6 ms·

This is really important and an often missed point. The handover can cause more errors than a fatigued doctor. So you would need to solve this problem at the sa

This is really important and an often missed point. The handover can cause more errors than a fatigued doctor. So you would need to solve this problem at the same time (eg what if there was a way to change doctors without a handover)

watwut 8y ago
I find it extremely unlikely that so many patients have difficult handover and accute condition that 24h+ shifts are necessary as the norm. Even assuming some patients and situations are like that, it should not be normal (which it is) and there should be enough recovery after (which it is not really).
- Spooky23 8y ago
  Never underestimate the a ability of people or systems to fuck up. When I had back surgery, due to a miscommunication in the nursing staff turnover I wasn’t given any pain relief 3 hours after a major surgery until late the next day. My grandmother was given PT on the wrong limb. Again, poor handoff. A friend got a big congratulations from the OB doing rounds when she was in the hospital. Small problem: she was there for complications of miscarriage.
  - watwut 8y ago
    That does not sound like defense of current system at all. It sounds like lack of process and system, relying on individual memory and recall instead. In particular, both OB and PT on wrong limb are not just handover errors. First I am bit surprised that babies and miscarriages mix - they don't in here (so you know which it is based on room, but I think cause of split is something else). PT on wrong limb is error of not checking what you are supposed to do before administering - but also sounds like error people are more likely to do under time pressure or when tired and falling into routine. All in all, after major procedure you are in hospital for days and they have to move you between doctors and nurses many times.
    - Spooky23 8y ago
      I hope it doesn’t sound like a defense. IMO this is a broken system that needlessly kills people as a matter of bureaucratic inertia. Surgeries performed by the Ob/Gyns are housed on a specific floor. The situation was that there wasn’t a transition as the shifts changed due to understaffing, and the person doing rounds didn’t bother to read the chart. In my surgical recovery state, the reasoning was poor situational awareness and burden on the nurses. Data was located in 4 different EMRs and they missed it. Half my family is engaged in various medical professions. Every one of them is dissatisfied with how these systems work.
  - StreamBright 8y ago
    https://www.amazon.com/dp/B0030V0PEW/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1 https://www.amazon.com/dp/B0030V0PEW/ref=dp-kindle-redirect?...
  - computerex 8y ago
    I had foot surgery a few months ago. When I came to from GA, my nurse was worried that my heart rate was a little too high. He did an ultrasound of my bladder, turns out no one had cathed me and I had 1200 ml of urine. Apparently the discomfort of an overfull bladder was causing higher heart rate. Nurse was shocked when he saw the ultrasound, ran to get the equipment to drain the bladder.
- SkyPuncher 8y ago
  You'd find it unlikely, but that's literally the argument residency's governing body is making towards 24hr+ shifts.
  - watwut 8y ago
    I know. I also know software development teams that believe that long night is simply necessary for every single deadline and everything is always at the last moment. And I know teams that make deadlines without long night - not always but often enough and sometimes sooner. The "it is totally impossible without 28h+ regular shifts" sounds like team in first category. Not blaming individuals here, these problems are cultural and systematic and largely steam from leadership.
ams6110 8y ago
Nurses have the handoff issues as much as the doctors if not more, and yet they work strict shifts.
- deleted 8y ago
  [deleted]
- rscho 8y ago
  Realistically, nursing is a job that is far more structured than is being an MD. This allows nurses to function much better as a group. That's precisely the crux of the matter and the (questionable) reason for the hours. Nursing teams are the stable basis on which the MDs rely on to fight the huge pile of s* * * work that escapes the standard pathways in which we try to shoehorn every patient.

watwut 8y ago

I find it extremely unlikely that so many patients have difficult handover and accute condition that 24h+ shifts are necessary as the norm. Even assuming some patients and situations are like that, it should not be normal (which it is) and there should be enough recovery after (which it is not really).

Spooky23 8y ago
Never underestimate the a ability of people or systems to fuck up. When I had back surgery, due to a miscommunication in the nursing staff turnover I wasn’t given any pain relief 3 hours after a major surgery until late the next day. My grandmother was given PT on the wrong limb. Again, poor handoff. A friend got a big congratulations from the OB doing rounds when she was in the hospital. Small problem: she was there for complications of miscarriage.
- watwut 8y ago
  That does not sound like defense of current system at all. It sounds like lack of process and system, relying on individual memory and recall instead. In particular, both OB and PT on wrong limb are not just handover errors. First I am bit surprised that babies and miscarriages mix - they don't in here (so you know which it is based on room, but I think cause of split is something else). PT on wrong limb is error of not checking what you are supposed to do before administering - but also sounds like error people are more likely to do under time pressure or when tired and falling into routine. All in all, after major procedure you are in hospital for days and they have to move you between doctors and nurses many times.
  - Spooky23 8y ago
    I hope it doesn’t sound like a defense. IMO this is a broken system that needlessly kills people as a matter of bureaucratic inertia. Surgeries performed by the Ob/Gyns are housed on a specific floor. The situation was that there wasn’t a transition as the shifts changed due to understaffing, and the person doing rounds didn’t bother to read the chart. In my surgical recovery state, the reasoning was poor situational awareness and burden on the nurses. Data was located in 4 different EMRs and they missed it. Half my family is engaged in various medical professions. Every one of them is dissatisfied with how these systems work.
- StreamBright 8y ago
  https://www.amazon.com/dp/B0030V0PEW/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1 https://www.amazon.com/dp/B0030V0PEW/ref=dp-kindle-redirect?...
- computerex 8y ago
  I had foot surgery a few months ago. When I came to from GA, my nurse was worried that my heart rate was a little too high. He did an ultrasound of my bladder, turns out no one had cathed me and I had 1200 ml of urine. Apparently the discomfort of an overfull bladder was causing higher heart rate. Nurse was shocked when he saw the ultrasound, ran to get the equipment to drain the bladder.
SkyPuncher 8y ago
You'd find it unlikely, but that's literally the argument residency's governing body is making towards 24hr+ shifts.
- watwut 8y ago
  I know. I also know software development teams that believe that long night is simply necessary for every single deadline and everything is always at the last moment. And I know teams that make deadlines without long night - not always but often enough and sometimes sooner. The "it is totally impossible without 28h+ regular shifts" sounds like team in first category. Not blaming individuals here, these problems are cultural and systematic and largely steam from leadership.

ams6110 8y ago

Nurses have the handoff issues as much as the doctors if not more, and yet they work strict shifts.

deleted 8y ago
[deleted]
rscho 8y ago
Realistically, nursing is a job that is far more structured than is being an MD. This allows nurses to function much better as a group. That's precisely the crux of the matter and the (questionable) reason for the hours. Nursing teams are the stable basis on which the MDs rely on to fight the huge pile of s* * * work that escapes the standard pathways in which we try to shoehorn every patient.