Protecting Sleep in the Hospital, for Both Patients and Doctors • Hacker News Board

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

#41

Post by Theodores » Wed, Jun 05, 2019, 9:02 AM UTC

lazyasciiart wrote: post #30

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 o…

Nice parents!

But what if you were born into a family that were not able to look out for you?

From the sibling comments I get the feeling that people in countries where private health insurance is needed that the concept of healthcare for all is not imaginable. I was writing in the context of the NHS, as introduced by the Labour government in the post WW2 UK when Britain was broke and broken.

It goes against the NHS ideal to have some patients be able to pay for an upgrade, you get what you are given. There are no up-sells.

In recent years the neo-liberal politicians have chipped away at the NHS, slashing budgets and outsourcing services. Now that I consider what people in the USA get for healthcare I wish to take back all of my grumblings about the UK's beloved NHS! Sure it can be improved on but the values that go with it - universal and for all - are important to me. I would not feel happy paying for a better bed than the next guy or being the person that can't pay for that better bed. I have a sense of fairness that this goes against. I imagine I would not have that 'survivors guilt' feeling if private healthcare was all I knew.

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

#42

Post by arethuza » Wed, Jun 05, 2019, 9:13 AM UTC

Theodores wrote: post #41

lazyasciiart wrote: post #30

Earlier quoted context omitted.

> 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 o…

Nice parents! But what if you were born into a family that were not able to look out for you? From the sibling comments I get the feeling that people in countries where private health insurance is needed that the concept of healthcare for all is not imaginable. I was writing in the context of the NHS, as introduced by the Labour government in the post WW2 UK when Britain was broke and broken. It goes against the NHS…

"There are no up-sells."

That's not completely true - when our son was born we paid for a private room in an NHS hospital. Mind you that was ~20 years ago don't know if they still do it.

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

#43

Post by Engineering-MD » Wed, Jun 05, 2019, 9:23 AM UTC

I’m a doctor and I agree lack of sleep is a huge problem for inpatient care. I (and most of my colleagues) try to avoid waking patients wherever possible. The main reasons I need to wake patients at night is: a) they are unwell. This is unavoidable b) recanullating for fluids/medication that need to be administered overnight. c) for new admissions I need to do more routine tasks (ensure regular meds are prescribed in time for morning, or chase scan results/reassess patient/repeat bloods). This is necessary as for these patients (and patients who have become more unwell in hospital) there are too many unknowns to be able to safely leave it until morning, or need to be ready for theatre the next day.

The main problem I have is that I often wake up everyone else in the same bay due to lack of private rooms and the need to turn on lights and often shout at dead patients so they can hear me.

Beeping machines is a big problem, and the sooner they are made to wirelessly notify the better.

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

#44

Post by amitport » Wed, Jun 05, 2019, 9:24 AM UTC

scarejunba wrote: post #39

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…

The understaffing is because decades ago the AMA decided to limit the number of doctors. The AMA is run by doctors. Good for them for having power to run protectionism but I'm not going to thank them for it.

understaffing in hospitals is very common globally (AMA is definitely not the sole factor, and possibly not even a major one)

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

#45

Post by diamondlovesyou » Wed, Jun 05, 2019, 10:13 AM UTC

phire wrote: post #34

AlphaWeaver wrote: post #19

Earlier quoted context omitted.

> I'd like to find a watch/fitbit for her and either find or write an app that just fills the screen with a color based on her current sleep phase... Related to this: I looked into trying to get real time sleep data found it surprisingly hard. Fitbit, for example, only makes sleep data available after sleeping is over and the device is synced to the cloud. If anyone has a good solution to this I'm all ears.

An accelerometer based approach (which the fitbit uses) can't actually tell the difference between someone who is just lying there still and someone who is in deep sleep. All it can do is measure movement (which might mean they are awake, or it might mean they are in REM) and no movement. Then it can post-process it later and use the length of stillness and the patterns/amount of movement to infer probable sleep cycl…

My Fitbit also has a heart monitor. It never confuses "just lying there" with actual sleep, for me at least.

Note that your heart rate slows during sleep, which is useful for detecting sleep cycles etc. Which is why I mentioned the heart monitor.

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

#46

Post by kdelok » Wed, Jun 05, 2019, 10:32 AM UTC

Engineering-MD wrote: post #43

I’m a doctor and I agree lack of sleep is a huge problem for inpatient care. I (and most of my colleagues) try to avoid waking patients wherever possible. The main reasons I need to wake patients at night is: a) they are unwell. This is unavoidable b) recanullating for fluids/medication that need to be administered overnight. c) for new admissions I need to do more routine tasks (ensure regular meds are prescribed in…

I must confess that the main reason I'm replying is to correct the darkly amusing dead->deaf typo that I'm hoping you made.

However, I wonder if you could comment on whether you think a) that you and your colleagues' approach is reflective of the broader medical community, b) you think earplugs could be feasibly issued in shared wards (from a financial/hygiene/other perspective)?

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

#47

Post by NLips » Wed, Jun 05, 2019, 10:34 AM UTC

arethuza wrote: post #42

Theodores wrote: post #41

Earlier quoted context omitted.

Nice parents! But what if you were born into a family that were not able to look out for you? From the sibling comments I get the feeling that people in countries where private health insurance is needed that the concept of healthcare for all is not imaginable. I was writing in the context of the NHS, as introduced by the Labour government in the post WW2 UK when Britain was broke and broken. It goes against the NHS…

"There are no up-sells." That's not completely true - when our son was born we paid for a private room in an NHS hospital. Mind you that was ~20 years ago don't know if they still do it.

They still do, or did in 2015 and 2018. We were lucky enough to not need the doctor-led hospital unit - using the midwife-led maternity unit instead (where private rooms are standard). However, we were moments away from foreceps being used - a doctor-administered intervention - for the first birth, which would have necessitated a move downstairs to the hospital wing, and thus a ward or payment for a private room.

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

#48

Post by smartbit » Wed, Jun 05, 2019, 10:51 AM UTC

Even without awakening by medical staff or sounds (ear plugs do wonders), with some illnesses patients can only sleep on their back which can be a unpleasant experience if you're used to sleeping on your side. It takes time to get accustomed to and in the mean time patients get little sleep with all mentioned effects. Pillows designed for sleeping on your back [0][1] with special curvatures for your head and neck to relax on ease falling and staying asleep. If a 10% of the patients sleep better and are released earlier from hospital or get to work faster, these pillows are a very small costs compared to costs savings, both personal & society.

Anyone seen hospitals with Orthopedic pillows? Or doctors recommending pillows for sleeping on your back?

[0] https://en.wikipedia.org/wiki/Orthopedic_pillow#Back_sleepin...

[1] eg "Emolli Contour Memory Foam Pillow" on https://www.forbes.com/sites/forbes-finds/2019/02/21/pillows... (advertising article)

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

#49

Post by dazc » Wed, Jun 05, 2019, 10:53 AM UTC

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…

'Doctors and nurses don't have the time to keep the sleeping schedule of all their patients into account.'

Speaking from the UK, where this problem has been well publicised, the biggest complaint being disturbance during the night when it ought to be obvious that most people will be asleep?

Accepted there will be exceptions where patients are sleeping during the day and this does present obvious problems. However, where medical staff are carrying on their normal work routines or idly gossiping at night time without regard for their patients is inexcusable.

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

#50

Post by xattt » Wed, Jun 05, 2019, 10:55 AM UTC

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…

Have you had a conversation to address concerns about your spouse’s care? There is always some flexibility around the care that she’d be receiving, and one core component to that is your rational/measured input, either in person or by phone. Framing your concern as rational helps immensely in establishing a dialogue with care staff. It sounds like your core problem is that you want to be bothered less.

Nurses are not there to make every patient's stay miserable. At least in my practice setting, we are extraordinarily receptive to suggestions around care and stepping in as informal advocates when families are not available.