9 ms·
> More sleep and no more 100-hour workweeks for sailors That's the far more important solution.
by spyspy 9y ago
> More sleep and no more 100-hour workweeks for sailors
That's the far more important solution.
- imglorp 9y agoThere was a similar shakeup in the airline industry after tired pilots made fatal mistakes. Regs were adjusted to improve pilot sleep schedules.
- travmatt 9y agoHave we instituted similar reforms for med students, or do they still compete on the basis of how little sleep they get?
- imglorp 9y agoI don't know, but least doctors have a reason for 30 hour shifts: continuity of care improves patient outcome. If they are rested but keep switching doctors, every shift you get a new doctor who's got to read up on you from scratch.
- imnotlost 9y agoHow about two or three doctors rotating in shifts? You get continuity of care, and more rested eyes looking at the same issues.
- tedsanders 9y agoCan you share your sources for that? I've heard from medical residents that longer shifts do not result in better patient outcomes. The first paper I Googled agrees - it shows longer shifts for surgeons are not safer (longer shifts had 9.1% rate of complications/death and shorter shifts had 9.0% rate): http://www.nejm.org/doi/full/10.1056/NEJMoa1515724 http://www.nejm.org/doi/full/10.1056/NEJMoa1515724
- arkades 9y agoWhat the literature consensus largely shows is that there's a roughly equal swap between more sleep/shorter hours resulting in more mistakes due to hand-offs, and longer shifts resulting in more mistakes due to exhaustion. People in favor of longer shifts (read: docs who are long out of training and hospital admins that rely on residents as some of their most cost-effective man-hours) argue this shows that shorter shifts do not provide patient benefit, so fuck it. Those in favor of shorter shifts (read: pretty much everyone else) argue that if it's all equal for patients, we shouldn't be torturing residents (they're people, too), and that what this really shows is that the hand-off process is shit and needs to be improved upon. More sleep and better hand-offs are the road to better patient outcomes and happier (or at least sane) residents. And it's worth noting that the fight for sane hours has, thus far, only extended to first-year residents. Second+ are still dogmeat. ...and that's the literature position. From first-hand experience, though, I can tell you true horror stories. Mistakes due to hand-offs can be reduced; mistakes because one of my colleagues had a dissociative episode during a way-too-long period without sleep is harder to catch. But no one discloses lapses in sanity during these studies.
- yardie 9y agoThank you! I kept hearing this "doctors need to be on call 30+ ,40+, 50+ hours because of handoff issues." Rarely has anyone mentioned they need to fix the handoff issue instead they prefer to keep the status quo.
- mattkrause 9y agoYou also have to look at the baseline in these papers. Many of these studies do daft things like compare 24 and 28 hour shifts, neither of which is likely to be anywhere near optimal performance. Hand-off also seems like a thing that could be improved in many different ways, while fatigue is driven by fundamental limits of human physiology.
- logfromblammo 9y agoSeems like a patient handoff/briefing is something technology could improve, with automatically generated digests, AI-flagged indications, and well-designed infographics, whereas no machine on Earth is currently capable of getting 8 hours of sleep for you.
- protonfish 9y agoI'd like to see data on that. I highly doubt anyone who hasn't slept in 30 hours can think straight.
- chrisseaton 9y agoI think they're on call for 30 hours. I don't think they literally stay up for 30 hours routinely. They have a mess where they can sleep.
- Broken_Hippo 9y agoBeing on call for 30 hours might as well be the same. All it takes is one patient that has a few emergencies in a short time frame for the sleep to get messed up. We have better regulations for train engineers and conductors - all for safety. My uncles do it, and my brother did for a while. Always on call, but once their shift starts, there is a strict limit on how long their shift is and a strict limit to how long they have free to sleep.
- dnautics 9y agothere have definitely been cold, calculating, studies done on the cost/benefit of doctor sleep to shift changeover ratios, and I don't know if it's 30 hours, but i do recall that it does not comport to your 'feel good' notions of how much a doctor should sleep.
- pavel_lishin 9y agoYeah, and when we had a newborn, we could "sleep when she sleeps". Guess how well we felt, and how capable we were of anything but the most routine tasks?
- kobeya 9y agoI would certainly not want my doctor or surgeon to be as “alert” as a new parent..
- 9y ago
- thearn4 9y agoI understand the issue with continuity of care, but to be honest that sounds like a communication problem at its core rather something that absolutely can only be addressed with aggressive scheduling.
- FLUX-YOU 9y agoIt is a communication problem, but it needs a good filter because you can generate so much information through the EMR and other systems feeding into it (even plain-text sentence generation which just string-interpolates data -- naturally this takes time to read and it builds up quickly). Plus, multiple people can contribute to the medical record simultaneously. Unfortunately the definition of a good filter is going to vary as much as workflows from hospital to hospital.
- pavel_lishin 9y ago> If they are rested but keep switching doctors, every shift you get a new doctor who's got to read up on you from scratch. Every time my wife or I or my kid have been in the hospital, we've been there for more than 30 hours. So the problem still exists - someone still has to read up on our situation. I'd much rather those notes be written down by someone who isn't on their 26th hour awake.
- euyyn 9y ago> So the problem still exists It's obviously statistical. It exists, yes, but to a lesser extent.
- amalag 9y agoI don't understand how that make sense. What if you have a patient who comes in at the end of a shift. Wouldn't it make more sense to have more overlap in order to transition patients? I think doctors egos wouldn't handle that well.
- kwhitefoot 9y ago> continuity of care improves patient outcome. This is brought up in every such discussion. Is it really true that US and UK hospitals have better outcomes than EU/Scandinavian ones where the EU working time directive is taken at least a bit more seriously?
- Caveman_Coder 9y agoThe problem is that increasing manning doesn't really contribute to the military industrial complex...so there isn't a real incentive to make room in the budget for additional personnel. When I was in the Navy we routinely had 100hr+ workweeks while in port and the older guys said it was the same back in the day.
- deleted 9y ago[deleted]
- euyyn 9y agoHonest question from someone that has no idea: Does training in these shitty conditions help performance in case of war, where those conditions might be necessary?
- Pica_soO 9y agoNo, they are there to break people and get them to rebond as a temp family. You really get to learn who is what kind of guy/girl doing repeated 100 hr weeks
- euyyn 9y agoIs that an official reason, or speculation?
- moftz 9y agoProbably more along the lines of a ship requires X number of crew working 24 hours a day to run properly and the ship can only hold a crew of less than 3X (8 hours shifts, 7 days a week). It's not going to be a simple 9-5 job for everyone on the ship but there should at least be some scientific justification behind whatever shift scheduling the Navy decides on. Do people work better when doing long shifts with long breaks in between or short shifts with short breaks? Can people doing day shifts work longer than people doing night shifts? Do people work better with regular shifts or with ones in different lengths? It's obviously going to be different for every position, anyone making critical decisions shouldn't be overworked but the guy cleaning toilets isn't going to do too much damage being tired. It all boils down to how much can you work someone until it becomes an issue.
- hectorr1 9y agoIt's actually much worse than that. At sea, those with operational responsibilities don't work a normal day or week. Not only are you working over 100 hours, but you destroy your circadian rhythm. While it shows 23 hours of sleep in every 72, that's under optimal conditions when things aren't breaking and operations / drills aren't interrupting everything. This is what my full 72 hour rotation looked like in 5 on / 10 off: DAY 1: 0600: Wake up, shower/shave, breakfast, make rounds to Engineering and Combat to get situational updates, head to bridge for turnover. 0700-1200: Watch 1200-1300: Lunch, maybe some personal time 1300-1700: Work, maybe catch a nap for an hour (1) 1700-1800: Dinner, or skip it for a workout 1800-1900: Intel Brief 1900-2100: Work, personal time, or nap 2100-2200: Coffee, round for watch, get to bridge early to adjust eyes 2200-0200: Watch DAY 2: 0200-0700: Sleep (5) 0700-0800: Breakfast 0800-1100: Work 1100-1200: Lunch and rounds 1200-1700: Watch 1700-1800: Dinner 1800-1900: Intel brief 1900-0100: Sleep (6) DAY 3: 0100-0200: Coffee, rounds, more coffee, turnover 0200-0700: Watch 0700-0800: Breakfast 0800-1200: Work, maybe nap (3) 1200-1300: Lunch 1300-1600: Work 1600-1700: Dinner, turnover 1700-2200: Watch 2200-0600: Sleep (8)