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My understanding is that the research shows that the harm to patient care from information loss during doctor shift turnover is worse than the harm from fatigue
by munificent 1y ago
My understanding is that the research shows that the harm to patient care from information loss during doctor shift turnover is worse than the harm from fatigued doctors.
Yes, a tired doctor sucks. But a tired doctor who already has the patient's state loaded into their head may still be better than doctor who is completely fresh in both senses.
It's a hard problem.
- harperlee 1y agoThat only works if the mean stay in the hospital (or at least the critical care period) is several hours but also way below 24h…
- Timon3 1y agoLonger shifts mean fewer shift turnovers for any patients that stay a sufficient amount of time, especially if longer than 24h. The world doesn't run on boolean logic. A solution can improve an issue without solving it completely.
- Fire-Dragon-DoL 1y agoWhat about the harm to the doctor themselves+the harm to the patient? Would the sum of both be worse?
- arjvik 1y agoOne signed up knowing the risk (not defending, I also think its insane, just devils advocate)
- thaumasiotes 1y ago> My understanding is that the research shows that the harm to patient care from information loss during doctor shift turnover is worse than the harm from fatigued doctors. This would not appear to apply to emergency surgeries. They aren't done by doctors who are familiar with the patient anyway. (Neither are non-emergency surgeries. Surgeries are done by doctors who do that kind of surgery. Familiarity with the patient is useful in deciding what surgery should be done, but not in doing the surgery.)
- renewiltord 1y agoThe European Working Time Directive has requirements for rest, etc. Either Europeans have much better hand-off procedures, they don't know how to comply with the rules they make, or they're fucking idiots who are going to kill people due to information loss during shift turnover. It was proposed decades ago. I wonder what compliance is like in Germany, etc.
- K0HAX 1y agoInstead of 1 doctor covering a 24 hour shift, why not pair them and overlap? 12:00am - 6:00am: Doctor 1 and Doctor 4 are doing everything together. 6:00am - 12:00pm: Doctor 1 and Doctor 2 are doing everything together. 12:00pm - 6:00pm: Doctor 2 and Doctor 3 are doing everything together. 6:00pm - 12:00am: Doctor 3 and Doctor 4 are doing everything together. This way, all 4 doctors only do 12 hour shifts, and the patient's state is maintained continuously through all 24 hours.
- ineedaj0b 1y agoDoctors do not get along and that’s too many Drs. Each patient often has multiple speciality Drs visiting them and reviewing their case up to 3 or 4 sometimes already. Imagine being on consult and trying to figure out which guy on a team of 4 you should talk to about such and such.
- someguyiguess 1y agoIf engineers ran the world
- lostlogin 1y agoThat’s a lot of handovers.
- deleted 1y ago[deleted]
- munificent 1y agoHere's an anecdote that might help answer. When my wife was pregnant with our first doctor, she started hemorrhaging spontaneously ten weeks before her due date. We rushed to the ER. 1. Shortly after, a doctor A came in, asked some questions, looked at the chart, and told us she was having the baby tonight. Holy shit our life is about to get crazy and we're going to be parents 2+ months early! He leaves. 2. Several hours later doctor B comes in. We ask about delivery. "Oh, no. You're not going to have the baby now. But you will have to be on bed rest until the due date." Jesus, my wife is going to have to quit her job. 4. Even more hours later, now the next morning, doctor C arrives. "OK, you're free to go home. No bed rest needed. Just let us know if anything else happens." My general experience with doctors is that you get as many unique opinions as there are doctors in the room. This is not an indictment of the profession. Human bodies are insanely complex, there is way more variation between them than most people realize, and doctors are operating under very very limited time and information. Having overlapping doctors would likely cause even more patient confusion and increase the risk conflicting treatments. Also, it would obviously double the cost of care. (My wife and baby were fine. Partial abruption. Very scary and my daughter was born five weeks early, but no other significant problems.)
- arcticfox 1y ago> Yes, a tired doctor sucks. But a tired doctor who already has the patient's state loaded into their head may still be better than doctor who is completely fresh in both senses. AI fixes this. Imagine the boot time of loading a patient's state from dozens of labs and files vs. a summary that gets you to exactly what they're going to end up remembering anyways. And if a doctor finds something interesting that the AI doesn't flag, they should be flagging it in the chart for the next doctor anyways.
- deleted 1y ago[deleted]
- solsane 1y agoIn my experience, AI summarization is a pretty lame application. I don’t really need a block of potentially wrong, rephrased text. I’ve got a feeling that the same applies to healthcare.
- munificent 1y agoJesus Christ you have to be fucking kidding me. Your solution to information loss during doctor handover is to insert a brainless hallucinating program with zero responsibility into the middle?
- toast0 1y agoIf charting was sufficient, doctor (and nurse!) handover wouldn't be a problem.
- amluto 1y agoI have never, in my entire life, ever personally encountered a situation in which a doctor paid enough attention to anyone over a period of time exceeding two hours that I could possibly believe that keeping the doctor on shift for a long time had the slightest benefit. I’m sure cases exist. But I’d be rather surprised if they’re common.