Since bootstrapping my own sleep aid startup (https://trycosmo.com/), I've been surprised at the lack of priority society places on sleep in general. Better sleep would help patients recover better and shorten hospital stays. The inability to sleep, especially in the ICU, likely results in tens of thousands of unnecessary secondary infections and deaths per year.
I like the author's approach of simply refusing to give blood at night. My guess is that hospitals default to checking vitals so frequently to avoid liability-- could you imagine the headline if a patient died because his vitals had not been checked for eight hours?
A simple "Do not disturb" sign for patients would resolve all of these issues.
> These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
> Your search - site:trycosmo.com peer review - did not match any documents
Sounds promising. Untested sleep drugs, sign me up!
It's actually just melatonin, L-theanine and magnesium in one pill. So nothing sketchy but also not anything new or interesting. Just a combo pill like most other supplements on the market.
Well, first off there's an app. You'll agree that is a very important and useful benefit. You can Gravitate with new friends, Cosmo your SleepMeme with other Cosmonauts, and share your sleep successes with your non-Cosmonaut Earthling contact list!
To address your first sentence, the difference between Cosmo and other sleep aids is that, unlike Benadryl, it promotes natural deep REM without that 'grogginess' in the morning.
You don't get automatic refills from Big Box supplements. You can easily forget about it and let the charge ride on your card because it's just $30/mo.
Because the components are incredibly easy to source/package utilizing Chinese labor with incredible margins, they also have a refreshing peppermint smell!
You're right, the formula isn't groundbreaking. We did this intentionally to focus on the tried and true. We've also found that many sleep aids contain these ingredients, but only in very small quantities (1mg or less).
Is there anything else you would potentially like to see included?
When my wife was in the hospital after the birth of both our two kids (premature so they weren't in the room with her to care for, they were in the NICU).... I chose to go home to sleep as the nurses just came and went endlessly. Someone had to get sleep.
Then my oldest son was in the hospital for a while. He was sick so I wasn't too surprised he was napping all the time until spent a few nights sleeping at the hospital with him and realized he was probabbly napping constantly in the day because the nurses would wake him, and me.... constantly all night.
When we went home we both crashed and napped a bit and then slept all night... i swear he recovered faster after catching up on sleep at home.
There are preliminary results showing that when the NICU dims it's lights during the day and goes even darker at night babies recover faster. 5 weeks faster on average. (That's from "Why We Sleep")
I once spent two weeks in hospital with a smashed vertebra waiting for operation. I'm sure many of the individuals involved are trying their best, but it definitely feels more like a place for dying than a place for healing.
My wife just finished up a 22 hour labor and is desperately trying to get some sleep but the nurses refuse to stop yelling and laughing directly outside of her door.
Nurses cluck in packs like chickens, completely without concern for patients interrupting their social hour. You have to order them around because they're not smart or conscientious enough to do that on their own. If they were smarter, they would be doctors. They don't have empathy, so you have to pull rank or use a stick, because a carrot won't work.
I never said it would be easy, but it's important. Although honestly, unless the nurses want to be intentionally awful at their job, they will listen to you. They may not always be able to obey the letter of your request, but they absolutely should figure out a solution to any problem that's interfering with recovery.
Right, and I never said I wasn't doing it. But since this post was about how hard it was to sleep in hospitals, and I was in a hospital and my wife was struggling to sleep, I figured I'd share my story.
There is also a possibility that their reaction would not favourable. Sure, they may shut up but, afterwards, the relationship between his wife and the carers could become frosty?
Rude people tend not to like their shortcomings being challenged.
The birth of our first child was a very good lesson in assertiveness for me. I learned that as the spouse, you're basically the only one with a full overview of the whole process. In the hospital, shifts change, they're taking care of multiple births simultaneously, and I'm the only one who knows how my wife feels.
That gives you a powerful mandate to do whatever is necessary to take care of your partner. So absolutely to tell them to please go somewhere else because people are trying to sleep here.
Some things I had to do:
* My wife's (artificially induced) contractions were coming so fast that she had no time to recover. I noticed she was crying, which she absolutely never does. I warned the nurses, and they lowered her oxytocin (or whatever it was) and gave her some morphine.
* Later, after enthusiastically encouraging her to push and saying that the baby was coming, for two hours, I asked if the baby was actually coming. They didn't know. "Could you check?" Turns out the baby was stuck and had to be pulled out. I really wonder when they would have noticed this if I hadn't asked.
And this was at a Dutch hospital that's known for their good childbirth and maternity care. I was quite surprised about our experience (though it was a very complicated pregnancy).
The birth of our second child was a breeze. I was all ready to do my job again, but the baby was already born.
Yep. We did. And then another group came by equally as loud. And then the shift changed. Equally as loud. I would have to stand outside the door shushing people all night to be effective. And then we’re the annoying patients nobody wants to deal with.
I felt the question and answer to be a little flippant, which is fine, but hear this: Sometimes there are reasons, very genuine reasons. I've been recovering from a recent stay. I, too, was interrupted frequently - every 45 minutes in fact. After a few nods off and being woken up by a knock at the door repeatedly I asked 'why' and the staff gently explained that me sleeping for too long would be a bad idea for a few reasons:
1. My surgery affected my nervous system and thyroid; maintaining blood flow (especially in my legs) was important.
2. Knowing how I felt at the time kept the nurses informed about the dosage of medicine they should administer. Hormones and their effects can change rapidly.
3. Having a patient awake for blood draws, or an emergency, is useful. I’m not a small person; turning me over for some blood is much easier if I am awake and cooperative.
I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.
Ask your doctor (and nurses!) to keep you informed and educated about your situation. You're responsible for yourself. Medicine isn’t always intuitive, especially if you’re not yourself yet.
I don't think all hospital patients meet all (or even any) of the three points you listed. Hospitals should wake up folks that actually need it (e.g. folks like you in your past situation), and leave those who don't need it alone to sleep.
I mostly agree. The author of the piece didn't go into much detail about their medical needs at the time - perhaps they were a high-attention patient and didn't know it? Hence my call to educate oneself about their own situation. When you're in a foreign bed/room, in some amount of discomfort, on (likely) new medicine, you probably aren't the best judge of neediness and intent. The best you can do is ask and see what you can do to make the situation better.
There should be an equal call to educate hospital staff, to inform patients about their requirements, and to apply their requirements on a case-by-case basis instead of applying it to all patients regardless of needs.
The author makes it pretty clear, hospital staffs should wake up patients if absolutely necessary.
"If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don’t do that check once every four hours."
..
"..I made a sort of handshake deal with my nurses to leave me alone between 11 and 7. This mostly worked (and was reasonable in my case since I was only there waiting for the first round of chemo to start). I also refused to allow the night nurse to draw blood at 4 am, and that was that. She never came back, and that was fine: after all, there are lots of cases where they really don’t need your counts on a daily basis. And they certainly don’t need them at 4 am. That’s merely for the convenience of doctors, who want the results back by 8 am."
...
Tangentional, but why recent head trauma shouldn't be allowed to sleep?
I had a very severe head impact couple of years back, and while I was fuzzy at the time of impact, few hours before I go to bed, it was not until the day after when, my internal functions went half way south. I am not certain if the weakening of some of my external senses immediately happened or not.
Tangentional, but why recent head trauma shouldn't be allowed to sleep?
This was dead, but it seems like a sensible question so I vouched for the comment to resurrect it.
My understanding is that with any head trauma doctors are concerned about the possibility of bleeding into the brain, and it's much easier to detect the neurological symptoms of this in a patient who is awake. But I'm not a medical doctor; someone else here may be able to provide a more in depth answer.
My mother is a doctor (in a different specialty), and this came up when we watched 10 Things I Hate About You, which repeats the myth.
You're correct; as far as the patient is concerned, it's better for them if you let them sleep. But it's easier for everyone else if the patient isn't allowed to sleep, as sleeping and dying look exactly the same.
My son managed to get himself a concussion in kindergarden once. Our doctor told us that as long as he's able answer questions normally and focus on whatever he is doing, he's fine. Let him sleep, but it's wouldn't be a bad idea to wake him up once or twice and evaluate his situation. Using the excuse that he should go to the bathroom was the least intrusive way to do this.
I do not know how many dead people you've attended to, but the ones that I have seen generally lack pulse or breathing. Both of those vitals are monitored for inpatients. And if one of those goes, the other goes too in short order.
Sleeping patients, on the other hand, usually pulse at least once per second, and breathe every six seconds or so.
What do you think "dying" means, or looks like? What signs would such a "dying" awake person display, that a "dying" sleeping person wouldn't?
Choking? Pulse goes up and breathing becomes shallow.
Cardiac arrest? Aneurysm? Torn blood vessel? Shot in the head? Stabbed in the chest? Poisoned? Spider/Snake bite? Fell off bed and broke hip? All these "dyings" are easily detected by pulse and breathing monitors.
"and it's much easier to detect the neurological symptoms of this in a patient who is awake"
In this context, I imagine neurological symptoms would be things like cognitive function, spatial coordination, memory functions, and linguistic functions.
All of those are things that are not really possible to assess while sleeping, but would be possible to assess in a patient who is awake.
Cranial bleeding can be caused by blunt head trauma, can raise intra-cranial pressure high enough to kill you, and there are only three ways to detect it: a) medical imaging scans, b) changes in patient behavior, or c) drill a hole in the skull and insert a sensor.
If the patient is sleeping, you can't use a) or b). Now, there might be an argument that everyone should get c) and lots of sleep, but drilling into a person's head is not risk-free either.
Sure, if there's a real medical need to wake the patient up, they should absolutely do so. But waking the patient merely to draw blood in the middle of the night when that could just as easily be done in the morning or evening, is stupid and harmful.
Although as someone pointed out above, if the doctor gets the results in the morning because the bloods were taken overnight, they might be able to discharge the patient immediately and get a bed before lunchtime for another patient. If they wait to take bloods in the morning, the patient might be in another day for no particular reason.
Five years ago in Switzerland I could get a full blood panel from my Dr's office in the mall within twenty minutes. The blood came straight out of my arm, into the vials, and into vials went into the analysis unit.
Maybe there needs to be some investment in better analysis equipment for routine draws.
> 3. Having a patient awake for blood draws, or an emergency, is useful. I’m not a small person; turning me over for some blood is much easier if I am awake and cooperative.
> I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.
Well, yes, it would be enormously practical in a large number of situations if we wouldn't sleep. It would also solve a lot of problems if we didn't need to eat. Problem is, those things are biological necessaries with immediate adverse effects if we neglect them. I also believe there is a solid body of research showing the importance of sleep for recovery.
I'm not a doctor or nurse and the blood flow argument does sound reasonable - however, the other two arguments sound a lot like "it's more practical and less risky for us if you're awake", which I don't see is a valid reason. Also, by what medical school is >45 minutes of uninterrupted sleep "too much"?
> Ask your doctor (and nurses!) to keep you informed and educated about your situation. You're responsible for yourself. Medicine isn’t always intuitive, especially if you’re not yourself yet.
This mentality is fundamentally flawed. We don't allow truck drivers to drive for more than 11 hours a day because lack of sleep impairs your cognitive ability. But we're expecting patients recovering with potentially days without rest to make informed decisions?
A counter to your example...
When my youngest was born, my wife had complications with delivery due to high blood pressure. They refused to release her or the baby until two conditions were met. One was that her blood pressure was lowered and the other was that the baby put on a % of weight. Without intervention neither would have been released. I had to pull the care team aside during a group visit to ask them:
"Is high blood pressure a symptom of insomnia?" Yes
"Is a REM cycle 90 minutes?" Yes
"Have we had more than 45 minutes in recovery without your staff waking my wife?" No
They left us alone for 3 hours straight and magically her blood pressure returned to normal.
We then had to have the attending pediatrician point out to them that the medications given during labor caused water retention and that apart from the lack of weight gain, the child was 100% on track and doing extremely well.
The hospital we were at, Emory, is highly regarded but their whole system seemed to be fundamentally flawed because it didn't take into account the continuous interrupts. Or rather there was no distinction between 3 uninterrupted hours of rest and four 45 minute periods of rest.
For the birth of my second child, I learned to manage hospital staff so that they would leave my wife and newborn alone unless there was an emergency. I proactively scheduled scans, vital checks for the next morning so that the patients could rest.
The experience was so much better than what my wife and first child had. I do not understand why hospitals cannot do this kind of considerate scheduling by default.
Can you elaborate on how you worked with the hospital staff to make this "considerate scheduling" possible?
My initial feeling would be that the staff will do their jobs when it convenient for them to do it, regardless of when you would prefer them to do it. How did you manage to convince them to modify their scheduling?
Probably by asking, or skipping tests/interventions. Ultimately everything is patient’s choice.
It may work okay (administering one patient’s daily meds last amongst the caseload of patients).
Other times, by deferring the 6AM blood draw to 10AM could mean your providers don’t have a fresh picture of the patient’s condition during morning rounds.
I just asked! The head nurse on the floor knew that unless there was an emergency, we would like to rest between 9PM and 7AM. We would have preferred 8AM, but it was a teaching hospital and they needed to get rounds underway early in the morning.
Talk to the nurses. They control everything on the floor, the doctors are just passing through.
Not OP, but the same way you get anything 'management' done - get to know people, make them like you, understand procedures and incentives of everything and everybody involved, trust but verify, always be proactive and ahead of everything and everybody.
Good job. I was surprised how much I as a husband had to take charge on because the hospital had no idea what was really going on. You need to ask stuff from the nurses if your wife needs anything.
Probably rich people in high end hospitals don't have this problem. I don't know this for a fact, I'm just comparing here the shitty experience that I had with the experience that a friend seemed to be having in a luxury hospital.
Well, at least the wealthy end up in private rooms, which is a big help. If you are unfortunate enough to share a room with another patient, then either he will be sick enough that the staff keeps you awake half the night as they attend to him, or he will be feeling fairly well, and will insist on watching Family Feud all night on the TV mounted on the wall.
From what I heard most new hospitals have gone private room only for triage reasons alone - sure a broken leg isn't contagious but hospital bugs are downright nasty.
Hospitals are designed to collect money first and foremost.
Anything having to do with your healing is a secondary concern. The only occasional exceptions are in profit centers like OB.
Usually the night nursing staff are better as there are fewer doctors and managers around. When my wife and I were hospitalized for a few days at various points we quickly grew to hate the morning, as that’s when various parties would show up to say hello and log an encounter.
Not only are they "designed to allow patients as little sleep as possible", but also doctors too. Residents and doctors frequently have take on 30-36 hour shifts.. How they could effectively treat patients with this level sleep deprivation is beyond me.
Maybe hospitals just have a vendetta on sleep in general?
[0] says:
> Handover is clearly a time when errors or omissions in key information can have critical consequences. Statistics from the National Confidential Enquiry into Patient Outcome and Death showed that in 13.5 per cent of cases where patients died within four days of admission, poor communication − between and within clinical teams − was an important issue contributing to the adverse outcomes.
Well yeah, a handover after thirty hours at work would be incredibly dangerous.
That doesn't mean you should extend the shifts, quite the opposite. How can we get real data on work quality from well-rested doctors when the comparison is between thirty and thirty-four hour shifts?
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.
> 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.
The 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.
How 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?
To 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.
May 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.
I don't know the reach, but many agricultural activities can be a euphemism if you put a significant pause in front of them. "Where are alice and bob? Oh they're out... (gathering fruit|sowing barley|haymaking|looking for lost sheep|etc)"
To be fair - its a very suspicious time to be haymaking. Threshing maybe yes - but haymaking... A word of advice: Don’t burn the candle in both ends - you need your strenght to work on the jarls estate (unless you are on a tenth or headtax plan of course).
Since someone already guessed that you live in Switzerland, may I also ask if you are in an apartment building with neighbors above/under/around you? We have similar neighborly complaints in Austria where (at least in cities) almost everyone lives in apartment buildings and thus when someone runs the washing machine, you not only hear it, you also feel it. In the USA, I think most people in cities are living in individual houses and therefore things like running a washing machine at 10pm would probably not even be audible by any neighbors.
> 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.
And a vendor lock-in is the goal of the vendor, both in medical and consumer space! Which is why such protocols rarely happen in either.
The medical space has a surprising number of widely used protocols. If you’ve ever gotten a CD with the raw data from some scan, it probably had a crappy proprietary viewer and the raw data. The raw data is almost invariably DICOM, and there are plenty of open-source viewers.
I suspect there are strong economic factors here. When a hospital buys a $2M imaging machine, the vendor is making money on the machine, not on ads, and that $2M machine had better interoperate with the HIPAA-compliant image archiving and distribution system the hospital already has from some other vendor.
> The medical space has a surprising number of widely used protocols.
There are also a wide range of interpretations of a single protocol. See the horror of HL7.
In terms of DICOM viewers, I’ll be the one who mentions Horos. If it doesn’t do what you want with a DICOM or have a plug-in that does, you are doing something quite unusual. Before the psych department come at me - I work in radiology. Functional imaging is best served with other tools, and I don’t understand them.
Technically yes but seriously just don't. CAN is a horror show for security that can't handle a radio without being a security liability and medical privacy violations are expensive let alone wrongful deaths.
Interestingly 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.
I 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.
their braking system is passive, no energy means error means brakes engaged; unlike, say, cars where no energy means .. nothing and any accident can occur.
This makes me think about data backups. It might make sense to only get a notification if a backup failed, but then how do you know the backup system is actually functioning at all?
However, the downside of that solution is that the failure signal relies on correctness of the machine. In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate.
It sounds like an excuse for not networking at all really. Or upgrading equipment. Just a primitive cables to a data station on a cart outside the room would handle it better on every level than trying to figure out which thing isn't beeping when it should. Have it beep if it loses a signal. Better yet it can handle triaging far better when networked. Signal lost and "patient definetly not breathing" are two very different triage levels for one. You want to restore signal as soon as able but it isn't a mobilize a crash team to resuscitate situation. Nearly everything else has abandoned beeps as the sole indicator with good reason.
I understand where you coming from. However, would the patient know if machine is functioning correctly if it is silent? What happens if it's not plugged in correctly?
> 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.
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.
Can'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.
> 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.
I basically lived in a hospital room for the past week, though I’m not sick. The machine that pumps and monitors your iv fluids constantly emits screaming alarm tones. An alarm can be triggered if you bend your arm the wrong way, obstructing the iv. But most often the alarm is triggered because of air in the line. You can silence the alarm. But if a patient is not accompanied by someone, they will probably have to sit there with the alarm going off for 10 to 20 minutes at a time before the nurse finally arrives and deactivates it. That happened to us once and I never left again after that.
And it’s true — nurses barge into the room quite unceremoniously, wake you up, and perform tests on you in the middle of the night. It’s very annoying and leaves everyone except the nurses very hagard in the morning.
When I was at the Stanford cardiac unit last, they let me sleep. That wasn't the problem but they had a problem giving me privacy: door wide open, curtain wide open.
I was also at Stanford hospital earlier this year, for a few weeks over two different stays. I don't know which is the cardiac unit, but I remember being in units D1, D3, F3, and G2. Some times I was closer to the door; some times closer to the window. In both cases, I had times when I would need to specifically ask a nurse (or nurse assistant) to close the door (or the curtain), but I don't ever remember having pushback on my request.
Patients with privacy are patients who end up dying. Hospital floor plans are designed to ensure that nurses can see if patients take a turn for the worse.
For both of our children, the hospital caused us more stress and discomfort than anything else. Newborn baby's finally asleep, wife is comfortable re pain, finally start to get some sleep.
Then the nurse comes in at 2 am, writes her name on the board, asks us questions that they should have the answer to, then leaves.
Nurse change 3x a day, baby doctor checking in to ask if were ok, mom doctor doing the same, house keeping, meal people 3x a day. Plus any legitimate and needed medical attention e.g. baby shots/bath /moms wound dressing change
With our second, insurance would've covered another 2-3 days in the hospital, but my wife nearly had a mental breakdown between normal post partum depression, nursing difficulties, and people interrupting every quiet moment we have with our new family member, so we left asap.
For our first child, for the first 24 hours or so postpartum, my wife and child both needed something checked every couple hours.
Our overnight nurse said something like "I'll be doing your wife's checks at midnight and 2am, and your baby's at 1am and 3am". When I asked if my wife and child could be checked in the same entries, it turned out they could. I was surprised the hospital didn't do it by default that way for less time sensitive checks.
Did you have your child in the US? If so I am curious, do the nurses come and visit your home the next day and a week after? I live in Canada and was very surprised when they came to check on the baby and my wife the next day, looking for jaundice, bleeding, etc. I'm genuinely curious if that is covered by insurance in the US?
I would guess it depends on the specific circumstance as well as the insurer. With that said, I'm not the GP (but am based in the US), but in our case the hospital arranged for a visiting nurse to do a check in the next day and it was covered by our insurance.
I've been in the hospital without insurance. They bill you for gratuitous stuff regardless of whether you have insurance. They don't mention that there will be a bill when they ask if you want your newborn's hearing checked or if you want to try the experimental sap-based wound sealer they happen to have (both things that actually happened). They seem kind and polite. Then they bill you. One doctor looks over another's shoulder for five minutes. They each bill you.
This is in the US, mind you. In fact, both stays were in Nashville, TN, in the early 2000s.
Sorry for missing this, I don't check HN every day!
Both medical systems that we had children with (in SF) do not do in-home followups, at least not for us. We had to go back the day after discharge for both of our children (for bilirubin draws). Would be nice so soon postpartum to have in-home visits.
A key lesson I learned with our first child was "just about everything gets easier once you leave the hospital", so with our second we prioritized GTFOing ASAP. It was a good decision.
Our experience would not have been different (Austria). Especially with the first kid going from hospital home was a bit regretful because of all the services you get in the hospital you need to replace at home.
We had a family room for me, my wife and the newborn. They served food, there were replacement clothes and diapers in unlimited supply, no washing etc.
With the second we opted for having only two days in the hospital because I have to deal with the bigger one going to daycare and then we had to go to the child doctor for the remaining tests since we couldn’t do all in the hospital.
If you have a good hospital I would do that over leaving early for sure.
I would have been happy to stay in a private room for longer too, I've been around young children a lot since I have a large family, but being responsible for a newborn was a scary prospect to get used to.
Regarding food my overriding memory of being the father in Finland was that we'd get food delivered to the room and each plate was labeled. Half the meals had the mother's full-name written on them. The other half just said "man".
I'm sure they took my name at some point, as I was registered as the parent in the country-wide population index, but as far as the hospital was concerned I was just "man".
(In Finnish the word for man & husband are the same, so perhaps I was "husband" rather than "man"!)
Yes.
Having a different person coming in every 5 minutes to check something else.
Somewhat tempered by having to go back in a week later, so all these things aren't useless. Child birth isn't the risk free thing we like to think it is.
> For almost all mammals it is, just not for humans,
No, childbirth in nature is incredibly risky. But loss of life is expected in nature and disabilities, malformings etc. simply die whereas humans try to avoid life loss or any disadvantage for the offspring at any cost.
We had our first child ~3 months ago. We had a room to ourselves and nurses/midwifes would only come in once or twice a day unless they were paged (which we did, they were a godsend). This made the stay as comfortable as could be, and we could get all the quiet time alone we wanted, although sleep was in short supply for other reasons.
This was in Copenhagen, Denmark, so the entire stay was free. Sadly, the central hospital is removing this practice and kicking out patients after 4 hours.
Is it free to walk down the sidewalk in your country? Under your definition it's not, since ultimately taxes likely paid for that sidewalk, but I think most people would describe it as free.
Depends on if you think in purely capitalistic terms (most but not all Americans) or not (again, most Europeans). I mean one way to think about it is the sidewalk is exploitable by businesses as a potential source of revenue for people who want to ride electric scooters (and other businesses that directly grow the economy) and they can pay lobbyists who drive the engine of American economic growth (lol), whereas you as a pedestrian is hardly doing an activity on that sidewalk that directly contributes to economic growth, so yeah, in a way you are getting your walk down the “free” sidewalk subsidized.
Walking on the way to the bank, to get a loan, to start a business qualifies as economic activity.
As does going to the store, and a whole bunch of other things.
The USA built the Interstate Highway System for exactly the reason of economic growth. The ideas behind it are no different from the ones that justified sidewalks.
Should any small town evaluate their sidewalk projects, like we have the Interestate Highway Project, assuming they have the records and they probably don't, they would find those sidewalks probably returned a couple times their cost already, and will continue to deliver that, easily funding their upkeep.
(something we seem to have forgotten about roads, which has allowed tolls to encroach on and marginalize said growth and value)
That's a little different in as much as there's negligible marginal cost to walking down the sidewalk, once it is constructed. The same is not true of a marginal hospital stay.
Subsidization is when the costs of a product or service are hidden from you (Universal healthcare, a supplier takes you out to lunch, an employer pays for a worker cafeteria)
Free is when there are no costs (watching a sunrise, receiving a hug)
Similar situation in Finland; we had a baby over Christmas two years ago. We spent a few days in a private room with a checkup on the baby/mother around noon and 6pm.
We paid €250 or so for 3 or 4 days (genuinely can't remember I guess my sleeping wasn't so great. Oops!) for the three of us, so it wasn't free, but it was pretty cheap.
Similar experience here except the meal people were 9x a day, not 3. They would come in to take an order (as I recall there were generally two options) 30-60 minutes before the meal was delivered, and then again some time afterward to clean it up. Which I feel like I shouldn't complain about, since they're providing you with food (although only for the patient, not the poor, sleep deprived dad...) But man was it annoying when you were just trying to get a few minutes of sleep!
Yeah, my wife and I fled the maternity/recovery ward ASAP after both of our children, because it was so hard to rest and so unpleasant there.
The first time, my wife had preeclampsia during the labor and, fair enough, there were some significant interventions to make sure that her recovery was going apace. But the second time? She had a textbook uncomplicated delivery and fundamentally all we were doing was waiting to make sure that nothing crazy cropped up in the first 48 hours after birth. There was no reason for disruptions in our rest every hour or two.
This must differ wildly between hospitals. In Oklahoma City we were only bothered a few times a day and never at night during our 3 day stay with our newborn (plus the kitchen cooked us a 5 course gourmet meal to send of off on the last day). And I was often able to meet the nurse at the door and handle whatever they needed quietly without waking mom or child.
I would imagine patients in the hospital have much bigger problems than how much sleep they're getting. They'll probably be awake all night anyways worrying about their over-billed hospital bill and how their insurance company is going to get out of paying for it.
But is that because there are just nog enough nurses to do the checking that would be medically beneficial, or because of deliberate choices/scheduling? (am Belgian, not always impressed with quality of healthcare)
Having spent two spells recently in hospital after surgery, it didn’t bother me in the slightest being woken for 30s every few hours. Usually it coincided with me being brought painkillers, water and snacks. All of which were welcome.
There was also no issue regarding beeps in the post operative care unit that I remember. I was also given my personal belongings, as soon as I was able to structure a coherent sentence, which included headphones.
Similarly to other commenters, I should point out you might not be so quick to use technology to solve this problem. Implementing technology into an area where lives are at risk (ICU) takes a long time - with good reason. I saw a comment talking about a centralised monitoring desk. Good luck finding a ward where you are always staffed enough to have someone watching that. There is a good reason sounds have remained as the primary monitoring cue for so many years.
Danish company AudioCura is offering an auditory logging device [0] designed specifically to identify disturbances preventing sleep and rest in hospitals.
I'm lucky enough never to have been in hospital myself, but FWIW:
I was recently on the jury in a coroner's inquest. A patient had died suddenly in his sleep in hospital. The solicitor whose agenda was to make the hospital look bad aimed to suggest that nurses should have been entering his room every 15 minutes to check his breathing, but all medical staff witnesses argued that sleep is too important to disrupt by entering the room during the night, unless absolutely necessary. They used a torch to shine on the patients chest through the window to check for breathing, and specified that they tried not to shine on them directly (watching a shadow on the wall is preferable).
I know a torch is a flashlight but it amuses me to think of a nurse wielding a flaming torch walking down the hallway, peering into rooms.
It's been awhile since I was in a hospital overnight but checking in on a (presumably) stable patient every 15 minutes is madness. You hear all sorts of crazy things during jury duty--I love it.
Of course not a normal patient, but I would imagine that it would not be unreasonable to be checking an ICU patient's vitals every 15 minutes. It's called "intensive care" for a reason.
I spent two nights in hospital in the UK after surgery for a broken arm. They were pretty good about not interrupting my sleep.... except for putting me in a ward with a bunch of sick people who were coughing and wheezing and groaning all the time.
It very much depends on what's wrong with you. I've been hospitalised multiple times. Most of the times were fine, but once was neurosurgery, and I'd be woken up at regular intervals throughout the night to answer "What's your name? Where are you? What year is it? How many fingers am I holding up?" At some point there must be a crossover between the risk of an undetected problem vs the risk inherent in lack of sleep.
Not to mention "PAGING RESPOND MET CALL CODE BLUE"[0] followed by a crash cart tearing off down the hallway at 4am, and of course once you've been in the hospital for a few days you know that "MET call" means someone is probably dying and "code blue" means it's from cardiopulmonary arrest, which doesn't really help soothe you back to sleep.
Anecdotal data point: I have been hospitalised a number of times in Europe (German, Austria) and this article really resonated with me. Every time I returned home, I was relieved to be able to get back to a regular sleep schedule and it really befuddled me during my stays that I never seemed well rested, as if this was somehow the hospital administrators task to ensure that I didn't just use my hospital visit as a pseudo-vacation.
That was my reaction too. My wife was in and out of hospital for two years in Drammen, Norway (2015 to 2017), and I never got the impression that her sleep was interrupted. I spent quite a lot of time with her in the hospital and the staff were quiet, courteous, helpful, and kind. They weren't always as available as one might wish but that was fairly rare.
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[ 4.2 ms ] story [ 334 ms ] threadI like the author's approach of simply refusing to give blood at night. My guess is that hospitals default to checking vitals so frequently to avoid liability-- could you imagine the headline if a patient died because his vitals had not been checked for eight hours?
A simple "Do not disturb" sign for patients would resolve all of these issues.
Sounds promising. Untested sleep drugs, sign me up!
To address your first sentence, the difference between Cosmo and other sleep aids is that, unlike Benadryl, it promotes natural deep REM without that 'grogginess' in the morning.
You don't get automatic refills from Big Box supplements. You can easily forget about it and let the charge ride on your card because it's just $30/mo.
Because the components are incredibly easy to source/package utilizing Chinese labor with incredible margins, they also have a refreshing peppermint smell!
Here is some more information on anti-histamines and sleep: https://www.bcm.edu/news/sleep-disorders/experts-warn-agains...
Is there anything else you would potentially like to see included?
Then my oldest son was in the hospital for a while. He was sick so I wasn't too surprised he was napping all the time until spent a few nights sleeping at the hospital with him and realized he was probabbly napping constantly in the day because the nurses would wake him, and me.... constantly all night.
When we went home we both crashed and napped a bit and then slept all night... i swear he recovered faster after catching up on sleep at home.
It’s not even medical. Just rude.
https://news.ycombinator.com/newsguidelines.html
There is also a possibility that their reaction would not favourable. Sure, they may shut up but, afterwards, the relationship between his wife and the carers could become frosty?
Rude people tend not to like their shortcomings being challenged.
That gives you a powerful mandate to do whatever is necessary to take care of your partner. So absolutely to tell them to please go somewhere else because people are trying to sleep here.
Some things I had to do:
* My wife's (artificially induced) contractions were coming so fast that she had no time to recover. I noticed she was crying, which she absolutely never does. I warned the nurses, and they lowered her oxytocin (or whatever it was) and gave her some morphine.
* Later, after enthusiastically encouraging her to push and saying that the baby was coming, for two hours, I asked if the baby was actually coming. They didn't know. "Could you check?" Turns out the baby was stuck and had to be pulled out. I really wonder when they would have noticed this if I hadn't asked.
And this was at a Dutch hospital that's known for their good childbirth and maternity care. I was quite surprised about our experience (though it was a very complicated pregnancy).
The birth of our second child was a breeze. I was all ready to do my job again, but the baby was already born.
Talk to the charge nurse to change rooms, escalate to the admin on call if needed. Get the sleep now while you can.
1. My surgery affected my nervous system and thyroid; maintaining blood flow (especially in my legs) was important.
2. Knowing how I felt at the time kept the nurses informed about the dosage of medicine they should administer. Hormones and their effects can change rapidly.
3. Having a patient awake for blood draws, or an emergency, is useful. I’m not a small person; turning me over for some blood is much easier if I am awake and cooperative.
I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.
Ask your doctor (and nurses!) to keep you informed and educated about your situation. You're responsible for yourself. Medicine isn’t always intuitive, especially if you’re not yourself yet.
"If a patient is at low risk and can go six or eight hours without a vitals check, for example, perhaps don’t do that check once every four hours." ..
"..I made a sort of handshake deal with my nurses to leave me alone between 11 and 7. This mostly worked (and was reasonable in my case since I was only there waiting for the first round of chemo to start). I also refused to allow the night nurse to draw blood at 4 am, and that was that. She never came back, and that was fine: after all, there are lots of cases where they really don’t need your counts on a daily basis. And they certainly don’t need them at 4 am. That’s merely for the convenience of doctors, who want the results back by 8 am." ...
I had a very severe head impact couple of years back, and while I was fuzzy at the time of impact, few hours before I go to bed, it was not until the day after when, my internal functions went half way south. I am not certain if the weakening of some of my external senses immediately happened or not.
This was dead, but it seems like a sensible question so I vouched for the comment to resurrect it.
My understanding is that with any head trauma doctors are concerned about the possibility of bleeding into the brain, and it's much easier to detect the neurological symptoms of this in a patient who is awake. But I'm not a medical doctor; someone else here may be able to provide a more in depth answer.
You're correct; as far as the patient is concerned, it's better for them if you let them sleep. But it's easier for everyone else if the patient isn't allowed to sleep, as sleeping and dying look exactly the same.
I do not know how many dead people you've attended to, but the ones that I have seen generally lack pulse or breathing. Both of those vitals are monitored for inpatients. And if one of those goes, the other goes too in short order.
Sleeping patients, on the other hand, usually pulse at least once per second, and breathe every six seconds or so.
Choking? Pulse goes up and breathing becomes shallow.
Cardiac arrest? Aneurysm? Torn blood vessel? Shot in the head? Stabbed in the chest? Poisoned? Spider/Snake bite? Fell off bed and broke hip? All these "dyings" are easily detected by pulse and breathing monitors.
"and it's much easier to detect the neurological symptoms of this in a patient who is awake"
In this context, I imagine neurological symptoms would be things like cognitive function, spatial coordination, memory functions, and linguistic functions.
All of those are things that are not really possible to assess while sleeping, but would be possible to assess in a patient who is awake.
If the patient is sleeping, you can't use a) or b). Now, there might be an argument that everyone should get c) and lots of sleep, but drilling into a person's head is not risk-free either.
Maybe there needs to be some investment in better analysis equipment for routine draws.
> I can imagine anyone with recent head trauma shouldn’t be allowed to sleep either.
Well, yes, it would be enormously practical in a large number of situations if we wouldn't sleep. It would also solve a lot of problems if we didn't need to eat. Problem is, those things are biological necessaries with immediate adverse effects if we neglect them. I also believe there is a solid body of research showing the importance of sleep for recovery.
I'm not a doctor or nurse and the blood flow argument does sound reasonable - however, the other two arguments sound a lot like "it's more practical and less risky for us if you're awake", which I don't see is a valid reason. Also, by what medical school is >45 minutes of uninterrupted sleep "too much"?
This mentality is fundamentally flawed. We don't allow truck drivers to drive for more than 11 hours a day because lack of sleep impairs your cognitive ability. But we're expecting patients recovering with potentially days without rest to make informed decisions?
A counter to your example...
When my youngest was born, my wife had complications with delivery due to high blood pressure. They refused to release her or the baby until two conditions were met. One was that her blood pressure was lowered and the other was that the baby put on a % of weight. Without intervention neither would have been released. I had to pull the care team aside during a group visit to ask them:
"Is high blood pressure a symptom of insomnia?" Yes
"Is a REM cycle 90 minutes?" Yes
"Have we had more than 45 minutes in recovery without your staff waking my wife?" No
They left us alone for 3 hours straight and magically her blood pressure returned to normal.
We then had to have the attending pediatrician point out to them that the medications given during labor caused water retention and that apart from the lack of weight gain, the child was 100% on track and doing extremely well.
The hospital we were at, Emory, is highly regarded but their whole system seemed to be fundamentally flawed because it didn't take into account the continuous interrupts. Or rather there was no distinction between 3 uninterrupted hours of rest and four 45 minute periods of rest.
The experience was so much better than what my wife and first child had. I do not understand why hospitals cannot do this kind of considerate scheduling by default.
My initial feeling would be that the staff will do their jobs when it convenient for them to do it, regardless of when you would prefer them to do it. How did you manage to convince them to modify their scheduling?
It may work okay (administering one patient’s daily meds last amongst the caseload of patients).
Other times, by deferring the 6AM blood draw to 10AM could mean your providers don’t have a fresh picture of the patient’s condition during morning rounds.
Talk to the nurses. They control everything on the floor, the doctors are just passing through.
Thank you for even mentioning this is possible.
Anything having to do with your healing is a secondary concern. The only occasional exceptions are in profit centers like OB.
Usually the night nursing staff are better as there are fewer doctors and managers around. When my wife and I were hospitalized for a few days at various points we quickly grew to hate the morning, as that’s when various parties would show up to say hello and log an encounter.
Maybe hospitals just have a vendetta on sleep in general?
Might be a starting point at least.
[0] https://www.hsj.co.uk/technology-and-innovation/taking-the-r...
That doesn't mean you should extend the shifts, quite the opposite. How can we get real data on work quality from well-rested doctors when the comparison is between thirty and thirty-four hour shifts?
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.
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.
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.
And a vendor lock-in is the goal of the vendor, both in medical and consumer space! Which is why such protocols rarely happen in either.
I suspect there are strong economic factors here. When a hospital buys a $2M imaging machine, the vendor is making money on the machine, not on ads, and that $2M machine had better interoperate with the HIPAA-compliant image archiving and distribution system the hospital already has from some other vendor.
There are also a wide range of interpretations of a single protocol. See the horror of HL7.
In terms of DICOM viewers, I’ll be the one who mentions Horos. If it doesn’t do what you want with a DICOM or have a plug-in that does, you are doing something quite unusual. Before the psych department come at me - I work in radiology. Functional imaging is best served with other tools, and I don’t understand them.
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.
Of course, one might very well argue that 'turned on' is not 'worthy of attention'
[1] http://www.smartcockpit.com/docs/A330-A340_Overhead_Pushbutt...
However, the downside of that solution is that the failure signal relies on correctness of the machine. In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate.
> In the current system, the failure signal is guaranteed to occur during failure with a zero false negative rate.
I can easily imagine software bugs that make the machine continue beeping even if the normal function doesn't work anymore.
Somehow, this sounds like an excuse for lazy design.
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-shou...
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.
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.
And it’s true — nurses barge into the room quite unceremoniously, wake you up, and perform tests on you in the middle of the night. It’s very annoying and leaves everyone except the nurses very hagard in the morning.
Nurses work hard. Believe me, they are haggard in the morning.
Then the nurse comes in at 2 am, writes her name on the board, asks us questions that they should have the answer to, then leaves.
Nurse change 3x a day, baby doctor checking in to ask if were ok, mom doctor doing the same, house keeping, meal people 3x a day. Plus any legitimate and needed medical attention e.g. baby shots/bath /moms wound dressing change
With our second, insurance would've covered another 2-3 days in the hospital, but my wife nearly had a mental breakdown between normal post partum depression, nursing difficulties, and people interrupting every quiet moment we have with our new family member, so we left asap.
For our first child, for the first 24 hours or so postpartum, my wife and child both needed something checked every couple hours.
Our overnight nurse said something like "I'll be doing your wife's checks at midnight and 2am, and your baby's at 1am and 3am". When I asked if my wife and child could be checked in the same entries, it turned out they could. I was surprised the hospital didn't do it by default that way for less time sensitive checks.
This is in the US, mind you. In fact, both stays were in Nashville, TN, in the early 2000s.
Both medical systems that we had children with (in SF) do not do in-home followups, at least not for us. We had to go back the day after discharge for both of our children (for bilirubin draws). Would be nice so soon postpartum to have in-home visits.
We had a family room for me, my wife and the newborn. They served food, there were replacement clothes and diapers in unlimited supply, no washing etc.
With the second we opted for having only two days in the hospital because I have to deal with the bigger one going to daycare and then we had to go to the child doctor for the remaining tests since we couldn’t do all in the hospital.
If you have a good hospital I would do that over leaving early for sure.
Regarding food my overriding memory of being the father in Finland was that we'd get food delivered to the room and each plate was labeled. Half the meals had the mother's full-name written on them. The other half just said "man".
I'm sure they took my name at some point, as I was registered as the parent in the country-wide population index, but as far as the hospital was concerned I was just "man".
(In Finnish the word for man & husband are the same, so perhaps I was "husband" rather than "man"!)
Somewhat tempered by having to go back in a week later, so all these things aren't useless. Child birth isn't the risk free thing we like to think it is.
For almost all mammals it is, just not for humans, where gestation and partum are uniquely difficult and dangerous.
No, childbirth in nature is incredibly risky. But loss of life is expected in nature and disabilities, malformings etc. simply die whereas humans try to avoid life loss or any disadvantage for the offspring at any cost.
As I understand it they have a high level of testosterone so the females develop penises, which they have to give birth through.
The wikipedia page backs me on the penises but couldn't see the reason mentioned (but does mention penile spines?!) https://en.m.wikipedia.org/wiki/Spotted_Hyena
I'll stop mentioning penises now.
This was in Copenhagen, Denmark, so the entire stay was free. Sadly, the central hospital is removing this practice and kicking out patients after 4 hours.
This is a ridiculous conversation.
As does going to the store, and a whole bunch of other things.
The USA built the Interstate Highway System for exactly the reason of economic growth. The ideas behind it are no different from the ones that justified sidewalks.
Should any small town evaluate their sidewalk projects, like we have the Interestate Highway Project, assuming they have the records and they probably don't, they would find those sidewalks probably returned a couple times their cost already, and will continue to deliver that, easily funding their upkeep.
(something we seem to have forgotten about roads, which has allowed tolls to encroach on and marginalize said growth and value)
Free is when there are no costs (watching a sunrise, receiving a hug)
We paid €250 or so for 3 or 4 days (genuinely can't remember I guess my sleeping wasn't so great. Oops!) for the three of us, so it wasn't free, but it was pretty cheap.
The first time, my wife had preeclampsia during the labor and, fair enough, there were some significant interventions to make sure that her recovery was going apace. But the second time? She had a textbook uncomplicated delivery and fundamentally all we were doing was waiting to make sure that nothing crazy cropped up in the first 48 hours after birth. There was no reason for disruptions in our rest every hour or two.
self-induced sleep deprivation intensifies
Source: home, Brussels Belgium
If you don't have any super critical stuff or you call the nurses because of pain, they'll leave you alone from 9/10pm to 6/7am
Having spent two spells recently in hospital after surgery, it didn’t bother me in the slightest being woken for 30s every few hours. Usually it coincided with me being brought painkillers, water and snacks. All of which were welcome.
There was also no issue regarding beeps in the post operative care unit that I remember. I was also given my personal belongings, as soon as I was able to structure a coherent sentence, which included headphones.
Similarly to other commenters, I should point out you might not be so quick to use technology to solve this problem. Implementing technology into an area where lives are at risk (ICU) takes a long time - with good reason. I saw a comment talking about a centralised monitoring desk. Good luck finding a ward where you are always staffed enough to have someone watching that. There is a good reason sounds have remained as the primary monitoring cue for so many years.
[0] http://www.audiocura.com/portfolio/sou/
Why do I hate inflammatory clickbait garbage so much?
I was recently on the jury in a coroner's inquest. A patient had died suddenly in his sleep in hospital. The solicitor whose agenda was to make the hospital look bad aimed to suggest that nurses should have been entering his room every 15 minutes to check his breathing, but all medical staff witnesses argued that sleep is too important to disrupt by entering the room during the night, unless absolutely necessary. They used a torch to shine on the patients chest through the window to check for breathing, and specified that they tried not to shine on them directly (watching a shadow on the wall is preferable).
It's been awhile since I was in a hospital overnight but checking in on a (presumably) stable patient every 15 minutes is madness. You hear all sorts of crazy things during jury duty--I love it.
No! Don't spare me the details! I read for the details!
What a strange way to end an article...
Aside from the first day/night after surgery, I’ve never felt like Hospitals are against slept?!?
My Wife had a c-section in October. Again, other than first day/night after surgery, never felt like we were interrupted all the time.
Is this article about America or something?
Even heart rate monitor alarms are turned off/down locally;
Not to mention "PAGING RESPOND MET CALL CODE BLUE"[0] followed by a crash cart tearing off down the hallway at 4am, and of course once you've been in the hospital for a few days you know that "MET call" means someone is probably dying and "code blue" means it's from cardiopulmonary arrest, which doesn't really help soothe you back to sleep.
[0] the jargon is probably wrong
That was my reaction too. My wife was in and out of hospital for two years in Drammen, Norway (2015 to 2017), and I never got the impression that her sleep was interrupted. I spent quite a lot of time with her in the hospital and the staff were quiet, courteous, helpful, and kind. They weren't always as available as one might wish but that was fairly rare.