starve during a hospital visit or end up broke buying supplemental calories in the shop. Then there is the sheer difficulty of navigating the typical hospital if you are somewhat disabled…

A room and service upgrade would be totally worth it, and probably in the noise for most hospital bills.

It really is amazing that hospitals are not patient-focused. I think the problem is that their real customers are insurance companies, who don't generally care how patients are treated.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#26

Post by munmaek »

Tharkun wrote: post #20

I know that sleep is critical to healing. And I know that a lot of what happens to you in a hospital is very unpleasant. And I know that some things might seem silly, banal or irrelevant. But please remember that this is all done from a desire to keep you and other patients alive and (relatively) well. Hospitals are always understaffed. Doctors and nurses don't have the time to keep the sleeping schedule of all their…

Particularly with the human shortage, it would seem that some sort of a computer management system would be prudent here, no?

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#27

Post by Aromasin »

Tharkun wrote: post #20

I know that sleep is critical to healing. And I know that a lot of what happens to you in a hospital is very unpleasant. And I know that some things might seem silly, banal or irrelevant. But please remember that this is all done from a desire to keep you and other patients alive and (relatively) well. Hospitals are always understaffed. Doctors and nurses don't have the time to keep the sleeping schedule of all their…

It's basic cost-benefit analysis. I completely appreciate where you're coming from, but despite all your points many of the checks are still silly, banal and irrelevant - the benefit of waking someone up mid sleep cycle to ask them what they want to eat, or to get them to fill out a questionnaire, or to take a blood sample when they've only had one an hour or two before, is not worth the cost. You're giving a passionate response about how lucky we are to have that care anyway, but frankly you are vastly underestimating the devastating effects broken sleep has on the body. Most of the patients are on opiates anyway, so sleep is already at a premium (sedation =/= sleep).

Hospitals are understaffed, but that does not mean they have an excuse to endanger patient safety by ruining their best method of recovery; sleep. Many of my friends work in sleep science. Ask any of them what they think about the current ways we treat patient sleep, and they'll go on an hour long tirade about how absolutely ridiculous it is - how there are 100s of things that we could be doing differently, but don't because of antiquated science and work dogma, and there is almost no reason for close to 50% of times we wake patients up.

I highly recommend "Why We Sleep" by Matthew Walker. He puts a massive spotlight on the health implications that are cause by lack of sleep, especially for the elderly who make up the most hospital patients.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#28

Post by Sevrene »

Tharkun wrote: post #20

I know that sleep is critical to healing. And I know that a lot of what happens to you in a hospital is very unpleasant. And I know that some things might seem silly, banal or irrelevant. But please remember that this is all done from a desire to keep you and other patients alive and (relatively) well. Hospitals are always understaffed. Doctors and nurses don't have the time to keep the sleeping schedule of all their…

I do agree with what you've said, but I don't agree with the conclusion, so I want to provide a counterpoint and I hope I don't come across as unconstructive in doing so.

Just because doctors and nurses have a desire to help, doesn't mean that anything they do is therefore the right thing to do. Like you said, we know that sleep is critical to healing so doesn't that go against nurses and doctors having a desire to prevent harm? I would think that something preventing healing or causing emotional stress is de-facto harm.

Yes, hospitals can be understaffed and underfunded, but that's hardly an excuse when we know some of their practises can cause harm. You wouldn't let a nurse do something harmful and let them say "Sorry we don't have the budget". We can sit here and say that yes, here's the reason but that doesn't actually mean that's what they ought to be doing.

There seems to be quite a lot of bias for doctors and nurses because they do work that is seen as very important and good. While that is true, it can often cloud judgement when deciding what we ought to do in a prescriptive medical sense. There's been many occassions where doctors or nurses were holding back advancement of their own field because they're just people and like all people they have their own faults and their own bias. I don't say this to say that doctors are bad, or cause harm, but rather that some are bad and some do cause harm, even if they're trying their best to stop you dying.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#29

Post by Scoundreller »

jcims wrote: post #7

My wife has been in the hospital regularly over the past 18 months probably 20 days total. This is a renowned research hospital with a gorgeous, vibrant facility and spacious rooms. They absolutely 100% ignore any semblance of a sleep cycle for their patients (as well as proper nutrition but that's for another day). Constant interruptions to check vitals, ask if we want to pick a meal, beeping infusion pumps, a whole…

> research hospital

> a whole squad going on rounds with banal questions

I’m sure there’s a better way, but that’s par for the course for a research/teaching hospital. The patient’s room is a real-life classroom and lab, with everything that goes along with that.

Re: Protecting Sleep in the Hospital, for Both Patients and Doctors

#30

Post by lazyasciiart »

Theodores wrote: post #15

There are a lot of exemptions in healthcare, sleep is part of this exceptional world, I was told bluntly 'we are not operating a hotel here' last time I spent a sleepless night in a hospital. Food is another area of concern. You can starve during a hospital visit or end up broke buying supplemental calories in the shop. Then there is the sheer difficulty of navigating the typical hospital if you are somewhat disabled…

> ave had discussions about this with plenty of people and the idea of customer service in healthcare is poo-pooed. Is there anywhere in the world where it has been given a try?

I spent several days in hospital for surgery as a teenager in Australia and my parents (with private health insurance) paid for me to have a private room, which I remember as being pretty comfortable and not filled with interruption. On the other hand I was on serious painkillers and couldn't even stand up so I may not be a reliable witness.

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