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Doing things like making sure medical staff arent forced to work while sleep deprived would go a long way to avoiding errors in the first place. Policy changes

Doing things like making sure medical staff arent forced to work while sleep deprived would go a long way to avoiding errors in the first place. Policy changes that walk the walk and substantively prioritize safety over profit can help create safety culture from the top down. Having more staff available in general can also make redundancy checks more feasible.

adrianN 6y ago
It is my understanding that the error rates skyrocket when patients are handed off between medical staff. Longer shifts reduce the number of hand-offs and thereby reduce the number of errors overall, despite sleep deprivation being a source of errors in itself.
- carlmr 6y ago
  Considering error rates due to sleep deprivation must rise at some point and the hand off error rate is probably quite constant there may be an optimal hand off. However that doesn't mean this is the global optimum. There are probably ways to reduce hand off errors, e.g. by introducing hand off check lists. Sleep deprivation errors on the other hand can only be reduced by reducing sleep deprivation, giving crystal meth to the doctor (probably unethical and unsustainable) and by general poka yoke style changes that will have benefits even when not sleep deprived. So the global optimum can probably be shifted to somewhere where the doctor is not sleep deprived and the hand off is organized. Which is also more humane towards the doctor.
  - eru 6y ago
    You could probably have overlapping shifts? After eg 6h of work, don't accept any new patients, but finish treating the ones you already have, if possible.
    - carlmr 6y ago
      Overlapping shifts could just be seen as a better hand-off. However I think the hand-off issues are probably the same that you have in any project. There's a lot of implicit knowledge. E.g. you've noticed patient X was breathing heavily, but you weren't sure if it meant something, if you see that again 10h later you might investigate, while for the other doctor if he started after 8h he might notice it for the first time, and have a similar wait and see approach. In this case one procedural way to make this better would be to teach doctors to write up anything unusual they notice during the day, and read this list of unusual events during hand-off to the next doctor.
      - eru 6y ago
        That's a good idea, but I was suggesting something slightly different: try to minimize the number of hand-offs by overlapping shifts and stopping the acceptance of new cases for the outgoing personnel.
  - michaelt 6y ago
    > there may be an optimal hand off. Presumably the constraint here is having an integer number of shifts per 24-hour day - 3x8 hour, 2x12 hour, 1x24 hour and so on.
    - carlmr 6y ago
      Technically a day is not a hard constraint in the short term. Maybe if you do one 36h shift, however unlikely, produces fewer errors than a 12h shift with 2 hand-offs. Long term we know about adverse health effects of inconsistent sleeping patterns, so those would factor in as well.

adrianN 6y ago

It is my understanding that the error rates skyrocket when patients are handed off between medical staff. Longer shifts reduce the number of hand-offs and thereby reduce the number of errors overall, despite sleep deprivation being a source of errors in itself.

carlmr 6y ago
Considering error rates due to sleep deprivation must rise at some point and the hand off error rate is probably quite constant there may be an optimal hand off. However that doesn't mean this is the global optimum. There are probably ways to reduce hand off errors, e.g. by introducing hand off check lists. Sleep deprivation errors on the other hand can only be reduced by reducing sleep deprivation, giving crystal meth to the doctor (probably unethical and unsustainable) and by general poka yoke style changes that will have benefits even when not sleep deprived. So the global optimum can probably be shifted to somewhere where the doctor is not sleep deprived and the hand off is organized. Which is also more humane towards the doctor.
- eru 6y ago
  You could probably have overlapping shifts? After eg 6h of work, don't accept any new patients, but finish treating the ones you already have, if possible.
  - carlmr 6y ago
    Overlapping shifts could just be seen as a better hand-off. However I think the hand-off issues are probably the same that you have in any project. There's a lot of implicit knowledge. E.g. you've noticed patient X was breathing heavily, but you weren't sure if it meant something, if you see that again 10h later you might investigate, while for the other doctor if he started after 8h he might notice it for the first time, and have a similar wait and see approach. In this case one procedural way to make this better would be to teach doctors to write up anything unusual they notice during the day, and read this list of unusual events during hand-off to the next doctor.
    - eru 6y ago
      That's a good idea, but I was suggesting something slightly different: try to minimize the number of hand-offs by overlapping shifts and stopping the acceptance of new cases for the outgoing personnel.
- michaelt 6y ago
  > there may be an optimal hand off. Presumably the constraint here is having an integer number of shifts per 24-hour day - 3x8 hour, 2x12 hour, 1x24 hour and so on.
  - carlmr 6y ago
    Technically a day is not a hard constraint in the short term. Maybe if you do one 36h shift, however unlikely, produces fewer errors than a 12h shift with 2 hand-offs. Long term we know about adverse health effects of inconsistent sleeping patterns, so those would factor in as well.