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

Re: Why Do Hospitals Hate Sleep So Much?

#471

Post by philwelch » Wed, Dec 05, 2018, 9:54 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…

> Elementary school starting so early all the kids are half asleep in class.

The primary purpose of K-12 education these days is to keep kids locked up so their parents can go to work. If Mom and Dad have to be at work at 8, as is often the case, the kids have to be at school before 8. Teenagers, who naturally sleep in later than younger kids, would be better served starting school at 9, but because our society still infantilizes teenagers and young adults, we can't systemically trust them to fend for themselves in the mornings.

This isn't to say that K-12 schools are entirely unconcerned with actual education, but it has to accomplish this goal within the constraint of keeping children locked up.

Re: Why Do Hospitals Hate Sleep So Much?

#472

Post by technofiend » Wed, Dec 05, 2018, 10:38 PM UTC

da_chicken wrote: post #352

technofiend wrote: post #190

Earlier quoted context omitted.

>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 er…

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.

I think those two items and the tribal knowledge that handoffs are more dangerous to the patient helps the overwork model persist. Sounds like it's past time the medical industry prove that handoffs are more dangerous to patient outcomes. Doctors are trained to be problem owners and problem solvers, but that doesn't make them good team players. And lowering handoffs also limits oversight and prevents second guessing which is great if you're convinced you're always right, but clearly doctors are not always right and patients often pay the price.

Re: Why Do Hospitals Hate Sleep So Much?

#473

Post by hedvig » Wed, Dec 05, 2018, 10:44 PM UTC

esm wrote: post #411

ineedasername wrote: post #240

Earlier quoted context omitted.

Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really neces…

The counter argument that I have heard is that patient handoffs are where a disproportionate number of errors occur. Increasing the number of shifts means that more patients in the ED or on the floor will have care fragmented between providers, making it more likely that results will not be followed up or that changes in a patient's status will not be recognized. I don't know at what point the errors from sleep depri…

This would be easy to do a controlled experiment to compare.

Re: Why Do Hospitals Hate Sleep So Much?

#474

Post by hedvig » Wed, Dec 05, 2018, 10:52 PM UTC

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.

There's no error in hand offs. Attending doctors are detached and spend just a little time with a patient during their stay. Nurses and PAs do most of the work.

Re: Why Do Hospitals Hate Sleep So Much?

#475

Post by TimTheTinker » Wed, Dec 05, 2018, 10:59 PM UTC

cbzbc wrote: post #367

TimTheTinker wrote: post #340

Earlier quoted context omitted.

Just an idea - you could try putting them to bed 15 min earlier every few days, and if they have trouble sleeping put on a short kids audiobook. Two of the most peaceful I know of from Audible are “The Tailor of Gloucester” read by Meryl Streep and “The Little House”.

Also depends on how young they are, if they are of reading age, then putting them to bed a little earlier and then allowing them to read for 15-20 minutes on their own can also be another way of calming them down. Some of the kids mindfulness podcasts (Peace Out as an example) are also good for this kind of thing

Scripture Lullabies is really great too - very peaceful & soothing.

Re: Why Do Hospitals Hate Sleep So Much?

#476

Post by trashtester » Wed, Dec 05, 2018, 11:03 PM UTC

jessriedel wrote: post #201

trashtester wrote: post #149

People die or suffer serious harm in hospitals all the time. This often happens during sleep, and in many cases it could have been prevented if the patient had been checked on more frequently. It is much easier to confirm that the patient is ok if they are awake. When the nurse softly asks "do you feel ok?" when drawing blood in the night, it is not just meant as soothing, but just as much to check if further treatme…

Source? I've asked nurses why they constantly wake up patients and they always say it is because they are supposed to get X data ever Y hours. None of them have ever said they purposefully wake a patient to just ask how they're doing. If they wake you up while they're checking something, obviously they are likely to ask is you need anything. But that is not the topic of the discussion. Also, its usually phlebotomist,…

I did a text analytics project some years back, where we were scanning for signs that a (avoidable) patient injury had happened (such as bedsores, brain damage due to lack of oxygen or glucose, fall injuries for patients that should not walk around on their own, hospital infections, what have you).

All documents in the patient records were analyzed, including the ones filled out during routine checks etc, which included sections for checking for vital signs, mental state, etc.

There are pros and cons to waking a patient just to check for vital signs, but if you do have to wake her/him, basic monitoring should be performed. (whether or not it is recorded)

I don't know how widespread the use of phlebotomists is in my country, or if the occupation exists at all (separately from nurses/medical assistants).

Re: Why Do Hospitals Hate Sleep So Much?

#477

Post by lovich » Wed, Dec 05, 2018, 11:14 PM UTC

random878 wrote: post #341

lovich wrote: post #327

Earlier quoted context omitted.

I can imagine how that is for the specifics, but what is the response from the medical community on sleep? We know it's damaging to be sleep deprived and that hurts patients and medical staff. We also know that being sleep deprived craters ability to do _any_ job after far less than the 18-24 hour shifts that medical staff are routinely working. Why is this ok is medicine and not any other type of human endeavor?

You are conflating two separate issues. Sleep deprivation in doctors is an entirely different question to that of patients sleeping while admitted into hospital. >what is the response from the medical community on sleep? I can't answer such a general question. >Why is this ok is medicine and not any other type of human endeavor? It would be impossible to cover this without hitting a significant word count. It's also…

Would you mind explaining then? We'll never learn if its never said

Re: Why Do Hospitals Hate Sleep So Much?

#478

Post by AnthonyMouse » Wed, Dec 05, 2018, 11:20 PM UTC

vkou wrote: post #429

AnthonyMouse wrote: post #408

Earlier quoted context omitted.

> Buses are allowed exemptions to booster seat rules, minivans aren't Buses are allowed exemptions for pragmatic reasons, not safety reasons. Whatever the rule is, it should be the same for both, in which case there is no relative advantage. If you're not willing to allow it for a minivan, why are you willing to allow it for a bus? (This also doesn't apply to high school students who don't need them anyway.) > How do…

> Buses are allowed exemptions for pragmatic reasons, not safety reasons. No, buses are safer, period, even without seatbelts. Occupants of bigger vehicles have much better outcomes in auto collisions, and buses are some of the biggest vehicles on the road. Also, most school buses don't do much freeway driving... Not having a seatbelt in 25 mph collision is one thing. Not having a seatbelt in a 70 mph collision is le…

> No, buses are safer, period, even without seatbelts. Occupants of bigger vehicles have much better outcomes in auto collisions, and buses are some of the biggest vehicles on the road.

By causing much worse outcomes for occupants of the other vehicle or pedestrians in the same collision. Not really something you want to have around your schools and homes where your kids may be the pedestrians or occupants of the other vehicles.

It's also no help for single-vehicle collisions, which are nearly two thirds of auto collisions. 12 ton bus vs. 2000 ton overpass, overpass wins.

In addition to the unfortunate high center of gravity that increases the probability of rollovers (which are especially likely to cause injury without seatbelts).

> Also, most school buses don't do much freeway driving... Not having a seatbelt in 25 mph collision is one thing. Not having a seatbelt in a 70 mph collision is lethal.

Which is a reason why statistics make school buses appear safer than they actually are -- a minivan picking up the same kids would be on the same roads with the same traffic speeds, even if the "average" minivan would be on different roads traveling at higher speeds.

That may even be a good basis for the rule -- car seat required if traveling more than 35MPH.

Re: Why Do Hospitals Hate Sleep So Much?

#479

Post by widforss » Wed, Dec 05, 2018, 11:22 PM UTC

analog31 wrote: post #265

widforss wrote: post #77

Earlier quoted context omitted.

I'll never forget the night I was visited by police in northern Norway because we committed the crime of ... haymaking at 11 pm.

Ironically, in the US we have a saying: "Make hay while the sun shines."

This was in northern Norway, in June. The sun was defininetly shining, even though it was at 11 pm ;)

Re: Why Do Hospitals Hate Sleep So Much?

#480

Post by cortesoft » Wed, Dec 05, 2018, 11:47 PM UTC

brahmwg wrote: post #386

cortesoft wrote: post #379

Earlier quoted context omitted.

> 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.

Probably depends what you study and at what rate. Alot of students work fulltime in addition to studying fulltime, which basically puts sleep and eating secondary or even tertiary. Socializing isn't on the radar for many.

Working full time and going to school full time is basically having two full time jobs... that would clearly hinder sleep.

The statement, however, said college means no sleep. That is a bit disingenuous to say that was meant to imply the person was working full time.

That would be like saying "living in an apartment means no sleep!" because you lived in an apartment above a 24 hour bowing alley.