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Comment by arkades | Hacker News Reader

> intensive care unit (ICU)

There are only two reasons for someone to be in an ICU: they require a therapy no other floor will administer, or their condition/therapy requires very frequent administration/titration/observation. These two reasons frequently overlap.

Sleep isn’t optional in general. It’s optional in the ICU, because the premise is “if you don’t need this level of attention to survive, you absolutely shouldn’t be on this unit.”

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That is a fair point, but if, as this story implies, by the end of the process sleep deprivation was the main impediment to the patient's recovery, and might have led to additional procedures and the problems they bring, then there would be an issue here.

I also wonder if, like 'emergency room', 'ICU' has lost some of its meaning in some places.

Wife recently spent a couple of days in hospital for surgery/recovery. She was in a normal double-occupancy room for recovery (i.e. not ICU), yet was still woken every couple of hours by someone taking vitals, drawing blood, doing respiratory checks, bringing food, etc. And the room was hardly ever really quiet because if someone wasn't there to see her, someone was attending to the person on the other side of the curtain that divided the room. She said she hardly slept.

Yes and there is an added benefit to frequent interruptions: despite all the monitoring equipement, a human assessment can go a LONG way in detecting trouble. My wife used to be an ICU nurse and her first code (CPR) in her career was when she was doing some routine stuff for the patient and noticed the color of their skin "looked different". When the patient's heart stopped beating, she was already there to get it back going, saving some precious delay.

For non-ICU stuff, yes there could be some better coordination around sleeping time, but again there's so much non-verbal stuff going on in just a physical assessment.

What would really be useful is having cleaning services and admin/billing services come at the same time (well, right after) a nurse comes, to take advantage of that interruption.

Agreed, but even the medical services aren't coordinated. I was in for 4 days earlier this year -- in addition to being woken for blood draws, I was woken on a diff schedule for meds and still a third for breathing treatments..meaning every 2 hours I was woken up 3 different times...then early am they'd come to get a breakfast order.

Nor are they going to be coordinated, because each of these services addresses a number of different units in the hospital. In order to have all of these services available for each patient in concert, we'd need to multiply the staffing by four or five fold. That holds as true for coordinating physician visits as it does for the other services.

I don't want to make it sound like it's impossible. It's not. But it is incredibly inefficient - which is why it doesn't happen - and the answer to "How can we make it happen?" is "Pay for it."

I think it is absolutely standard in that situation to at least take vitals every couple/few hours, no way around it. It's annoying to be woken up so often, but it's done for good reasons.

First observation every few hours is fine, but their is little coordination between hospital workers so people are often interrupted multiple times an hour which cuts the time for the next interruption.

That’s cost effective for the hospital but simply not viable longer term. To be clear waking someone up every 2.5 - 3 hours is very different from waking them up every 2.5 hours and another 2+ random times during the night.

As long as somone is only in the ICU for 72 hours it’s not a huge deal, but start talking a week and it’s a significant issue.

So, my partner had the option of either going home directly after surgery or spending the night in the hospital. The hospital staff wanted her to go home. She wanted to stay. (She has issues with post-surgical pain.)

If the hospital staff had sent her home, she would not be woken every two hours. The medical staff were fine with that.

It would have been perfectly reasonable for them to let her sleep; it would have been no more risk than they were advocating for.

Clearly it was optional.

> Clearly it was optional.

Unless there was some regulatory, legal, or hospital requirement that she receive a certain standard of care. They may have been fine with her sleeping through the night at home, but if she's in the hospital they need to take care of her.

It would not be an easy sell in a courtroom to explain that while you checked everyone except her every 3 hours, you let her sleep through the night and there was an issue that cost her life.

Not that the physicians and nurses should have been taking that into account but the folks crafting the regulations or hospital policy very well may have.

Clearly there was an organizational reason, but those reasons had nothing to do with what she actually needed according to her physicians, which was rest and painkillers.

What you've just said supports the article's argument that hospitals are designed to prevent people from sleeping.

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