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The article quotes a doctor speaking about nursing care. This is as accurate as asking an automotive engineer about automobile repair. Same field, different ski
by legostormtroopr 8y ago
The article quotes a doctor speaking about nursing care. This is as accurate as asking an automotive engineer about automobile repair. Same field, different skill sets.
Nurses are trained to identify trends across many (sometimes too many) patients. Sure its inconvenient if a nurse monitors your blood pressure or oxygen levels every 2 hours after surgery, especially when you are sleeping, and especially if you recover perfectly.
But if you have a post-op internal bleed that occurs during the night, when you are asleep and unable to let someone know you are feeling woozy (because you are asleep), that's when trouble occurs. Frequent observations mean nurses can identify when things are going south before you get to an emergency situation.
Blood pressure drops sharply over 2 hours, monitor every 15 minutes, see if it stabilises. If it doesn't raise the alarm quickly.
Same with audio on machines, that constant beep is annoying to you, but it means the machines are operating and you are getting your prescribed fluids - silence on a night ward is a sign something is wrong, and quickly precedes an emergency alarm.
- amluto 8y ago> Same with audio on machines, that constant beep is annoying to you, but it means the machines are operating and you are getting your prescribed fluids - silence on a night ward is a sign something is wrong, and quickly precedes an emergency alarm. Sure, if there is one source of beeps, then no beeps would be conspicuous, but when there are many things all beeping, having one of them stop beeping may not be so obvious at all. A simple technological solution seems appropriate here. Have each machine that needs to work check in every couple seconds with each of two centralized monitoring machines. Have each monitoring machine alert the nurse desk if a monitored machine stops checking in. This is silent and has no single point of failure.
- mathrawka 8y agoThe nurse desk is a SPoF. If something goes wrong with that area, then how can you tell each monitoring machine is working?
- NegativeLatency 8y agoFailover to beeps?
- amluto 8y agoThe nurse desk is a desk. If the desk literally fails, you have serious issues, and your average multiple person desk is well enough engineered that there isn’t a single piece that can fail and take out the entire desk. But there are generally multiple nurses at the nurse desk, and there are often multiple desks, too. Also, you could hook the monitoring system up to the PA system. edit: when I say hooking it to the PA system, I mean that, if no one acknowledges the light or computer message or whatever, then an announcement could play after a set delay.
- ascar 8y agoNetwork failure in the desk room sounds like a complete outage for that.
- woolvalley 8y agoHow do you know if each machine is reporting in a consistent manner without being there 24/7 and making sure they beep all the time vs %40 of the time?
- ajmurmann 8y agoTo me the beeping also seemed like a quality backwards solution where much better, seemingly obvious solutions exist. Reality is probably much more complicated though. In a solution like you described and I had in my head we'd need a agreed upon protocol between IV drip and monitoring device. Probably the same standard should be used by other, similar devices. If that doesn't happen we get vendor lock in. In addition we are taking about medical devices so everything has to be fool proof, audited, double checked and certified. So what might be cheap in a consumer device now probably made the IV drip an order of magnitude more expensive. That is, if we agreed on a protocol in the first place.
- abecedarius 8y agoI’m sure you’re right, but being unable to sleep when you need to heal is bad. "It’s complicated" is not a get-out-of-jail-free card.
- m_mueller 8y agoMay I weigh in with an outside perspective? My impression is this is a cultural issue, i.e. Americans are very insensitive to noisy disturbances during sleep hours. Biggest examples for me are your freight trains. Deadly accidents? Sure, the only solution is to disturb sveryone in a 5 mile radius around each crossing. In my home country this is unthinkable. People get chewed up, sometimes called the police on, for even running the washing machine past 10pm.
- sunkencity 8y agoabsence of signal is not a good indicator of operation. it is the same signal as total failure of your system.
- dingaling 8y agoInterestingly that reflects Airbus vs Boeing cockpit philosophies. In the early 1980s Airbus adopted Dark Cockpit where the default state of all annunciator lights is off. If one illuminates then it indicates something worthy of attention. The colour of illumination indicates functional state; blue is good, amber is malfunctional.
- andai 8y agoWhen would something illuminated blue? When it's both working smoothly and worthy of attention?
- jon-wood 8y agoI assume that's for indicators of abnormal, but safe, state. One example could be the undercarriage being down, a situation that would usually not be expected, but when you're in the process of landing doesn't warrant attracting your attention as an error state.
- michaelt 8y agoAccording to [1] for the wing anti-ice system, Blue = Turned on, Unlit = Turned off, Amber = Malfunction Of course, one might very well argue that 'turned on' is not 'worthy of attention' [1] http://www.smartcockpit.com/docs/A330-A340_Overhead_Pushbuttons_1.pdf http://www.smartcockpit.com/docs/A330-A340_Overhead_Pushbutt...
- Scoundreller 8y agoCentral monitors are quite common. There are even entire units based on it (telemetry).
- Xcelerate 8y agoSeems like it’s backward to me. The machine should be silent if everything is ok and start beeping if things are going wrong.
- wnevets 8y agobut what if the alarm isn't working when something is wrong?
- onion2k 8y agoHow would you tell the difference between a machine that's working and a machine that's been switched off?
- Myrth 8y agoMake it play a quiet calming music to the patients taste
- ethbro 8y ago> Same with audio on machines, that constant beep is annoying to you, but it means the machines are operating and you are getting your prescribed fluids This article is a terrible treatment of the issue. The NYT article [1] or actual research papers are far better. To try and sum up the actual issue that's being discussed: it's a tragedy of the commons situation, where the commons is a patient's sleep. Every device and procedure priorities derisking above ALL else. In aggregate, this results in a huge negative impact on sleep. The suggested change in behavior is to simply prioritize quality sleep somewhere about "irrelevant." From the original research, a few points (from memory): - Outcomes for non-critical patients are not substantially improved by the "every 2(?) hour vital check" regime. It's followed mostly because of legacy medical inertia - There is little effort to batch interactions - A substantial amount of sleep-disrupting noise is a modern hospital is non-functional From personal experience at a good cancer research hospital in a major city, one omnipresent alarm was a low battery warning... for a device that was plugged into mains power. No one knew how to turn it off or fix it. [1] https://www.nytimes.com/2018/12/03/upshot/why-hospitals-should-let-you-sleep.html https://www.nytimes.com/2018/12/03/upshot/why-hospitals-shou...
- killjoywashere 8y ago> There is little effort to batch interactions The nurses are highly incentivized to batch interactions, just like waitstaff. What you don't see is that if the nurse has is working on the batch for patient A, and patient B crashes, then the nurse is too tied down to respond and calls in a colleague, who shows up to crashing patient B and tries to get up to speed.
- ethbro 8y agoCan't speak for all arrangments, but with my mother's post-surgical care, it was typically different draws for different purposes. E.g. This or that specialist wanted to run a test, so they sent someone or had a floor nurse draw. But none of this seemed to be sync'd to the regular interaction schedule.
- deleted 8y ago[deleted]
- mcv 8y ago> Same with audio on machines, that constant beep is annoying to you, > but it means the machines are operating and you are getting your > prescribed fluids - silence on a night ward is a sign something is > wrong, and quickly precedes an emergency alarm. Sure, but that stuff should be monitored from the nurses' station, not by patients who are trying to get some sleep.