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

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

#61

Post by joshgel » Wed, Jun 05, 2019, 11:59 AM UTC

kdelok wrote: post #46

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)?

Sounds right. I’ll add (as in another comment) that nursing hourly rounds is mandated by my institution. Personally i go out of my way to avoid waking you up, but it’s not a hotel and if I’m even a little bit worried about your trajectory, I won’t hesitate to wake you up.

My hospital gives out ear plugs. Luckily never had to test it but the beeping is so loud and annoying that I doubt they’d work for me.

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

#62

Post by brlewis » Wed, Jun 05, 2019, 12:05 PM 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…

Unfortunately sleep phase detection is not real time, even assuming you could get staff to pay attention to it. If you can get the hospital to care about sleep though, maybe they could start coordinating enough to consolidate wakings.

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

#63

Post by u801e » Wed, Jun 05, 2019, 12:13 PM UTC

joshgel wrote: post #60

HeraldEmbar wrote: post #31

The arrogance of nurses and physicians in constantly waking patients up, completely unaware and uncaring of the health detriment that comes with loss of sleep, is inexcusable. While some people can go back to sleep after being awakened, there are many of us who have real difficulty getting back to sleep, and sometimes it doesn't happen at all.

That’s a bit to far in my opinion. I’m a physician. Now days, if you are admitted to a hospital overnight it implies you are probably pretty ill. We push hard to ensure that only patients that need to be in the hospital are (wasn’t always that way). Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Additionally, there is evidence that hourly rounding prevents some bad outcomes l…

> Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying).

Could this be accomplished by using devices that monitor patients vital signs and report the data back to the nurses station? Then spot checks would not really be needed.

> Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls.

Could you list some of the studies you're referencing?

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

#64

Post by brlewis » Wed, Jun 05, 2019, 12:15 PM 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…

Hi. I work at Fitbit. I don't speak for Fitbit, but the page below does. You are probably right that real time sleep phase data would require EEG, but wrong about Fitbit using motion data to infer sleep phases. Without heart rate Fitbit only measures awake/restless/asleep. REM/deep/light is estimated only when heart rate data is available.

https://help.fitbit.com/articles/en_US/Help_article/2163#Aut...

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

#65

Post by NikolaeVarius » Wed, Jun 05, 2019, 12:26 PM UTC

u801e wrote: post #63

joshgel wrote: post #60

Earlier quoted context omitted.

That’s a bit to far in my opinion. I’m a physician. Now days, if you are admitted to a hospital overnight it implies you are probably pretty ill. We push hard to ensure that only patients that need to be in the hospital are (wasn’t always that way). Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Additionally, there is evidence that hourly rounding prevents some bad outcomes l…

> Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Could this be accomplished by using devices that monitor patients vital signs and report the data back to the nurses station? Then spot checks would not really be needed. > Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls. Could you list some of the studies you're referencing?

I find that anecdotally, I really REALLY hate being connected to shit during a hospital stay. A nurse waking me up is infinitely less disruptive than having another dozen sensors on me permanently.

Doubly so when, now nurses have to track uptime of all those sensors.

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

#66

Post by joshgel » Wed, Jun 05, 2019, 12:35 PM UTC

u801e wrote: post #63

joshgel wrote: post #60

Earlier quoted context omitted.

That’s a bit to far in my opinion. I’m a physician. Now days, if you are admitted to a hospital overnight it implies you are probably pretty ill. We push hard to ensure that only patients that need to be in the hospital are (wasn’t always that way). Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Additionally, there is evidence that hourly rounding prevents some bad outcomes l…

> Sometimes in sick patients, checking vitals is required (to make sure you aren’t dying). Could this be accomplished by using devices that monitor patients vital signs and report the data back to the nurses station? Then spot checks would not really be needed. > Additionally, there is evidence that hourly rounding prevents some bad outcomes like patient falls. Could you list some of the studies you're referencing?

I'm really excited about [0], but as far as I know there is no way to take blood pressure without touching the patient. If someone here could invent it, I could probably provide a test environment for large scale investigations.

Re: studies. I can't say I know the evidence that well, so I wouldn't want to mislead, this isn't my area. A google search for Hourly Rounding reveals lots of articles, but I haven't poked into the underlying data that proves it is a successful strategy (if that exists). I guess I overstated my confidence above.

[0]: http://people.csail.mit.edu/mrub/vidmag/

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

#67

Post by lojack » Wed, Jun 05, 2019, 12:36 PM UTC

xattt wrote: post #50

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…

We ran into this with my daughter who needed multiple surgeries. Two different experiences in two different hospitals.

First hospital was world renowned, ranked #1 in the world for the category of care she needed. This hospital seemed to spend all their money on what I would call “celebrity surgeons”. World renowned, only the best. I suspect the side effect is that they spent much less money on nursing care. There was only one or two nurses to a single floor overnight, and they utilized nursing assistants for everything. I got lots of attitude from the nurses, I suspect it was part of the culture. Their schedules were also much more rigid since they had a lot more patients to cover with limited resources. They also seemed to focus a lot more on the raw numbers and not the individuals. We fought tooth and nail to get a schedule that worked, and got a small amount of wiggle room, but it took a lot of work.

Second hospital was a completely different experience. They had a good surgeon, who had good outcomes, but didn’t have as many surgeries under his belt, so less data. I suspect this meant he took up less of the budget. This hospital had zero nursing assistants, and each nurse only had one or two patients at any given time. This resulted in the nurses advocating for us, and actually working their schedule around us.

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

#68

Post by Theodores » Wed, Jun 05, 2019, 12:42 PM UTC

NLips wrote: post #47

arethuza wrote: post #42

Earlier quoted context omitted.

"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.

Forceps?

I thought that forceps had been replaced by sink plungers. Obviously not the sort you buy in the DiY store but the expensive medical grade. The same principle applies though, suction cup goes on baby's head and with one pull the baby is born!

I thought the suction cup approach was standard now with the benefit to the technique being no birth marks.

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

#69

Post by bigtex » Wed, Jun 05, 2019, 12:52 PM UTC

Man is this so true. Years ago I had a daughter spend some time in a hospital and they wanted to change her diaper every 2 hours...during...the...night! Sure the child who is recovering from brain surgery should have their sleep interrupted 5 times to change a diaper. I am fairly certain no sane parent wakes up a perfectly sleeping baby to change a diaper. My wife kindly told them we didn't need that and they obliged.

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

#70

Post by mhalle » Wed, Jun 05, 2019, 1:03 PM UTC

GaurVimen wrote: post #52

Good luck trying to change the hospital mindset. Doctors actually have a term for patients who suffer sleep deprivation: hospital-induced-psychosis. It should be called a crime and the head nurse and doctor in charge of the patient ought to be arrested.

Hospital delirium is the current accepted name for this condition. It covers much more than sleep. It includes the stress of complex and potentially life threatening medical and social conditions, confusion related to time of day and time unconscious, the effects of medication, and possible underlying mental health issues. All compound each other.

Your charge against doctors and nurses is extreme and unwarranted. Health professionals don't exacerbate these problems willingly or intentionally. ICU delirium puts doctors and nurses at risk of injury or even assault by patients with vivid hallucinations.