I am an RN in a very large busy hospital. I agree that we wake patients far too often. I also know that the vast majority of the nursing staff would prefer to let our patients sleep. We have noise monitors in the halls and official quiet hours. But some patients require hourly blood tests, close vital sign monitoring, etc. and my unit isn't even an ICU. I would love to be able to adjust my patient's medication schedules, but often they are time-sensitive medications. Waking someone up at midnight to give a painful injection is absolutely my least favorite nursing task. I often wish we could be more nimble with our care, but the bureaucracy of the health system is daunting.
4
I had major back surgery 2 months ago. Because the hospital was overbooked for rooms, I was in the recovery room for 13 hours. I asked if my spouse left my phone or iPad and they said no. I was on a gurney, no bed, with no way to communicate with my spouse. A shift nurse lent me her cell phone so I could call. When shift changed at 6:45 am, Dr’s we’re on a computer station less than 20 ft. away and my anxiety went into over drive. The nurses apologized but they couldn’t do anything. When my Dr. arrived at 7:30 am, he was furious and had every right to be. Over the next 2 hours the powers that be at the hospital did everything to get me a room, which they did. However, it took the Dr. to communicate versus me, the patient or the nurses. Unacceptable.
2
A hospital is one of the only places where an adult is forced into sharing a room with a complete stranger and that person's friends and family. Providing patients with private rooms eliminates a lot of the truly unnecessary disruptions, and protects the patient's privacy. Nurses do need to regularly check on patients, but changing protocols to minimize the times a patient must be wakened would greatly improve the quality of patient care. And it sure would be appreciated if night shift workers were considerate enough to keep their voices down when walking the halls.
5
And don’t forget the staff members complete inability to close the door behind them further subjecting patients to all the racket in the hall. Heaven forbid your room be next to the nurse’s station.
7
I just read a letter from someone saying that he could not get any sleep because of his roommate's TV being on all the time. I have been in lots of hospitals, including ICUs, as well as a rehab facility. The only solution to the TV problem (don't get me started) is PRIVATE ROOMS. Private rooms alleviate a wide variety of other problems as well, such as all kinds of personnel coming to do things to the other occupant as well as all their visitors and phone calls - and they themselves. Someone who obviously as not been in a hospital complained that private rooms are too expensive. But I absolutely think not. When you consider not only the sleep deprivation and reduced mental health due to shared rooms, but also the increased risk of infection caused by shared quarters, I'm pretty sure that the cost-risk analysis would favor private rooms for all patients.
17
Ugh. My roommate and his wife talked nonstop, over the TV, they left on at all times.
2
The hospital where I consult (and supervise residents) has implemented yet another efficiency rule, aimed at maximizing revenue by minimizing length of stay, that all requested consultations must be seen by a resident and staffed by an attending physician within 24 hours. Since genuine emergencies are given priority from the day team, it means that our on-call residents are perpetually waking up people at 2 am who have been hospitalized for, say, intractable migraine, to (attempt to) take a complete medical history and do a physical exam. In other news, the hospital can't keep up with the number of MRIs ordered except by sending the inpatients for their imaging at 4 am, and we routinely give people sedatives or pain medicine to get them to sleep, then wake them up an hour later because that's when the team arrives at that patient's room for rounds. You can have efficient care or you can have compassionate care, but it seems to me that doing both in a busy hospital is virtually impossible.
8
A big thank you to my roommate during my recent stay at Kingsbrook Jewish and his buddy who visited him daily. They couldn’t have been a more quiet and respectful duo.
The doctors and nurses in the other hand...I guess I find it crass to hear residents yucking it up as loud as possible at 7am making fun of patents at full volume 10 feet away through an open door. I understand the need for teaching hospitals, but the behavior and comments were beneath the dignity of a caregiver.
Also, I had foot surgery and got my blood pressure taken 14 times a day. It was normal as it always is. Same with my blood sugar. The only thing those tests showed is that they made a mistake thinking I was a diabetic and not feeding me enough as my blood sugar was consistently in the 70s. Great job! I had a dangerous infection and was surprised to leave after only three days but relieved to be able to sleep. 5 days later I’m still adjusting to a continuous 72 hours without real rest.
10
For 2nd delivery (you do learn from your mistakes), I didn’t forget to pack ear plugs and a scarf to put around my head to be able to rest despite the noise and the lights.
3
1st delivery: woman sharing my room was snoring (not her fault of course) so I slept on waiting room couch 2 nights.
2nd delivery: I begged my OBG-gyn to let me leave as soon as possible and was out 20 hours after delivery.
Hospital is the last place to go to rest.
6
I can abide by Nurses and Doctors doing their jobs, but please, should I be subject to roommates' friends and relatives and their kids and phones? Also people don't visit to a hospital unless you are invited. Twice after giving birth I woke up to find uninvited people I didn't want in my room. Don't do this!
10
The WORST place to recuperate from any illness or medical procedure is in a hospital!!
When you aren’t being personal poked, prodded, poke at or otherwise being annoyed or disturbed, the patient sharing your room, or in the room across the hall is moaning or otherwise keeping you from getting any rest
Get OUT of the hospital as fast as you can. It can save your life!!
11
You occasionally find open wards over here, two rows of beds facing each other etc. They have curtains for privacy, and apparently it aids patient monitoring. They have too much light, noise, occasional confused elderly patients in them - plus the Obs at silly hours. At 6am they just put the lights on, shifts change, cleaners come and go etc. It drains you, and sometimes napping too much in the daytime is frowned on. Plus you are exposed to some trauma - aged 20, in the Emergency Ward, I heard an old man in pain for an hour or so, Drs running around him, just on the other side of the curtain. I fell into a short doze, when I woke he was dead.
After open heart surgery, I probably averaged 3hrs sleep. The lights and hubbub would keep me awake, then, as a side-sleeper, I would wake up in agony as my still-healing, recently-sawn open sternum would compress while I slept. Attempts to sleep upright failed.
But, it’s a hospital. I know the reasons for the lights, the noise, the interruptions etc and think they’re important or unavoidable. After too many days and nights in them, I see them as something to endure for a week or three. Grit your teeth, go away inside, battle the setbacks and fight to keep mind and soul intact despite everything. Press on regardless.
A few years ago, as a cardiac patient, I noticed a steady move towards private rooms with en suites. The improvement was wonderful - but I still ask for a sleeping pill. Nothing beats your own bed with a cat by your side.
4
I think hospitals should be more considerate of letting women get some sleep after they’ve given birth. It’s one thing to wake a woman to feed her baby, but to wake again between feedings to check vital signs after a completely healthy birth is, well, cruel. Especially since a new mom is about to spend the next few months getting very little sleep.
14
My husband had open heart surgery about one month ago. The surgeon had done 4 procedures during the operation, two being to correct congenital defects that had never been detected in his 72 years. In spite of the many pre-op tests, they couldn't wean him from the ventilator for 6 days. Once they did, he had ICU psychosis, (metabolic encepholopathy). He hallucinated, had delusions, illusions, and became combative. We were worried, but were happy the staff was always there, watching him very closely, that his surgical line didn't open seeing as his sternum had been opened, and there were physicians from just about every department being consulted, blood being drawn real often, bedside CTscans, skin care, repositioning, and you name it. Because he was in bed so long, he got pneumonia. IV antibiotics like crazy to prevent sepsis. He's diabetic, so much care for that, and constant monitoring of his heart, prevention of clotting with IV heparin, a chest tube, a previous wound on his knee from a fall required a drain at one point to remove clots that had formed under the knee. After about two weeks, they were finally able to transfer him to a special unit in a main hospital in Philadelphia. One day about a week later, he turned a corner and is back to joking with us, playing cards, doing physical therapy. His only problem is he wears out easily. With all the complications he had post op, we are happy his sleep was interrupted. He never would have made it if he wasn't.
5
I had an almost exactly similar experience as your husband did 12yrs ago now, ventilator difficulty and pneumonia included. It is hard at first and difficult for the first few weeks, regaining strength and learning to move unaided etc - but it does get better and you start to notice real improvements over what you had before. I wish him all the best, and hope all works out for him - and you - and that he makes a smooth recovery.
Sincerely,
A fellow cardiac traveller from across the sea.
3
@Mat
Thank you Mat. I'm glad yours went well, too. Something I didn't mention up there, is that he has no memory of any pain, or any of the time in the ICU at all. We think that is a blessing. They say people who experience traumas such as a car accident or this type of major surgery, don't remember things around that time. Do you remember that period of time before you started to come around? It's a blessing he doesn't remember, actually. Thank you for responding.
2
I was in the hospital for about a week with some broken bones after a fall. The initial frequent monitoring was no doubt necessary, but towards the end of my stay having all the lights turned on every 2 hours for vitals made it impossible to sleep and I was a total rage-case by the time I got home and slept for 12 hours. There needs to be room for discretion, leniency, and just letting an injured person get some dang sleep
10
When I was in the hospital they would wake me around 6am to take blood. It always destroyed my sleep. Also one time I switched floors and they screwed up my medicines. I told them about it, and when they found out I was right, they decided they couldn't skip a dose and had to wake me in the middle of the night for one pill.
The entire system is set up for the schedules of the doctors and nurses, with no regard for the patient.
14
Not disturbing patients is a great idea -- until a patient dies due to lack of adequate care. A friend of mine died during the night years ago following back surgery because nurses during post-op left him sleeping on his back instead of turning him overon his side. He threw up during the night and choked on his own vomit. He left a widow and a four-year-old child, who grew up without a father. Let the hospital staff do their jobs, insist on it, even, and catch up on your sleep later.
5
@Smford
I'm so sorry you lost a friend that way. It shouldn't have happened. But I do believe those nurses will never forget that the rest of their lives and it will haunt them. I don't know how doctors and nurses can handle knowing they were the cause of someone's death, but if we didn't have any doctors and nurses, that wouldn't be good either. Finding an answer to all of the lack of sleep without compromising the health of patients sure needs to be addressed.
3
I checked into a Scottsdale hospital five hours ago, at 3:00 a.m. During those first 5 hours, I was disturbed five times. One person—a doctor—woke me to tell me their plans for when I wake up in the morning! And I’m supposed to be here for 4 to 6 nights. Oh boy!
6
Ask a friend to bring you earplugs. I didn’t think of it first time I delivered a child. When I asked the nurse for earplugs, she laughed:) Eye mask is also a must. Finally, don’t hesitate to tell nurses and doctors that you can’t deal with them at some point when you need to sleep. You have rights. I « kicked » out of my room a whole group of drs (was hospitalized for a pneumothorax, so “glued” to bed) once. Told them I was exhausted and that what I needed most was sleep. They came back in the evening and they even apologized.
3
I found myself, sadly, hospitalized this past May and ladies and gentlemen, it was no picnic! I hadn't been hospitalized since 1985 and how things have changed since then. That was at Beth Israel and I had had a surgical procedure and recall the care as having been good. This time I found myself at Lenox Hill Hospital and I can disabuse readers who thinks that "location" equates with quality because Park Avenue and 77th does not a fine hospital guarantee. I was so sick upon arrival (severe colitis) that my usual critical self was nowhere to be found. I just wanted to get into bed and rest IF I COULD. So it was with not a little consternation that, after arriving by ambulance around 11pm I finally felll asleep by around 5am, only to be woken an hour later with the following query: "so, you have a pair of shorts, socks, and anything else?". Lucky for her I was too weak to throw her out. The same frivolous disturbances continued for 2 days and finally on the third I called my GP and reviewed in detail my condition, test results and so forth and made the following plea: AM I well enough to go home because, lord, I need some rest! After 3 days of IV antibiotics he said OK, and it was with the greatest pleasure that I checked myself out and, with some difficulty made it home and into bed where I could finally REST!
3
21 days of emergency hospitalization with discovered-at-the-last-minute cancer. To the noise and interruptions due to nurses & other humans add beeping monitors, a 'mattress' that moved and groaned (presumably to prevent blood clots/bedsores), inflated balloon-like things on my lower legs (prevent fluid retention?) and made noise, tubes everywhere, and lights left on when the midnight visitors left the room. By the time I moved to a rehab floor I was borderline psychotic, but I would not bet as to which side of the border I was on. Now I have a 'go bag' at home which contains lots of ear plugs and multiple sleep masks. Everyone was very nice and caring and they saved my life but I can't help thinking that some of the disruptions could have been prevented.
2
"Baby Friendly" initiatives were put in place by hospitals to lower nursing ratios, not promote family bonding, as the propaganda claims. The practice of not taking a newborn to the nursery for a few hours in the middle of the night to let the mother sleep is not "Mom Friendly". Women who have had major surgery or difficult deliveries need a little uninterrupted sleep to recover before taking their newborn home (where they will be sleep deprived for weeks or months). If a mom wants to keep her newborn in the room, no problem. If she needs a couple hours sleep, that should be an option.
5
@K M Walker, MD Actually, it was put in place to improve breastfeeding rates and reduce trauma to newborns. Even short separations from their mother are traumatic for babies. It's perfectly possible to both room in & sleep.
My uncle was a POW of the Japanese during WWII. He was in a prison camp for three years. After the first beatings and interrogations, the Japanese would pound sticks on the top of his and his peer's cages every few hours during the night (for months on end) to keep them from sleeping. This, he said, was the most effective way of totally breaking a prisoner. Prisoners would become delusional and psychotic. That's what sleep deprivation can do to you. Same thing happened to our POWs in Vietnam. This is a definition of torture and, as an RN, I can state that this happens every day in American hospitals. Much of this is for physician convenience. It is time for Joint Commission to mandate a policy to allow sound sleep for patients. Now, if your loved one is in the hospital and unable to sleep due to uncoordinated tasks, save and print this article. Give it to the hospital administrator on call. Demand a patient oriented care plan that clusters tests, vital sings, and other interruptions. If you are a physician reading this, please bring this article to your next medical staff meeting. This must change.
23
@BBLRN Absolutely agree that multiple interruptions per night is harmful to patients. Of everyone on the healthcare team, physicians spend the least amount of time in the patient's room, so they are not the major offenders. We need to work together to find solutions.
1
The comments reek of self-importance. Get a grip, people.
I was just in the hospital twice for a total of two weeks. I was sick, but not bedridden, and I had great conversations with the nurses and techs. I learned a lot about their work, shifts, how patients treat them, etc.
Hospitals have hundreds of patients and nurses take care of four or five at a time. Patients ailments and needs vary greatly, so no one can plan to be at your bedside when it’s convenient for you, Phlebotomists have to visit loads of people and lab results often need to be ready first thing in the morning.
Some readers want to be monitored remotely, but I’d be willing to bet they’d be the first to complain about the blood pressure cuff tightening without warning every three hours. And do you want that remote thermometer to be rectal or...?
No patient is going to be visited on their own timetable. It’s not fun to be awakened, but I’d prefer to be monitored regularly than have something suddenly go wrong.
Nurses really care about their patients’ health and well-being. I found 98% to be incredibly compassionate, competent and curious. It really is a calling.
10
The nurses are there for you, not the other way around. When you are ill, you need all the rest you can get, so it is incumbent on the hospitals to change their procedures. Adjust the schedule so they can take blood 2 hours later, with the techs schedule adjusted similarly. It's nice they had time to talk to you instead of dealing with a patient who needed them. Mine didn't have time, and all they did when in the hallways was complain about money, and the staffing levels.
7
I want to be clear—they talked to me while they were providing my care. I needed IV meds changed quite a lot and had other needs. They weren’t just standing around shooting the breeze.
Again, sometimes lab results are needed very early in the morning, so it’s hard to begrudge the early blood draws.
The nurse and techs never complained about their pay. I asked almost all of them if they were happy and the majority said they were. They seemed very sincere, so I don’t think they were fibbing. Maybe the system they work in, which is a non-profit, is run differently than the one you were served in.
3
I know the early morning blood draws are an interruption, etc. But when I get to work at 6:45, I want to make sure that my patients are doing ok. I look at lab values and recent vital signs as soon as I arrive. If kidneys are starting to fail, or hemoglobin has dropped, or someone is about to get septic, the interventions to remedy these should happen immediately.
As to pay, I think RNs are compensated pretty fairly at least in my area. But CNAs, Certified Nurse Assistants, are not. Not even close.
4
You’d think the most expensive healthcare system in the world, stacked with CEOs drawing $10M a year salaries, could figure out that sleep helps people heal. Can’t charge fees for sleep so not a priority.
19
Once again we are increasingly treating the Administrators and Insurance companies to comply with policies and procedures borne out of theory rather than common sense in order to "protect" ourselves, rather than treating patients.
5
I’ve been alway having like these Such as Changing mood, body tension.
Maybe most of people in this country would be having it like me.
People I’m living are constantly saying in mind each other (maybe it’s likely customs or culture) that you should be working hard, controlling your emotion, tolerate a little more so that you can get money each month, year, when getting older.
Like, these phenomenon(mena?) are functioning everywhere worldwide.
But I’m feeling what it strictly is.
We supposed to act for reducing our working hour and should demand pay increase legally. I’m sure that it is not demanding those illegally.
Go out in your home, Fight ourselves, win yourself!
I don’t do that. Sorry.
1
Over and over we read this same conclusion: hospitals are too loud and lack of sleep is killing patients. But nothing seems to change. Last year my mother spent several months in and out of care in Boston at a top teaching hospital. The noise was incredible and inescapable: not just beeping and alarms and interruptions and other patients' TVs, but the staff were constantly shouting to each other down the hallways at all hours of the day. It was torture and I'm convinced it held back her recovery.
10
I'll start by saying, my experiences in hospitals have been for week long sleep deprivation video EEG's to locate my epilepsy focal points.
I'll admit the sounds can get annoying for anyone who needs sleep. But they can be even more annoying for someone who is required to be sleep deprived. Lights can't be turned off, you're always listening to the machines, you're being interrupted by nurses at regulated times, listening to the sounds in the hallways, and a multitude of other ways that can keep a person awake.
Mentioned below, points 1 and 2 are things I do before having a major procedure in a hospital. Point 3 is an experience I had in a hospital.
1. I read the intake forms I'm required to sign before signing them.
2. Having a power of attorney for healthcare and making sure a nurse scans it into my medical record before going into the procedure.
3. One of the video EEG's I performed involved neurosurgery to find my epilepsy focal points. When the doctor started working me off morphine, they started Percocet instead of Vicodin. I asked the doctor why I was prescribed Percocet and they said it was because of Vicodin's addiction risks. I got sick on Percocet within a day, so they put me Vicodin and watched me for a couple days before clearing me to leave the hospital.
Do doctors take the Hippocratic Oath anymore? Doctors who have a first obligation to a corporation cannot promise "primum non nocere", first do no harm.
Doctors need to disentangle themselves from corporate interference in a doctors primary responsibility to help the patient to heal.
I observe that my corporately owned doctors are satisfied with having a middle man to collect fees and have sold their integrity as healers to corporations whose first and only obligation is to their shareholders.
So they try to have my best interests at heart, 20 minutes at a time, but healing takes more than doling out the cure for known diseases and ignoring the unknowns that are growing within and around us. It takes more time than corporate masters will give, to listen, observe and cogitate on previously unknown issues. Humans, including doctors, are not simple machines.
5
I had a similar experience when I went in to a hospital for a hip replacement in 2008. After the surgery they came into my room repeatedly during the night. As a result, by the next morning I literally felt sleep deprived. I was so tired I felt too weak to even stand up, let alone try to start walking, which they were trying to get me to do at 6 am.
Finally, I had had enough . . . I basically said, "I am exhausted, and I going to exercise my rights as a patient. I want everybody out of this room right now. Don't even think about coming back in here until I buzz you, now LEAVE!"
At 11:45 that same morning I awoke feeling refreshed and revived. I buzzed the nurse's station and said, "Let's get this party started." When the physical therapists returned (the same two young ladies I had thrown out of the room at 6 am) I got out of bed and walked down the hall and back using their walker. Then we did the same on crutches. Finally, we performed the same walk using only a cane. This time I went down the hall, then up a flight of stairs and back down again, before returning to my room. The therapists seemed shocked. My response was simply, "All I needed was a little sleep." I walked out of the hospital using that very same cane later that afternoon.
9
It is highly irresponsible and extremely poor journalism to casually add the risk "of becoming addicted" to the use of opioids for pain control over the course of a hospital stay which seldom lasts more than a few days.
The risk of such is nearly NIL.
Opioid addiction by pain patients in the case of chronic pain patients is exceptionally low. It's almost unknown for short term use for acute care. This was exceptionally ignorant and irresponsible fear-mongering.
Shame on the NYT.
12
Exactly. Thank you.
2
6 days in the hospital with an infection has convinced me the hospital is no place for a sick person. One night spent with a room mate who was mentally challenged and having a colonoscopy the next day. She need to have assisted/supervised colon blow. Well, let me tell you a ringside seat to that ordeal was unpleasant, disruptive and distressingly unsanitary. Then I had a room mate who had a large family who gathered around her bed all day talking loudly. I was so tired and needed sleep so badly I was crying with exhaustion by the end of the day. Even without the visitors, the endless noise in the hall was brutal because, after all, it is an active workplace for the staff. Then the bloody vital checks all day and night and then the doctors and their students all day and night with their same stupid repetitive questions that seem to only be asked to hear themselves speak, as my words were meaningless. I wised up after a couple of days and got ear plugs, but then the doctors would come in and have to wake me and it was funny to see how offended they were that they had to do this... apparently surprised I hadn’t the jumped to attention the moment they swept into the room. Of course, I’m sure in their experience, it was very unusual, because, why (or how) could anyone be sleeping under the circumstances?
11
A psychiatric hospital can be the worst place to get a good night sleep . Yes they have strict quiet rules for the patents that is broken all the time . Its hard if you have to stay in a thirty bed dorm in a state run institution . Private ones have a five minute check list at night so you're not allowed to sleep . If you over sleep in the morning you can expect to be dragged to the day room by security .
What gets me more than anything is how they gave my partner there for cancer treatment and complications a sugary diet. The food had very little nutritional value. Sugar feeds cancer, so I wonder...you trying to cure the cancer or extend it? Sleep is the least important fact about hospitals, they also need to properly feed the patients... Coca Cola is not a food your body should ingest while recovering.
5
What I think is important is that nurses do not prescribe medications. If a physician prescribes a drug treatment, the physician should ask the patient for consent--and discuss all the risks, benefits, alternatives, what the diagnosis is, how the drug is supposed to work, etc., rather than having a nurse come in and say: "Here, take this. The doctor said so."
4
@lucky13 In an acute care setting this would be become very tedious and absurd. Also, nurses are trained to talk with you about WHY you’re getting a medication and what the side effects might be. This is a part of their jobs. Doctors probably don’t even know all of the side effects. It’s cute that you think they would though...
2
ICU Psychosis is no joke. Serious paranoid delusions for my dad. And four months later I'm not sure he has fully recovered.
5
Duh. Unbelievable that lack of sleep as a problem is a revelation to medical staff. The orientation is, by default, what serves the institution, vs. what serves the patient.
11
My wife was awoken by a nurse and handed a glass of water and the sleeping pill she had forgotten to administer earlier in her shift.
10
I couldn't have said it better!... I just experienced knee surgery at a major hospital and was also staying in the Rehab Center to recover for a month. Throughout my experience, I was just hoping for sleeping better. It wasn't so much for the staffs to check on me as they were necessary and I needed, but It was just the vast open space with all the activities of people in those places and the lights and the noises were on constantly that I wished I were privilege enough to be in a cell with 4 hardening walls!
3
My husband, now deceased, experienced 'sundowner syndrome' after major back surgery. I thought his symptoms were perhaps more like concussion symptoms, because he forgot where he was and didn't recognize family members (including me) until he was transferred to a hospital where treatment for this condition was available. Once he got there he was a single person in a room a distance from the elevators and the bustle of the nurses' station; a staff member spent the night with him in his darkened room; necessary medical tests were scheduled together,rather than at random times; our family printed poster-size blowups of family pictures and taped them to the walls; a little later mild physical therapy was begun; and, finally, he received speech therapy. I noticed his greatest improvement occurred during his first week in this new environment, where he slept in a darkened room and someone was there at night to care for him if he needed it. (I had spent day time with him following his surgery, but needed rest at night, so wasn't with him then.) Eleanor. Oakland, Calif.
5
If you are well enough to sleep through the night without being checked on then you probably should go home. I'm all for the noise reduction idea but when you are a patient its the job of the staff to check on you. In addition to that there are many staff members that all have different work loads. The nurse, the PCT, PT, RT, OT cant all arrive at each patient's room at the same time to do what they need to do. We all get that sleep is important but if you really need to be in the hospital there really isn't a better way that is cost effective and practical.
8
Shared rooms can be a big contributor to sleep disruption, since you are subject to the other patient's activities, in-room medical procedures and guests. Having been hospitalized a few times I am convinced that the two best ways to sleep well in a hospital are to have a private room and a private duty nurse (who can do any necessary monitoring in less disruptive way). Of course, Medicare, Medicaid and most private insurance won't pay for either.
5
As a former critical care nurse I can say sometimes it is as simple as asking not to be disturbed. During my most recent hip replacement I asked not to be disturbed between 11pm and 6am unless there was a problem. It worked fine and my wishes were respected.
11
The craziest disruption ever happens at Northwestern Memorial Hospital in Chicago. When I was a patient there, I was awakened at about 4am every morning to be weighed!! The aid wheeled in a scale, flipped on the light, got me out of bed to stand on the scale and took my weight! Like my weight would be appreciably different a noon!! This absolutely nutty policy simply has no possible sensible reason!! It certainly isn't in the interest of the patient!!
16
@Casey Same thing happened to my best friend who was hospitalized with a broken ankle. At 2 a.m. they weighed everyone including my friend who could not stand up. It turned out that a bureaucrat had decided that the overnight shift was not busy enough.
1
Hospitals are so rigid, staff often has no say in when they do procedures or take vital signs. Last time I had surgery, I was too wonky from the anesthesia to notice noise and lights, but I did notice my roommate. She was wild and crazy, screaming on the phone, and threatening to beat me. It took the nurse the whole shift to get me moved. Surely, they could have done better than that!
5
My most recent hospitalisation was consumed with tests because they didn't know what was wrong with me. Fair enough. Some of those tests I requested. But six blood draws a day? How much can change in a few hours? There are some things that impede sleep that are totally avoidable.
(Note: I love nurses. I think they're the best people in the world, and most under-appreciated along with teachers.) Nurses can get awfully loud socialising through the night at their stations. It's good that they find camaraderie at work but hey can keep their voices down a bit.
The machine that beeps for three hours. If I can hear it, can't staff? Isn't the purpose of the beep to call attention to something?
Meal and other carts are noisy. Why? (Fix the wonky wheel.)
Noisy visitors in another room. Just close the door.
If you insist on my day starting at 6 am, don't then assume that my day shouldn't end until 10 pm. Let me call it a day at 8 pm. I understand some things have to work on a schedule - a hospital is a big, complex place and medicine has its scientific elements that require measurement and a quest for certainty. But can those processes be adjusted to human needs as well as the system's?
One of the problems is that the hospital schedule can be way off the patient's schedule. One example, I usually don't eat dinner until about 7:30. Adapting to a 5 pm dinner time is very disruptive to the rest of the day.
Speaking of that, oh, the food...
6
Steven, I often have patients whose blood I need to get EVERY HOUR. This is required so I can titrate their IV drips. Six blood draws in a day is a lot, and I do hope they were clustered. There are lots of things in your blood that can change from hour to hour depending on your illness and what medications you are receiving.
You are right about nurse stations. In my hospital, we have noise detectors at the nurse station that lets us know when we are getting too rowdy. It is a simple and inexpensive remedy.
Alarm fatigue is an ailment nurses suffer from all too often. We hate it as much as you do. Someone somewhere will figure out a way to make the alarms less intrusive and more effective. I HOPE.
If you are in the hospital and not that sick, you can ask to not be disturbed between the hours of X and Y nd get a sign on your door saying so. If your nurse is halfway decent, they will bare their claws at anyone who doesn't respect this.
Don't get me started on the food. It is so embarrassing. Especially when the other local huge medical system has excellent food.
2
After being admitted for a minor heart issue, my mom 86 years old waited for two overnights to be scheduled for CT/MRI. There was staff trafficking in and out due to another patient in her room, along w/her bed buzzing every so often and staff voices significantly elevated. They were going to have her stay another night, but knowing sleep was instrumental for her getting better, I walked her to a waiting area outside the elevators that was quite and lights low. She slept much better there leaning on my in a chair than her hospital bedroom! It wasn't until then that a doctor saw us and I told her the problem. We collaborated together to contact her primary care doctor to push for discharge and schedule her imaging outpatient. Her PC doc ordered them and we immediately discharged her and brought her home. She had a complete full-night sleep and the next day she had her imaging! There's got to be a better way to handle the elderly!
11
As a nurse, I agree that hospitals, nurses and doctors need to work to decrease waking patients although it is not as simple as it may seem. Another problem is people who want to visit the patient. Outside of close family members, there should not be a lot of visitors so the patient can get some sleep during the day and evening instead of feeling required to “entertain” company.
7
I have spent more time in hospitals than I can remember. I do remember that they don't let people sleep. The last time, after a heart attack, I was awakened so often (in a single room) that I cried desperately, "I'd rather be DEAD than awake right now!" The nurses finally heard me and let me rest a while. It is not serving patients to wake them constantly. I've even snuck out and fell asleep in a lounge just to get a little rest in the middle of the night.
15
The British Medical Journal just ran an editorial on this: https://www.bmj.com/content/363/bmj.k4808
with a patient perspective to complement it.
"Mediating noise is one of the challenges of being in hospital, but patients can be part of the solution."
https://blogs.bmj.com/bmj/2018/11/19/estelle-jobson-engaging-patients-hospital-soundscape/
4
My experience as the primary caregiver to a loved one left me terrified of hospitals.
That's right- terrified.
The number of things that can and do go wrong is staggering and you can become paralyzed in negotiating it. And I truly don't know which is the worst, the stupidity or indifference, that play roles in it.
But most infuriating is lack of common sense- OF COURSE constantly disrupted sleep is going to cause problems. And there isn't any excuse for it, with all the information we know have about the dangers of even short term sleep deprivation.
I watched my love one go through delirium. They were not a frail person going in, not one you'd think would at risk.
It's nauseating to watch. And I'm sorry to say not everyone fully recovers.
From the bottom of my heart, I hope I die young if that is all that awaits.
13
Having had several planned major surgeries and ailments that landed me in the hospital, I have developed a strategy.
I bring my own soap, cologne, toothpaste, shampoo, pillow and comforter. I bring a nightgown and robe that allow access for IVs. I bring small gifts for the nurses and attendants - $5 soaps, teeny bottles of perfume, little picture frames. Pretty things. My husband gets a big assortment of cookies or fresh fruit for the staff room with a note that says, “From Kathryn in Room—-“.
I am treated like a goddess. These are not bribes. This is recognition in advance that busy, overworked people are going to care for me, and they are mostly mis-treated by people in pain who are sick. They feel seen by me. I try not to whine or yell or demean. I say please and thank you. When I’m suffering I call for help. It has almost always been there.
The first two nights after surgery I hire a “sitter,” between the hours of 8PM to 8AM. This is not expensive and I have my own person watching my every breath and my husband can go home, walk the dogs and rest. One sitter told me, “I am your call button.” This helps a LOT after major surgery.
We, as patients, cannot control everything. But, we can be proactive and self-protective. This is called self-care.
19
@Kathryn If you have enough money, anyway. At least, everyone can treat the nurses with respect, that much is free.
6
@Joy Thompson - in most hospitals, you pay minimum wage or a little more. So few people know about it, I thought I’d mention it. They are not nurses. They’ll stay up reading a book (often the Bible) and wipe your brow with a cold cloth, or hold a basin you can throw up in! Of course not everyone can afford this, as it’s out-of-pocket. But, if you can, it’s a godsend. They are always such nice women.
6
@Kathryn
I have never heard of such a thing as "sitters". Are they hired through the hospital?
Why is it necessary to wake patients to ask whether they are experiencing any pain? If a patient is sleeping quietly, then the answer is obviously “no”. It happened to me, and it simply defied common sense.
18
David, I appreciate this perspective. As an RN, I try to not wake a pt to ask this question. However, high levels of pain are difficult to treat. Once we get pain under control, we don't want it getting ahead of us again, as that will again require extreme interventions. I will wake a pt who has been fighting pain so I can assess where on the pain scale they are and make sure they are not heading in the wrong direction. The last thing a pain patient wants is to wake up refreshed in the morning but in complete agony. It could take most of the day to get the pain back under control.
Another factor is a hospital's pain policy. We are required to assess every patient's pain twice a shift or every 2-4 hours depending on the pt's pain levels and interventions. If nurses do not follow this policy, we get in trouble. If I am on a night shift, and my pt is not in pain, I will assess before they fall asleep and as late in the morning before I leave as I possibly can. As will most night shift nurses.
@David
I suspect the nurse was also getting your vital signs and asking about pain. It's important to monitor vital signs to detect problems... A post-surgical patient might have an internal bleed or become septic. A patient with an infection may worsen (e.g., with sepsis, renal failure, respiratory problems, necessitating intervention). A cancer patient may develop an infection or complications from their therapy. Early detection and intervention is important. Grouping cares is best, and most nurses should do this. Early morning labs support quick intervention.
I usually outline the night's plan with the patient and work with them to achieve buy-in related to it. Occasionally, I will be able to let a patient sleep undisturbed for about five hours....(this is not the case in post-op day 0 patients who require frequent vital signs for the first six hours at minimum). I also try to work with them to do things while they are awake or wake up. --But, the needs of all the patients on the unit must be addressed, and sometimes certain patients (usually more ill) must take priority.
Streamlining is impossible when it meets hospital reality. The team rounds at 6AM and handoff begins at 5AM. Rounding without current labs leaves us fumbling for a plan - low on potassium? Elevated white count? You can't tell that just from looking. We set our blood draws for 4:45AM and occasionally they're not drawn until 6.
Why don't we just start later? Round at 7AM...maybe 8! This is a surgical service. Surgeries start at 715. Cut two hours off of that and demand patients be okay with rolling in at 5PM (or later) for their surgery? Good luck!
The rest of the world the hospital works with - outside offices, banks, the government, schools - keep banker's hours. If we don't have stuff ready early, it is likely it'll not get done
11
@Dr. Meh. Then other measures are needed in order to let a patient's body heal itself, which is what sleep does.
(Does you're self-identification as "Meh" suggest indifference? Not a quality I want to find in a doctor.)
4
My husband is in a hospital now. Another sleep-thwarting aspect of the hospital environment is the perpetual loud beeping of various sorts of monitors. A few break the monotone monotony by emitting little tootles that sound as if they could have come from a miniature clown car. Somehow they were less annoying. Monitors in patient rooms are echoed at the nurses’ station. There was one that ran almost constantly in the ICU that no one seemed interested in stopping.
Because my husband has sleep apnea, a monitor beeps insistently when his breathing (or blood gasses) are not optimum. Of course, this wakes him up. This strikes me as a silly way to deal with a disorder that interrupts sleep, but what do I know? As someone once said, “I’m a doctor, but I’m not that kind of a doctor.”
8
@Kathryn W Kemp
You may want to read up on apneic episodes and respiratory failure.
When I was hospitalized, I found that the only way I could get any kind of rest was by (1) asking for pain killers even when I didn't really need them for pain, but did need them to sleep, at least through the ambient noise day and night; (2) using earphones to replace the ambient noise with soothing music on my smartphone; and (3) using earplugs to blot out all noise. (I now keep earphones and earplugs in my hospital "go-bag.")
Of course, none of this helped me when they woke me up in the middle of the night to draw blood. They did this so often that I had almost no viable veins left. One night at 2 a.m. I had six people laboring over my poor punctured arms. It's ridiculous that they couldn't wait until 6 a.m., when the doctors and students were going to wake me anyway by using me as a teaching example.
Like everyone else, I've got a million other stories of sleep-interruption incidents in hospitals, suffered by relatives and friends as well as myself. I get that some interruptions are necessary, but hospitals need to tailor them to the actual needs of the patient and not blindly adhere to some inflexible policy designed to avoid lawsuits. Someday that will backfire on them, and they'll be sued for harming patients through unnecessary sleep deprivation.
8
During my stay the room temp was set at 80 degrees. When I asked to have it lowered I was told this is not a 5 star hotel and stop complaining. They did, however, lower the heat.
4
It is so hard to sleep in the hospital. I know because I've been there more times than I care to remember.
First, the REASON we are in the hospital is enough to keep true restorative sleep at BAY.
THEN the amount of light, noise of the machines and activity in the halls, and then the appearance of caretakers monitoring vital signs, all combine to keep us wide wake. Or Groggy at best.
Since most of the time, I've only had to spend one night in this chaos, I've recovered quickly enough. But once I had 4 nights in the cardiac care wing of a major teaching hospital. With my anxiety sky high, I felt I 'didn't sleep a wink'.
I know hospitals could do a bit better, but I'm not counting on getting in sleep in one.
4
At least some of the missing sleep is because of monetary conflict of interest. For example a very athletic friend needed a hip replacement. Post surgically however her blood pressure dropped precipitously low. So low in fact that she had some cardiac stress from the hospital 'routine'. This further tires you. And its worse in the morning hours. But no matter, the hospital forced her to submit to the "Physical Therapy" in the morning. There was multiple wakeups in the night as well. There was no ward she would be assigned with this condition, not understood till after departure. So rehab was only place she could get the minor assistance needed -the hospital bed next to a bathroom was most of it. So there is also the fitting square pegs into round holes, much inflexibility and robotic routine and system. This points to a system problem which then needs change from the top. A structural change beyond just a few tweeks.
6
I watched my aunt’s disposition and condition plummet after she was admitted to the hospital following a cancer-related seizure. She had been at home on hospice, rolling with all the punches of being near death but when they put her on that vibrating hospital bed and disturbed her ability to sleep, she became profoundly miserable and angry. The vibrating beds are intended to prevent bed sores but it seemed like the bed never stopped and she couldn’t properly rest even on sedation. When we got her back home she was much happier and better rested.
7
@Cybil M Why did the hospital admit her if she was on hospice? Hospice is comfort care only.
@Mary
People may go on or off hospice care. They also may receive palliative care in conjunction with curative efforts. Palliative care and hospice care both focus on comfort of the patient whereas curative care focuses on cure. Generally, in the U.S., hospice means care near end-of-life, while palliative care may be delivered over the course of any life-threatening/life-limiting condition to enhance quality of life.
Hahh! Here we go. Finally an article about my pet peeve with hospitals.
I have had the same experience as all the other readers who commented before me. I still remember being waked up many times the first time some 25 years ago as I had to stay at the hospital following a fall from a ladder. Already then I remember complaining to my wife about this and saying "how do they expect patients to get better if they don't let them get proper rest?"
And then I recently had to spend one night at the hospital for an ulcer. The same routine happened again: blood draw, vital signs check, and what not. I just cannot get back to sleep easily when my sleep is disturbed, so you can imagine how anxious I was to get out of this place.
But the injury did not stop there, it was later that it hurt even more, when I got the bill. I found out that I had to pay some $ 1,300 even though I had a decent insurance. The hospital had charged my insurance $ 8600 for one night room and board, presumably because they had hooked me on a cardiac monitoring system. Unbelieveable when you know that 1: I have no heart issues, 2: I am in an excellent physical condition, (regular gym and good diet etc) and 3: there is no heart issue in my family history. But no, they absolutely had to add a super expensive charge for no good reason, other than profit of course.
8
@Sansay I went to the ER when I was 62 and a few weeks later I got a bill for a pregnancy test. Had to pay $26. What a ripoff.
2
I just got home from a hip replacement surgery and can honestly say I got a good night's sleep thanks to an understanding night nurse named Zoe. During the nurse shift turnover, we had a meeting. I explained that I did not want to be awoken between 11pm-5:30am, when my surgeon was due. The vitals and blood draws could wait. At first she protested "but...but...but" then saw the merits of clustering her visits--which were better for her, and not just me. The made a big "Do Not Disturb" sign and closed my door at 11pm and tacked in on for the night.
It worked beautifully--.
Thank you, Zoe!
6
My husband has had three major surgeries in the last year. He was hospitalized for 5 weeks after the first one, and about the third week he started having hallucinations caused by sleep deprivation. The doctor ordered “clustered care,” meaning multiple procedures were done with one wake-up instead of coming into the room every 20 minutes for something. It worked like a charm; he slept and the hallucinations stopped almost immediately. Why can’t “clustered care” be utilized as a standard, with exceptions for people too ill to be left alone for several hours?
16
I think anyone who has stayed in a hospital or who has had a loved one stay in a hospital knows that patients get terrible sleep while they are there. It has always been a mystery to me why hospitals aren't more aggressive about fixing this problem. It doesn't take a medical degree to know that sleep is good for you, especially when recovering from disease or trauma.
12
There is a standard of care to be upheld overnight as well as during the day. If a patient has had surgery and the surgeon orders vitals to be taken every 4 hours then it'll happen 24/7 until the order is changed. Some antibiotics are ordered every 4 hours and it the med is to treat c-difficile, a life-threatening bacterium, then a patient will be awakened every 4 hours. When IV therapy is infusing and there is a higher risk of infiltration when people are changing positions in their sleep, nurses will tip-toe in the room using a small flashlight to check that IV. After working 10 years at a community hospital on the night shift, I recommend that technology (which equals $$) is amended to improve sleep quality (beeping IV pumps and bed alarms are the biggest noise makers). Keep in mind that patient acuity is significantly higher than in years past and the number of patients who are incontinent might be surprising to many. Skin care is vital to sustaining a person's well being as risk for infection increases once the skin barrier breaks down. Imagine the outrage in the morning if family or friend comes in to find their loved one lying in a saturated bed. There are many scenarios which require increased nursing interventions and checking on a patient more frequently both day and night.
18
How is it possible that hospitals can't monitor vitals automatically, and allow nurses to check them remotely, from their phones???
5
@truth 1. HIPAA - the nurses would not be able to use their own phones (and they shouldn’t be asked to anyway). 2. Hospitals wouldn’t provide nurses with phones for work. 3. Even if hospitals provided nurses with phones, patients would complain about it increasing healthcare costs.
@Mary During my hospital stay this week, every staffer who interacted with me, scanned my bracelet with a hospital-provided iPhone as well as any medication I received. One nurse had a question about something on me and took a picture of it with the phone and submitted it to the doctor right then. So, guess again.
2
@truth
This is possible, but it does not always allow for respiration checks, temperature checks, nor for mentation checks. Consider also the state of certain lines, e.g., IVs (may infiltrate), skin (breakdown), etc. By checking on patients regularly, nursing is able to intervene when things go awry (e.g., respiratory failure, renal failure, infection, sepsis, etc.)
1
When I was being treated (successfully, I add) for cancer at Sloan Kettering, they woke me up several times every night, sometimes for tests, but usually to ask if I was asleep!
In the years since, at home, I found myself frequently waking suddenly in the middle of the night, my heart pounding, convinced there were people in my bedroom leaning over me.
I sleep alone, so I know this isn't true. The situation has eased in recent years, perhaps because I now keep a night light on to dispel suspicious shadows.
9
@Andrew Porter
You may not have realized that your vital signs were being assessed, as was your mentation. Chemotherapy may cause issues with mentation and it may also set the stage for life-threatening infection. Frequent checks support early intervention that can mitigate sequelae.
Roommate situations are worse. When I was in the hospital, my roommate watched tv until 12am because he could not sleep. He was 78 and he was a very nice guy. His family brought him earphones so that helped a little.
Then there are snoring roommates in the hospital and I am a very light sleeper.
I think the whole hospital sleeping thing is designed for doctors, nurses and hospitals so that hospitals do not get sued. Hope NYT keeps writing about this sleep problem in the hospitals because sleep helps recovery tremendously.
19
Why TV??
I do understand that tv helps to pass the time, but it is also the cause for major sleep and emotional disruption. There should be no question that loud tv is powerfully disruptive to a healing environment.
At what point will healthcare really take responsibility for the creation and maintenance of a full healing environment? Why not Institute quiet and dim time for patients (ie no tv) after 10pm?
Hopefully, the Hospital TV Industrial Complex will shift to iPads.
3
So agree! After I gave birth I thought my baby and I would get some rest. Not much! We were both woken up repeatedly throughout the night, bright lights on etc, for various checks. And since we shared a tiny room with another new family, who were also checked of course-on a different schedule- we woke up for those, too! Was awfully stressful and so unnecessary.
15
My mom had multiple surgeries that I helped her through. I would talk with the nursing staff as to what was required for her safety. They were comfortable I was on board for her care, then I shut the door to her room and it stayed shut. The whole night. My mom could rest and heal.
I could quietly read and doze in a chair. I would check on her and if needed I could get a nurse. This plan worked over multiple visits. I would be tired but not too bad and my mom could heal. Win win for all.
11
And visitors! I spent 5 days in the hospital two months ago and had to ward off people who harangued me about coming to visit, like this was an opportunity to socialize. I was adamant about nobody visiting and two people actually took offense. I had cancer in my 20s and spent 3 weeks at MGH and learned then that visitors expect to be entertained and reassured and the onus is on the patient to make that happen.
It was draining to say the least.
16
@Susan - I so agree about visitors. I never know how I’ll feel at any given moment and don’t want to entertain visitors other than close family. It is so draining. Phone calls are ok. I also don’t want the darn flowers! They take up space, need tending, wither and the water smells! Who needs it. Bring a book or a hand cream or good-smelling soap.
People need to consult the patient about what they want and need. I asked for coconut water once and was so excited when my sister brought it. It was the perfect “gift.”
3
This article may well be true, but it's impossible to tell. There is no new information here, but it merrily flogs the old trope that patients are interrupted and rest poorly in the hospital (true) and they don't like it (true) but then goes on to infer a host of bad outcomes from this (???).
The idea that (for example) in the caption under the picture, "short sleep durations...are associated with hypertension" in the outpatient world applies to outcomes in the hospital is an interesting idea, but a real stretch.
Also no data to suggest that post-hospital syndrome would be better if hospital schedule was more coordinated (vs. being a byproduct of being sick).
Similarly, no data to suggest that if blood draws were "coordinated" and vital signs were skipped on seemingly stable patients at night that this would be harmless to patients. (sudden decompensation not found; labs deferred and therefore not drawn or reported late to accommodate "coordinated" time; etc).
I will say that the data on reducing sedative use is interesting, but is confounded by probably not being blinded ("RNs, we are doing a study on your unit to see if fewer interruptions makes patients happier and reduces sedative use" might lead to fewer sedatives being offered, even without an effect of reducing interruptions).
I don't object to the conclusions, but this the majority of this article is designed to catch, intensity, and reflect the reader's preexisting opinions on the matter.
6
@SW
P.S. I'm not saying that having a more pleasant (or less unpleasant) experience isn't a valuable goal in itself. But I am uncertain that the case has been made for concrete health benefits. One approach that perhaps will appeal to most: Get out of the hospital when you are well enough not to need round-the-clock frequent interventions.
2
@SW
There's plenty of data out there showing that even short-term sleep disruption alters cytokine production, affects the HPA axis and probably increases infection susceptibility (among other effects.) It would be hard to imagine that there are no negative health consequences from disrupted sleep in hospital patients. In a sufficiently sick person those negative effects may be outweighed by the need for frequent interventions. But many of the comments are about postpartum mothers, for example, who aren't sick at all. Not everyone in the hospital has the same needs, but everyone is subject to the same sleep disruptions.
6
As an RN, I completely agree that rest is vital to recovery, at my I institution we do what we can to reduce noise- private rooms when possible, limited visiting hours, holding other staff accountable for being quiet in patient areas. However, it is impossible in most cases to give patients a night’s sleep without interruption. Patients hospitalized for stroke must be awakened hourly for neuro checks to make sure that their condition isn’t worsening. Post op patients require wound, neurovascular and respiratory assessments, especially in the immediate post op time. Heart attack patients need frequent lab draws and vital signs. I tell my patients that if we could leave them alone for eight hours, they wouldn’t need to be in the hospital.
16
Nurses are held accountable and an easy blame when errors occur during nighttime hours . Patients already sleeping poorly compound the problem by sleeping during the day. A vicious cycle starts. Patients should never fear to use the call light or call out if they don’t feel well and should expect a quick response. So legally, a hospital will back a nurses discretion? I’m not hopeful on that one.
1
@Syram If you're sleep deprived enough that you're hallucinating and having anger outbursts, sleeping during the day is not compounding the problem, it's the only thing saving that person from even more serious issues. Not to mention that when you are seriously ill, your body needs far more sleep than healthy people.
1
I am a nurse at Yale New Haven Hospital (referenced in this article) where we adhere to quiet hours and clustering of care to promote sleep. It makes a huge difference in patient satisfaction, sleep hygiene and delirium prevention to be given autonomy as a nurse to reschedule blood draws and medications to prevent sleep disruptions. I didn’t realize that other hospitals don’t use these same strategies and hope that articles like this make a difference.
28
After 45 hrs of labor and an otherwise easy birth in Roosevelt hospital (2012), I was woken frequently by — not my baby — but by staff. It was horrible. I didn’t sleep much til I got home two days later, which by that point was four days without sleep. Waking regularly to feed a newborn was a breeze compared to that!
I did my next birth (2015) in the Roosevelt hospital Birthing Center to avoid those awful practices.
Sadly, the Birthing Center recently closed to create more private luxury suites. Good thing for me, my shop is closed!
Every aspect of this is about the money. It’s time for single payer!
18
@NYC
OMG... Single payer would be MUCH less patient centric as necessary service cost reductions would call for even MORE doctor/nurse centered efficiencies at the patient's expense.
In addition: Make sure new mothers have access to nurseries. I did for my first child, and it helped me get what sleep I could after a lengthy labor and c-section. The nurses still brought the baby at regular intervals for breast-feeding, but I had a chance to rest.
For my next birth, there was no nursery, and I remember how scared I was that either I or my husband would fall asleep holding the baby.
New moms need support so they can rest also.
10
Tailoring treatment schedules to patient needs instead of the hospitals convenience....WHAT A CONCEPT!
I would also like them to tailor treatment to a patient’s needs. Imagine being given a sedative in order to make the nurse’s life easier. I stood and argued with a nurse when she insisted that every single patient must receive a powerful blood thinner whether their doctor had prescribe it or not.
Clean the floors, improve the food and tailor the treatment and schedule to the patient....radical thinking?
11
@Justice Holmes My husband, and every single patient on his floor, was forced on to an acid reduction medication. It took him 8 years after he got out of hospital to get off of it. In those years, it's been found those drugs have dangerous effects, especially if used long term. He didn't even need it, it was just standard procedure. I actually got him to refuse it at first, but they bullied him into it when I wasn't around.
1
The flipside of this is that if you let the patients sleep all night and something bad happens, the hospital staff will be blamed for being inattentive and ignoring a sick, helpless patient.
11
@Kim The article states that, of course, some patients do need frequent monitoring. The idea is to consider each patient, and decide if tests and such can be clustered together, leaving more time for patients to sleep.
7
@Jodi P
Generally, if a patient can be left alone all night, I can't help but wonder if they should be discharged.
Don't forget the teaching hospital routine of grand rounds at 6 am-you finally get to sleep then something wakes you, the light goes on and 4 or 5 doctors and students are there standing at the foot of your bed. This is after trying to sleep with the interruptions all night and the noisy nurses station, monitors beeping, your roommate's care interruptions...
15
The hospital is similar to prison in that you’re subjected to the control of other people and you can’t leave your room. I think this article should be saved and pointed out to the nurse manager, the head nurse, on your floor, should you find yourself in the unfortunate position of hospitalization.
An accompanying article about the atrocious and detrimental food should be next. The institutionalized “juice” is pasteurized and replete with high fructose corn syrup. Their broth is saturated with sodium.
I made friends with the kitchen staff and was able to precur a daily salad of salmon, cucumbers and tomatoes. I also relied on friends and family for fresh green juices and organic fruit.
I kicked the staff out of my room at night and made them close the door to crack. The nicer you are the more accommodating they’ll be.
I relied on a volunteer to pick me up heavy duty earplugs and cajoled my neighbor into using headphones for her tv, which can be inserted into the tv remote, since she watched tv ALL day.
Last, they should do something about visiting hours. When you’re sharing a hospital room, your roommate may have visitors at all hours of the day and night (10:30 pm; the rule isn’t enforced) and this can be disruptive when you have only a curtain separating you.
Those visitors also think it’s ok to use your bathroom, which isn’t a public one, making an unsanitary condition worse.
17
And if you don't have a private room (almost nobody does), you are also awakened by staff coming to attend to the person in the next bed. Aargh!
6
The article didn’t even mention the patients who keep the TV on all night with the sound turned up while they fall to sleep.
12
I thought the same thing, but it's lack of someone with enough forethought, i.e. degree, to make that call. Otherwise, you must frequent more to compensate al lack of awareness.
1
Besides the usual wakeups all night this past week at a Long Island hospital where I was helping a patient/friend, one of the attendants woke up my friend at 10:30 p.m. and asked if he had a phone charger. Sometimes one has to wonder what all these attendants are thinking.
7
My grandmother, who died at age 83 over 40 years ago, said “Never leave a family member in the hospital alone.”
The key is to protect and advocate for your loved one ‘round the clock — everything from food, to their hygiene, to pain management and sleep is important to their healing and survival.
If there are too many interruptions, post a handwritten note on the door and enforce it. If your family member needs bathing ask for supplies and then insist on having help to bathe them. If the food is unpalatable, go to the cafeteria or order out. If you don’t want student doctors swarming in and out, you can opt out of their curriculum. If there are too many medications or vital sign measurements at night, speak up and insist on changing to the routine orders.
I have had to do these very same things.
Be reasonable, polite and careful, but not to the detriment of the basic needs of your loved one. Ultimately, you won’t regret being instrumental in caring for your loved one.
15
When my mother had a rupture of some critical muscle in the heart we were fortunate to get her to the hospital in time and fortunate that a very sharp nurse picked up on something and directed the cardiologist to prioitize the echo. Finally I was fortunate to be there when the nurse tried to give her a diuretic at 8:30pm a few hours after the surgery and I intervened in a not very gracious way to say - “are you trying to kill her?” My siblings were shocked but the diurectic was held and she recovered from a very scary episode.
3
She probably had papillary muscle rupture and sometimes patients need diuretics after open heart surgery.
7
Elderly patients with dementia and a staff without experience with those patients can end up with old people on antipsychotic drugs. The sci-fi environment can begin a downward spiral. Including not getting fed or turned in bed. Lots of documentation though.
5
For me, the biggest problem was roommates. Hospitals have become very accommodating for visitors, and one of my roommates actually had about 15 people visiting at the same time. While they try to be quiet it’s hard to keep a group like that really quiet. The nurses informed me that they had every right to be there, at any number, until quite late at night.
The other problem is that in a shared room, you are subjected to BOTH your treatment interruptions and ALSO those of your roommate.
the first night of an eight day hospital stay I was kept awake by the check in procedure of a roommate at 3am. FINALLY after what seemed like eternity, a kind nurse gave me earphones which helped to mitigate the situation. Why wasn’t I provided with them at my first complaint??
The solution is private rooms which are becoming somewhat more available in New hospital construction.
19
@Bonnie This week I spoke to a friend who was ill in hospital in Exeter, England. In the UK, they still have wards; forget about private or semi-private rooms!
Physician and nursing students should be required to participate in a program of hospitalization role play for at least 24 hours as a part of their curriculum. This alone would markedly change their practice and increase empathy. Additionally all other hospital staff--from environmental services all the way up to the C-suite, should engage in a similar exercise during onboarding as part of orientation. Transformative.
26
@Healthy Nurse
Make that 48 hours and I'm on board.
11
"Patient-centered care" is a PR phrase but rarely realized. After CABG I was in a two patient room, so I was awakened by care for me and care for her. TVs were on all the time, roommates came and went and there was no coordination of outside people: PT, Care Coordinators, x-ray. Everyone in the hospital came into my room when it was convenient or required for them, not for me. After 12 days I was not only recovering and in pain, but exhausted. I had compassionate care from nurses and from the Patient Care Tech who treated me with kindness and gentleness. My surgeon saved my life. I am grateful, but when oh when will patients be the drivers of healthcare?
20
Hospitals get reimbursement for all of those interruptions. Change the payment system and patient experience will change.
24
I was hospitalized for one night for work up of chest pain and got zero sleep also. The nursing station, which was just outside my door, was very noisy all night with non stop chattering/talking all night. My alarms kept buzzing every time I went to sleep so as soon as I fell asleep the alarm would wake me up. When I had a question during the night about how low my Blood pressure was getting due to the meds that they gave me, they told me that I was bothering them since they were on top of it so I shouldn't ask anymore questions. Finally they shut off the alarms which were set too high, so I finally could get some sleep. I ultimately was found to have a negative workup ( nothing wrong with me) but felt like I could have had a negative outcome just from the hospital experience alone. The resident told me in the morning that I had asked too many questions during the night so they might need to move me somewhere else but I was discharged later that day. I hope I never need to be hospitalized again- I'm not sure I will make it out alive.
24
I always ask questions, no matter what! It is your right to be informed!
5
The legal risk of veering from a standard practice is too great to a hospital without a physician order, and they aren’t going to risk it for a little sleep. The nurse knows that they are on the line when that patient doesn’t wake up and wasn’t checked on. Same with beeps and bells. Lawyers keep patients awake, not nurses, doctors or hospitals.
23
@Diane,
Excellent point. My wife was a hospital nurse, and I had sleep deprivation in a hospital after heart surgery. A patient can demand to be left alone & heart patients are monitored electronically 24/7.
Hope things change.
3
@CH I refused a blood pressure last year in the middle of the night last year bc I was exhausted from an ankle break, 8 screws, 1 plate. The nurse refused my refusal bringing another nurse in begging me to let her take it. She wore me down bc I was not getting any sleep regardless! She was awful! I have great blood pressure, was recovering nicely, just wanted to rest!
6
@Cardinal123
It's great that you were okay, but that blood pressure check if not normal could have suggested problems that would have required addressing.... Post surgery patients are at risk for bleeding, sepsis, etc.
@aek. Well written piece. However all the 'shoulds ' are not going to happen. As a 30 year bedside nurse in hospitals I finally realized that nursing is not a true profession as it has no authority to implement programs or ideas of it's own. Physicians and hospital administrators have that authority.
In my experience, nurses, as a rule, do not stick together for a cause, nor do they even support each other well as 'professionals '. Most are there for the job and the money, and have little interest in the profession beyond that. Many are good nurses, but the idea of fighting for their territory in terms of the betterment of patient care simply does not happen, nor are their any inspirational leaders to coordinate that kind of effort.
17
I always figured that they were waking me up to be sure I was still alive and not in a coma.
4
Went to a a rehab center after my knee surgery ( talked into it by the discharge person; what did I know?). After my hip surgery despite huge pressure nothing could have persuaded me to go to a rehab center again. And boy was I ever pressured because I live alone. Not only was it a total waste of Medicare money, but being woken up every couple of hours was ridiculous. A horrible experience in a very nice Rehab Center.
10
We actually pulled my mother out of the cancer ward in the hospital and brought her home because they would wake her up round the clock to put another drug in her. She lived months longer as a result.
13
Until hospitals figure out a way to make money from their patients' getting a good night rest, it's going to stay loud, interruptive, stressful, and beepy.
41
Wake up sir. It’s time for your sleeping pill.
30
In every hospital I or a loved one has been in, the biggest source of noise especially at night has been NOISY EMPLOYEES.
They stand in the hallway outside your room and talk about patients, their kids, new cars, the weather -- and they laugh and make all kinds of noise.
Don't change the flooring -- tell your workers to SHUT UP
50
@KathyinCT
Yes, I had the same experience in 2007. I was across the hall from the nurses' station and when 11 pm came, and the shift changed, you'd have thought you were hearing 12-year olds at a sleepover! All night! I complained to the nurse who came in, then asked for a sleeping pill which took an hour and a half to get. Then I complained to the doctor the next morning - HA! No results.
4
WHAT??? Somebody had to do a study to figure this out: that a hospital is no place for a sick person. I made the huge mistake of reading this right before going to bed and know that I will lose sleep over the emotions this article has churned up. Hospitals are NOT places for rest or healing. It is all about the heavily parasitized medical, industrial complex that passes for healthcare in this country.
Practically anyone you talk to has their own horror story. Here’s my family’s: my mother age 92 and of very sound mind at the time went to the emergency room at the direction of her primary care physician to get checked out for lingering cold symptoms. A preliminary X-ray revealed pneumonia, but they, the nameless, faceless people who seem to be in charge wanted a scan with contrast dye. The dye fried her kidneys and she spent over 90 days receiving “care” for her acute kidney injury ending up as a dialysis patient. We counted hundreds of needle sticks, mostly at 4 a.m. and countless other indignities, the worst being skin tears from bandages being ripped off.
No one should go into a hospital alone. They are not safe places. Patients need to have unapologetic advocates with the heart and soul of a stalker, not that it helps a whole lot given the ceaseless turnover in nurses, aides, therapists. You rarely see the same person twice. No one is in charge, no one is accountable. it is almost impossible to pierce the veil that obscures secret handshake world of a hospital.
50
A counter-anecdote after all these nightmare stories - in May, I spent a week in Touro Infirmary here in New Orleans. Never slept so well in my life! Admittedly, the morphine was probably a factor, but so too was the kindness & consideration of the doctors, nurses, and hospital staff.
They were at my bedside in a minute when I needed them (or just wanted some juice) and happy to chat if I craved company, but always did rounds, tests, and labs on a reasonable schedule and otherwise left me undisturbed to heal. Five stars!
6
Old nurse here. 30 years in the 'business ' as health care is now called. The idea that 'the patient comes first' started to go out the window when hospitals became corporate systems in the 90's. Now they are fully accountable only to their own plethora of rules and regulations, insurance coverage and all that that entails regarding documentation. This is now all nurses, lab techs, and all 'ancillary ' staff pay attention to. Hospitals are no longer a place of compassionate patient care or consistent and knowledgeable attention.
Many of us older nurses tried to ameliorate this conundrum by skipping steps in obnoxious over monitoring, never waking people for trivialities like filling out menus, approaching people gently and quietly at night ( and don't turn on bright lights), and apologizing for the inconvenience of hospital routines. Much can be assessed by simply observing a patient, and having full knowledge re their age, underlying good or poor health, and the specifics of their procedure - rather than over monitoring .
When my loved ones are in the hospital I always try to be present, especially at night. Personal oversight by relatives is the only way to protect your loved one from rude and intrusive hospital staff and routines, and you must be pro active. It's relatives and friends who must do all the little things that provide comfort, rest, and support, especially for the elderly, and that promote healing.
50
I agree with what you write other than it is not just a feature of a corporatised healthcare system. It is the same in a non corporatised state health care system. Hospitals are busy doing what hospitals do - operating, scanning, medicating, monitoring etc. ‘Care’ in the wider sense of the word, is well down the food chain. I have too little experience up to now of hospitals to know if it ever existed.
3
@Gwen Vilen
Thank you for being one of those "old fashioned" nurses. I was battling with newer ones when an older nurse came duty for the night shift. She came in and introduced herself and I did a double take not at her looks but at her in charge, caring attitude. I immediately asked her if she was an old fashioned nurse and I meant it as a compliment. She smiled and said "yes". I explained that I needed help with getting my mother pain killers as she had been in agony from a badly bruised hip and I could not get the current doctor to give her anything other than tylenol and was fighting him on giving her high blood pressure medicine. (Her high blood pressure was caused by her extreme pain.)
She said yes, the night doc could prescribe vocodin. He did, they gave it to mom, 30 minutes later, Mom's blood pressure dropped from 160 over 95, to 80 over 65 and she was fast asleep, proving it was the pain driving her blood pressure up.
I am eternally grateful for old fashioned nurses. To be fair, I've had some newer ones who were terrific, too. But not that time.
14
I spent 2 weeks in Haiti (as a 'medical missionary') 35 years ago. Patients without families had to appeal to (usually) religious organizations for support in hospital. We've caught up to Haiti.
1
How does sleep deprivation contribute to recovery? After a couple of recent hospital nights with nearly no rest, I mentioned to nurses that I now had a sense of what political prisoners in East Germany were forced to endure. They seemed not to quite understand what I was driving at, but were clearly not amused. Probably good that I decided against using Abu Ghraib in my comparison!
21
My personal favorite hospital experiences. (1) A nurse woke me in the middle of the night to introduce the new nurse taking over her shift. This of course happens with waiters at restaurants. But at a hospital? (2) The bed kept undulating, accommodated by a loud motor noise. All night. When I complained, the nurse said it was to prevent patients from getting bedsores. But then when I pressed her, she admitted that only 1/3 of the patients were at risk. Of course, all this was in addition to being woken up for constant blood draws and other tests. All this occurred at a major hospital in Pasadena, CA.
15
You don’t want to throw a clot. You need the magic bed for a while. But when You are up and walking they could turn the darn thing off.
I was given hallucination causing painkillers and somehow thought the pneumatic bed machine was my spouse wheezing next to me. I may have told someone the machine was my husband.
The whole experience was weirdly hallucinatory, even after I got wise and refused the medication.
4
I was in the local St. Victim Hospital a few years ago. There were two sets of people to take measurements of me that required invasion of my sleep. One was on a 4-hour cycle, the other was on a 6-hour cycle. Imagine how little night-time sleep was available. I could not convince them to coordinate. Plus I was subjected to a continuous saline drip until I complained that I was so full that I was swollen and leaking.
When I finally escaped (after helping pay for just about every expensive machine they needed to pay for--irrelevant to my admission), I took a shower at home and slept for 16 hours.
Now we have another competing hospital in town, and my primary physician is part of that, so I need St. Victim never again.
11
Hospitals are where you get monitored until you are safe for discharge. What’s the point of being in a hospital if you are not monitored? Sleep is important, but so is making sure that your blood pressure is not 210/110 when you were admitted for hypertensive urgency. Yes - things should be streamlined when possible, as frequency of lab testing, vital sign checks etc should be reassessed during rounds - but if you are well enough to mandate that you shouldn’t be woken up until you rise naturally, then you probably don’t need to be in the hospital.
7
you are ignorant of the science of sleep and sleep disruption and how it associated with worse outcomes. I hope you don't work in a hospital and wake up your patients needlessly harming them.
23
Hospitals are not designed for rest and recovery, for all the reasons the article describes. Added to that, every doctor involved in the patient's care has to document a full physical exam daily in order for their services to be covered - whether the patient's clinical situation warrants daily exam or not. Waste of the physician's time and exhausting for the patient to be woken for needless examinations.
8
@JN
You are correct that the way in which doctors get paid results in a huge amount of unnecessary poking and prodding. It's always an option, however, to just restrict your exam to what's really necessary and accept getting paid less.
5
This article is spot on. When I started doing hysterectomies and prolapse operations as outpatient surgery, the first thing I noticed was how much better patients looked at their first postoperative appointment. I believe that much of this is due to the fact that patients sleep better in their own beds. The further I get into my career, the more I am amazed by how wrong our assumptions are about what conditions really require hospitalization. When there is no alternative, we need to rethink everything about the way we treat hospital patients to maximize the opportunities for rest and natural healing.
23
In 2003 I had a hysterectomy. On night two, still in pain and already sleep-deprived, a 95-ish lady with dementia and a need to scream was moved into my room in the other bed. That was it for me. I gathered up a pillow, blanket and dragged myself down the hallway past the nurse’s station who casually asked where I was going, until I found a little enclosed waiting room, where I pushed two chairs together and got a few hours sleep. A post-op patient, no less, sleeping alone in a closet-like room on two chairs. Nobody seemed at all disturbed by this. I insisted on being discharged the next day, wrote a complaint to the hospital and of course never heard a word.
31
I labored at home for 36 hours with my first child, then went to the hospital on a Monday night. I was in active labor, writhing in pain, all through the night, pulling an all-nighter. I labored the next day and delivered my daughter at 5:25 pm Tuesday evening. I was absolutely exhausted... totally spent. Shaking from fatigue. I was left alone in the delivery room for an hour while my husband and baby were taken to another part of the hospital to give her a bath and eye drops and who knows what else.
That night in the hospital I was awakened so frequently with my newborn it was absurd. Every 20 minutes or so. I needed rest, and clearly the hospital wasn't the place I was going to get it. I signed myself out of the hospital less than 24 hours after giving birth. A nurse I had never seen before came into my room to rebuke me with a lecture and tales of demise. She made sure to let me know I was making a big mistake.
I went home and both my newborn and I slept 5 hours straight, the first real rest in 4 days. What on earth are hospitals thinking when they treat patients like this?
40
Three + decades in health care taught me that sleep was essential for patients. But all those pesky, necessary checks must be done. Lawyers love to discover that they were not recorded in the chart. Not written means not done.
11
Like many important discussions in healthcare, good documentation can alleviate lawsuits too. For example, we have notes and documents verifying end of life decisions and when patients leave against medical advice. Why not have forms where more stable patients can sign that they agree to less nocturnal checks given the risks?
16
@Thomas LOL, perhaps not written means not done, but the opposite is not necessarily true - several years ago I was in the hospital for about 3 weeks, and in looking through the records afterwards I found that the nurse assigned to my hospital room had recorded vital signs for me during the time period that I was actually in surgery. I guess he figured that it was better to have too many records than too few....
And when I was recovering, I got interrupted every couple of hours, until I complained that I wasn't getting any rest. The docs and nurses were kind of surprised at my complaint and then quickly figured out how to combine their visits to give me more time uninterrupted. It was like the concept of letting patients rest had never occurred to them.
11
@Thomas written documentation is only useful if people read it! My grandfather, on his final hospital stay, was boggled at the questions the doctors asked him that he had already answered a million times. Like being asked about the prostate he had had removed 15 years before.
1
After 17 days spent in the hospital for heart surgery, I had to get out of there to get any rest. As part of training, all staff should be requires to spend a night in the hospital under the same conditions. And whoever buys the beds should be chained to them for three weeks. Terrible is to good of word to describe the beds.
27
@Alpha Dog
As a physician, I found the night I spent with a relative in a cancer unit to be an eye-opener (no pun intended). Vitals every 2 hours, IV pumps going off, all kinds of commotion, despite the fact that the plan was for him to be discharged home the next morning so that he could die peacefully in his own bed.
14
@Alpha Dog I spent only one night and swore I would never go again. All the nurses wore cologne, a respiratory therapist had the flu and the food.........l
9
My loved one was hospitalized on a neuro unit following brain surgery. Now, I fully understood the need to do "neuro checks" every two hours -- but NOT every random fifteen minutes ir so whenever a new resident, PA, intern, or whomever decided to come in to "get a set" for their own notes. After a day if this (a wife and reitred ICU nurse, I stayed in the room day and night) I dinally put my foot down, called them all in and said that I FORBID any more than one set of neuro checks every two hours, and that if anyone needed a set, they could all get together and agree on the time when they could all come in at the sane time (quietly), observe the check-er, and record those numbers. They quickly knew better than to argue.
And for all you hospital folks who are affronted by this -- I say "TOUGH !" -- just wait til it is your loved one, and see how you respond. I make no apologies.
60
@Atikin
I'm in academic medicine and I say more power to you! Medical education is full of pointless rituals that were established a hundred years ago. Sometimes it's hard for those of us who are products of the system to fully appreciate the impact of those rituals on patients and we need more pushback from patient and their families, not less, to get medical education to a place where patient comfort and dignity get the priority they deserve.
17
When my wife gave premature birth to our son and we spent 6 days in the hospital, the medical interruptions were bad enough. But they would wake us to ask for our lunch and dinner orders twice a day, and the wake us again twice a day to ask how we enjoyed our meals. Can’t we just fill out a menu and leave it on the door at our leisure? And give our in-room dining review the same way?
19
@Greg Marano Try getting them to leave meats off the menu.
1
@etherbunny I had a friend who is vegan and had to spend several days in the hospital, and they kept bringing her food that she will not eat. You'd think a big-city hospital dietician would know what veganism is, at least! I have a more balanced vegan menu in my desk drawer on any given day than what she received in the hospital. Luckily she had local family who could bring her food.
1
After I delivered my youngest child and was transferred to the maternity floor, my room was directly across the hall from the nurses' station where the staff chatted loudly all night long. I got absolutely no sleep and, while we could have stayed for another day, I got us checked out in the morning. It was like the nurses didn't even care that new mothers needed their sleep.
23
Good article. In addition to rubberized floors to help with noise, hospitals might want to try installing those nice white noise machines that sleep study centers use. I checked in for an overnight series of tests for insomnia, with what felt like 50 electrodes glued to my head, and still somehow managed to get a good night's sleep. It was like having a soothing air conditioning vent running the whole time.
10
I had a 40 hour labor at home before going to the hospital where I labored another 17 hours. You would think that after 3 days of intermittent sleep, a c-section, and years ahead of me with no sleep, that the hospital would give me atleast one good night. I finally asked to be discharged so that I could get some rest, even though I had complications that needed to be monitored a little longer than normal. They weren't even coming in to do anything important. It was all stuff that could have waited until a reasonable hour.
20
My 39 yr old brother had to have a tumor removed from behind his eye. We went to NYU Lagone which by all other standards was amazing.
The night before his 6 am surgery he had to have a procedure done to map his blood vessels so the surgeon and robots would know the specific lay out in his brain. This procedure had to be done under general anaesthesia. It was performed at 7pm and he had to recover in a room with 20 other people. The neighbouring patient was a child with a neurological problem. His parents were struggling to keep the child calm. This made my brother who was already nervous, very extra anxious. My brothers surgery was complicated because he is blind in the other eye, so the surgery had to go through his brain. The risk of him being blind the next day was high.
At 2 am he was brought to a private room and 3 hrs later he was prepared for surgery.
The aftermath was also a painful amount of intrusions but were all important.
What really worried me is that he started the controlled trauma of brain surgery without sleep for 24 hours prior because the person next to him was screaming. I cannot understand why it wasn’t important to keep his nervous system calm in the hours leading up to surgery. He didn’t sleep for 3 days.
His surgery probably cost a fortune. It isn’t like we have a budgeted national health program. I would have thought in our premium private system we could afford to give someone a Quiet place to sleep for 6 hr blocks.
His surgery was successful.
55
@Sarah
Please give best wishes to your brother. I was very sorry to read about the trauma he endured around his terrifying surgery. I am so glad that, in spite of it all, it was a success. Reading that made me feel so relieved!
Thank you for sharing.
12
@Sarah Thank goodness your brother is OK and thanks for sharing his story. Sleep is our natural restorative and it is ridiculous that hospitals do not support it. More business for them!
When I was a kid, my father ended up in the hospital for malnutrition due to being a workaholic, beer alcoholic. They wouldn't let him eat because they were so fixated on testing! So, he checked himself out and fattened himself up, primarily on butter pecan ice cream, and got back to eating normally.
5
Thank you Marty
I ran out of space in my first post. He did very well in the surgery. Unfortunately they didn’t have a bed available in the ICU he could fit into, he is very tall. They told us that they had extra long beds, but couldn’t find one. Hospital beds have footboards, so it’s really uncomfortable if you are too tall. That was also unnecessary suffering. I sat next to him all day in the ICU doing my accounting for my business, and adjusting the bed every 5 minutes to alleviate his pain.
I agree with another reader, NEVER leave your loved ones unattended in the hospital. Everyone needs an advocate, a care giver.
I want to emphasize that we are so grateful to the doctor and nurses that he could have this tumor removed that pushing his eye out and that he has no lasting damage to his brain or vision. His career is lighting for theatre, which he could not do blind. He has a toddler.
My aunt in England also had a terrible year medically. She had lung cancer and had to have the lobe removed. In England, they tell you when you are scheduled for surgery sort of last minute. You go and sit and wait all morning. With an empty stomach. Half way through the day they told her there weren’t enough beds in the recovery room so her surgery would have to be rescheduled. So stressful!l
2
About a dozen years ago, I had to spend about 3 months in the hospital over about a one-year period with three major abdominal surgeries and an unfortunate bunch of complications. As a physician myself, needless to say the perspective of a patient instead of caregiver was eye-opening (even when I wanted them shut). I've spent a few days in the hospital in the last few years and noticed significant efforts to lessen noise, definitely a good trend, but the interruptions in sleep for patients continues. My wife struggled to sleep after her hip replacement surgery because the IV pump rattled all night long, but at least she told the nurses not to bother her in the middle of the night and they respected that. When new patients arrive, and when rambunctious patients chirp during the night, noise is unavoidable. The best bet - if you can - stay away from the hospital or get out as soon as you can!
14
Architects are now much more aware of the intersection between human neurobiology, and the built environment, and how that impacts human health - and they need to be. For too long we have focused on the wrong things. Spaces that foster healthy human autonomic responses don’t have to cost more to design and build. It’s imperative that we not ignore designing for healthy human health outcomes, no matter the type of space.
12
Did a hospital consult Sunday morning. Was tickled to see on a sign in the elevator that Forbes Hospital has quiet hours not only from 10 PM to 6 AM but also from 1-3 PM--nap time : ) No ideas if it actually works. Suggested next target: phone ringer volume, alarms, and walkie-talkies at the nursing station. And I understand staff needs to de-stress and be a little social with each other--but it's tough trying to finish documentation when the voice recognition software can't hear me over staff chat. Baby steps....
11
This is news?? Hardly! Anyone who has stayed a night in a hospital has suffered this predominantly useless habit. And it might be harmful? That's news? Sleeping is a HUGE part of healthy lives. Destroy it for sick people? Words fail me.
30
@Mickeyd My mother was an old-school nurse. What she learned was that the body uses its down-time (sleep) in order to heal. Are they not teaching that nowadays?
14
Finally this problem is getting some attention. It seems a no-brainer: if you are sick, you should get a good night’s sleep. It often helps. I do hope this simple concept gains momentum in hospital communities.
15
I had a hysterectomy eight weeks ago and spent one night in the hospital. As I was wheeled into my room, my nurse told me that the most important thing I could do to help my recovery was sleep.
Then various personnel commenced poking, prodding, and waking me up every time I managed to doze off. I think I actually slept for maybe two hours.
Just ridiculous.
42
@Buckeye Lady
I had a similar experience 5 years ago - I eventually put the TV on a non-working channel in a futile attempt to at least get some sort of white noise, but recall that I got virtually no sleep.
3
Twice in the past five years, I spent significant time visiting my mother in the hospital. The first time was immediately after a major stroke, the second time as she lay dying from the heart disease that no one bothered to tell us about (even though we would later find out it was diagnosed during the first hospital stay).
Spend any amount of time witnessing hospital procedures, and count how many times you find yourself saying 'This is causing unnecessary harm. They count on us non-physicians being morons.
30
After going through 44 hours of labor I finally delivered our first baby just after midnight on New Years Day. No c-section or complications, just a normal, healthy, albeit long delivery. The nursing staff woke me up at least every hour to draw blood, ask if I had pooped, check my vitals, etc... I insisted on leaving before the first 24 hours so that they would leave me alone. My husband and I essentially hadn’t slept in 3 days and then we go home and have a newborn baby. Way to set new parents up for success. I don’t remember the first 3 weeks of my son’s life because I was sleep deprived before we even got him home.
34
I was hospitalized five years ago for a five day stay at a major NYC hospital. I had pneumonia. I experienced all that was included in your story and more. Constant blood draws, constantly being woken up and rarely saw a doctor. After the third night of this I told the nurse that I would not give anymore blood unless I saw a doctor. Sure enough, first thing in the morning a doctor arrived at my bedside asking me why I refused to allow another blood draw. My response was that unless I could speak to a doctor about my condition and when I would be allowed to go home, they were not getting one more drop of blood. Sure enough I got more attention from more doctors. I am also convinced that this stay with consistently interrupted sleep and an overdosing of IV antibiotics contributed to my being sick for six weeks after I returned home. Hospitals are no place to recover and often times other symptoms and illnesses occur upon discharge.
20
I have been a registered nurse for 13 years. I possess certification in my specialty, orthopedics, and I earned a graduate degree in infectious diseases and microbiology. I was a travel nurse for 6.5 years. As a result, I have worked at approximately 20 different hospitals. There ARE a lot of "interruptions" when you are a patient in the hospital. The vast majority of those "interruptions" are ordered by a physician. Those "interruptions" serve an important (and often critical) purpose. As nurses, we're damned if we do and damned if we don't. If we neglect to take your postoperative vital signs, say, every 4 hours and you develop a problem, you could develop a serious medical issue and I could lose my license and livelihood. So, while the nursing staff is often tasked with fulfilling those "interruptions," it is important for patients and their families and friends to recognize that we rely on other departments too. Inadequate staffing is a chronic problem in hospitals. So, as much as your one nurse with six patients would like to wait until 0630 to complete, say, 8-10 hours of work, that's simply unrealistic. If you don't want to be "interrupted" while in the hospital, take (better) care of yourself and increase your odds of not having to be a patient.
20
@Dsalcoda This mentality of blaming the patient for a hospital stay is unbelievable. There are so many reasons to be in the hospital could not be prevented by taking better care of yourself. The interruptions are real and too much. It’s not just nurses but physical therapy, specialists, anesthesiologists - the list is endless. It’s been my number one complaint from my hospital experiences as both a car crash victim and a new dad. My number two complaint is certain nurses who lack compassion, and that’s real too.
48
The week I spent in hospital after spine surgery was the result of a car accident (the other driver was inattentive and rear ended me). It had nothing to do with how I take care of myself. Away with you and your victim blaming!
20
@Dsalcoda
Well I am sure the cancer patients and people with injuries will appreciate your snarky advice
17
What a great, important topic! Having been the bedside pilot during a family member's ICU stays and more, I can attest that the sleep disruptions---even to those loved ones--that occur during hospitalizations can be quite debilitating. You feel like you barely get out of there alive... plus, what about the healthy benefits of a restitutional sleep? It's free, natural and no nasty adverse side effects.
16
@former MA teacher Therein lies the problem with a good long healing sleep. It is free, natural and has no nasty adverse side effects that require additional medication. Therefore, not to sound paranoid here, but Big Pharma and for-profits hospitals have nothing to gain and money to lose by letting us sleep.
8
I am amazed that this is news to anyone. Sleep has always been an important part of healing and everyone knows it. Hospitals have never allowed patients an uninterrupted night’s sleep and this is equally well known. It’s why you don’t ever fully recover until you leave a hospital. Hospitals just get you patched up enough to stagger home and sleep.
12
I was in intensive care after a massive heart attack triggered by compartment syndrome and infection in my leg. Memorial Day 2012. They gave me much less than a 30% chance of living 30 days.
Yet the constant awakening. In pain. A bit scared as I had a family to feed. And 5 a.m. again awakened. About every two hours. Did the social worker have to awaken me at 02:30 hr to ask me about my will and resuscitation? I mean, I was still considered in serious shape and six times they amputated higher and higher. Might sleep be desirable in this ward?
13
A few years ago, on a business trip I found myself in the most glorious hospital in a suburb of Chicago with a bad case of appendicitis.
The rooms were all private, the hallways carpeted, doctors were paged by a series of quiet musical tones, food was ordered from a menu, and patients were awakened at 11pm and 6pm for blood draws/vitals. There was peace...and quiet.
It felt like an upscale hotel albeit with a hospital bed. Compared with the big city, noisy hospitals I was familiar with, it was like like being in hospital heaven!
Where there is a will, there really is a way!
48
@LJB What hospital was that?
3
No complaints about the quality of care during serious surgery 5 years ago. But why in the world have hospitals decided that patients have to be active participants in what is understandably a 24 hour institution? Doctors should include detailed sleep instructions when giving their orders.
23
Why does the “healthcare industry” have to be told the obvious over and over and over for decades?
My mother had to go into care. Besides disrupting her sleep they ignored food nono's and used malicious compliance, in spite of doctor’s orders, about restraints which cost her an eye.
If we ever get universal health coverage, we'll need to add in universal healthcare rules for hospitals and assisted care places.
10
I had a planned C-section for a breech baby fifteen years ago. The first night I was so high on morphine, I only remember eating spaghetti for dinner and itching. But, the second night, oh my god. The toilet in the shared bathroom between mine and the next room must have flushed every 30 minutes. Nurses were in and out all day and night. Plus, I was across from the nurses' station where they cackled and screeched at the top of their lungs all night. The final straw was the floor polisher starting up at 5 am. I told the nurse who came in at 6 am to call my doctor and tell him I was going home, two days early. I was exhausted and on the verge of tears. My doctor didn't object at all and told me that the amount of noise in the hospital was a perennial complaint of patients and doctors.
42
@Adrienne writes "My doctor didn't object at all and told me that the amount of noise in the hospital was a perennial complaint of patients and doctors."
So who's in charge? Why is it so hard to get changes implemented?
15
As you sit there, or, lay there, it's quickly very obvious that it's all about "how to get more money - for something." Staff dropping by for mystery "checks" and "tests"; unknown and unasked for "specialists" doing the same; the "torture carts" going up and down halls 24/7; the "staff" yelling in the halls and chatting about things outside work at 1 a.m. - it never ends. This holds true for minor surgeries and terminal illnesses. "If she'd going to die in the next day or so, how is the blood test necessary? Will in cure the cancer?" If you want him to "rest," why don't you let him? It's tonsillitis, not meningitis." Last straw for me was someone coming in a 4:00 a.m. to wrestle with replacing the kleenex in the metal box on the wall - which wasn't empty... Idiots? Hardly. Idiots, but calculating ones... "What are you going to do about it?" Health care? "Criminal conspiracy" is closer to the long term truth. So many "nice" people, but none of them "working" for free or without benefits. I have "medical people" in the family... Fat and happy - and none willing to stay at "their" places of work. Their advice? "Don't get very sick, badly hurt, or, "too" old. I can take care of some family, but not many."
16
@Johnny Woodfin Blame delusional families for demanding blood tests we don't want to administer. If we skip dead grannie's cholesterol and she died, we'll still get sued!
> It's tonsillitis, not meningitis
Oh, it's a disease that can cause the structures in the back of the throat to swell and cause respiratory distress? It's someone who just had a surgery known for bleeding? Yeah, let that person sit around unattended for 8 hours. There's no way THAT can go wrong.
3
All I can say is - YES.
6
This is like "duh." Why are doctors, nurses and hospitals, who are supposed to be about healing, so clueless much of the time?
Twenty years ago, I spent 5 weeks in the hospital after a neat-fatal car accident. I told the nurses at one point, "No visitors, I need to sleep!" They were great and cut back on all the interruptions. We need to, as patients, speak up and be an advocate for what we instinctively know will help us heal.
Common sense really does go a long way!
19
When I read about hospitals drawing blood, I assume it’s a reference to billing. Now there’s a department that never sleeps.
17
Sometimes we have the chance to stop and look around and wonder how we as modern day Americans at the height of complexity and intelligence can be so clueless and obtuse and self harming. I won’t tell the stories of insanity in hospitals myself and loved ones have endured. But I will ask, how do doctors and nurses and administrators and insurance companies and patients not know that quiet and uninterrupted sleep is utterly critical to providing care and healing?
52
@Mike They don’t care!
1
One practice from the past needs to be brought back...quiet! Just like libraries these days, staff talk with each other in loud voices, day and night. Add in being equipment and you have a recipe for distressed patients. The old practice of hushed voices so as to not disturb most emphatically needs to return.
34
@George S, my family hasn't had much experience with hospitals, except for child birth. So when each of my three babies were delivered, in two different hospitals, I found the obnoxious noise of the medical care providers (mostly nurses, I would guess) to be shocking. They joked and pranked as though they were working at a fast-food restaurant.
30
Do you remember "Quiet. Hospital Zone?" Those traffic signs surrounded hospitals. Where did they go?
15
I was in the hospital at the University of Michigan last year for 3 weeks. The noise level was so high and the interruptions so frequent I did not sleep for five days. This resulted in hallucinations and delirium. Additionally there were no limitations on visitors. They came and went all day and most of the night. Dr. Navvab has good ideas but not practical enough. One should not have to modify the building for staff to be respectful of patients well-being by organizing treatments, lowering their voices and clustering treatments. I have been a nurse for over 40 years and remember that keeping the noise level down wasn’t an issue. Visitors hours were limited so the patients had somewhat of a schedule that allowed for naps and treatments. This is just a matter of common sense!
38
@Kayak Nurse
It seems like everything has shifted to the convenience of everyone BUT the patient.
21
@George S so True!!
1
The fact that it has taken hospitals this long to address an obvious issue drives home that hospitals are far too often focused on what is quantifiable.
25
@Renee And as such, billable and profitable.
7
The irony is that those of us who have visited patients of all ages and classes in the hospital -or been those patients - have actually observed this rigid wake up protocol and not demanded change. Or is it just arrogance without penalty that causes hospitals to persist with these intrusions? I suspect the latter.
18
@R. Anderson
Hmm, doesn't making people sicker increase the profits in the healthcare system? Why would they change to something that reduces efficiency and reduces illness?
6
During my 2 weeks in hosp., following heart surgery, the greatest annoyance were the overhead lights, shining straight into my face, day and night. Could hospitals, please, use some sort of diffuse type of illumination? Perhaps assisted by some sort of personal overhead lamp for use by the medical staff.
30
I went in for an infected appendix, and spent about two days in the hospital. I couldn't sleep the entire time I was there.
How can anyone claim that's good for health?
19
After having my second child, I was trying to get some rest in between feedings. After the second interruption in the middle of the night I lost and asked to be left alone so I could rest after almost 24 hours of labor. I asked them to put a sign on the door so I would not be bothered unless it was critical. I never saw the sign but it was so effective that I didn’t see anyone until morning and after that everyone knocked before coming in. The sign must have said crazy postpartum lady inside, do not go in.
50
One of the worst things I ever saw relative to patient sleep was something called "Patient Controlled Analgesia." Post-op patients were given a button to push when they felt their pain was not bearable. This was release a mini-dose of a pain control medication. This would, after a few minutes, take the edge off pain. The patient, if lucky, might go to sleep. Trick was the button reset to "off" for 6 minutes. After a while, pain returned and the patient, who woke with the pain, was expected to repeat the whole cycle. A clear side effect of this genius set-up was the patient could not sleep more than a few minutes without being reawakened by pain. I wound up sitting at my wife's bedside all night, pushing that button every 6 minutes so she could get some rest. After this, I was pretty much convinced that a lot of the decisions in health care were being made by people who had never had pain or cared for people in pain. But I'll bet somebody made a ton of money saying this little invention increased patient autonomy and allowed for fewer nurses to staff post-op areas. The further decision-making gets from patients, the more counter-therapeutic the ideas become.
33
Frank, when you noticed your wife’s pain was inadequately controlled you should’ve notified the nursing staff and the pain medication dose could have been increased. Never push a PCA button for a patient. Your could kill your loved one.
12
@Frank the staff should have been informed. The fix is to increase the incremental dose that each push delivers. PCA units are not meant to require activation that often.
14
@Frank
Next time, notify the nurse. The nurse should also have been doing frequent checks that should have allowed the nurse to detect inadequate pain control. Further, sometimes PCAs will include a continuous dose, in addition to a demand dose. PCA dosing may be adjusted by provider order. When adjustments are made, increased checks also occur (to detect things such as respiratory depression, pain level, etc.)
After my second surgery in 4 days for a badly fractured leg, I was woken up at 2 AM for an follow up x-ray.
If I hadn’t been so drugged up I would have told them to get lost. It couldn’t wait until 7? Just ridiculous.
22
My favorite...they woke me up at 4am to take my weight!!!!
54
@MPE For years beds have recorded weight. It is set to zero before you get in so weight is available on a screen at the bottom of the bed. This way people do not have to stand and many cannot, for weight to be taken. Today this number may even be available at the nursing station so no one need even enter your room for the number.
@MPE Yes, I was also awakened in the middle of the night and expected to get out of bed, after my second abdominal surgery in several weeks, because the nurse said he had forgotten to take it earlier - and it was time for him to go off shift and go home!
@MPE
They likely were seeking to detect fluid overload. Such a check should be timed with vital signs, labs, and/or patient waking up to go to the bathroom.
Recently I was sent to the hospital because it was feared I was getting a stroke and was there as an outpatient for tests, MRI, echocardiogram, blood draw, etc. and was kept overnight. I’d awakened with one side of my face drooping.
They wanted to give me an aspirin and Lipitor anally because I was being denied water or any liquids by mouth. I denied the aspirin and Lipitor; being warned I was doing so at my own risk.
Seems to me to be dangerous not to allow someone water for two days for fear of them becoming dehydrated.
Fortunately, it turned out, one side of my mouth may just have started drooping because of Bells Palsy. And now I even question that diagnosis because my face has gone back to normal; no droop, no numbness.
Also, I’d driven myself to the emergency room entrance. When the person wheeled me out, she took me to the general entrance and left me. She left so quickly that when I realized it she was gone and I had to ask for directions for the emergency room entrance that was one floor away via a different elevator bank.
6
@April Kane No, they denied you water because your face was drooping because of a stroke and they were worried you would aspirate anything they put into your mouth. That's what IV fluids are for.
Bell's palsy resolves spontaneously. If it went away...it's normal.
4
Norman Cousins wrote about this many years ago; basically that hospital routine does not aid recovery. He checked out and into a hotel room where he started his recovery from a severe collagen disease.A classic book that should be read again by anyone seeking medical help & every doctor who really cares.
19
I experienced the awful practice of being awakened at all hours of the night at four different hospitals and six different wards. Night nurses, phlebotomists, and others, really have no idea how disturbing the noise is, nighttime medications that could be given in the morning, bloodwork that could be drawn at 8 am instead of 5 am.
11
The most important change hospitals could make is to ban the so-called "semi-private room." A private room, with no one else's sounds, visitors, TV, tests, etc., would go a long way to ensuring that people could sleep. Also, why should adults have to share private space with complete strangers at their weakest? Of course it's financial. But shortening hospital stays by improving the health of the patient also makes the hospital money. Private rooms for everyone!
64
One of our local hospitals has done exactly that in a recent remodel. Almost exclusively private rooms. My dad was an inpatient there a year ago, and has been an inpatient twice recently at the other local hospital which still has almost all double rooms. Makes a world of difference. In addition to all the ways the doubles work against everyone’s recovery, there’s little to rival the awfulness of being forced to eavesdrop on one’s roommate getting a diagnosis of colon cancer. Dad wasn’t exactly mobile at that point, but they could have had the decency to ask me to step outside...
12
Understanding the problem is easy, but, beyond investment in the acoustics of a hospital, the solution requires staffing increases. If one person is taking care of a dozen patients, not all can be tended to at the same time. Coupled with that, there are surely practices related to mitigate liability, as at least one person has mentioned.
11
You think? Why are we only now seeing articles about this issue. Anyone who has ever stayed in a hospital knows its the worse place to recover because you get no sleep and this has been true for decades. The worse source of the noise is usually the medical staff, that finds it necessary to chat with other each while standing at the foot of your bed as if you do not even exist.
23
After a couple sleepless nights I had my wife bring one of our white noise makers from home when I was in hospital for a few nights. Positioning the noise maker near my head helped to block out much of the beeping and other noises, allowing me to get some sleep. But it couldn't block cancel out everything.
The worst part was that my room was across from the nurses station. They had a number of computer speakers which were constantly beeping for various alerts, and those speakers were turned outward - towards the patient rooms - probably to reduce the volume for the nurses.
Eye masks and noise makers may be good options hospitals can provide to help patients sleep. But the suggestions in this article (and comments) are the most important.
17
As an RN I can say that although I agree with sentiment of this article, it oversimplifies a complicated problem. Of course your doctors, nurses, and aids want you to be well rested. Of course we understand that sleeping on a hospital mattress, amidst flashing lights is difficult at baseline, even without our disruptions. However- and this is something I often think to myself but never say aloud to patients- hospitals are not spas. We are not here to give you some great experience with yummy food and cable television, we are trying to keep you alive and get you well again. Regardless of whether or not you think hospitals are patient-centered enough, or who may be to blame, this simply isn't how most modern hospitals are set up to function. I am required to document on my patients hourly, and certify that they are alive and well. I have medications that need to be administered at midnight, and follow-up vital signs that need to be taken at one. This is to ensure, for example, that the pain meds I gave you haven't sedated you too much. As much as possible, I collaborate with aids on the unit to "cluster our care" and minimize disruptions. Nobody enjoys waking a sleeping patient, but when we do it is necessary. Please don't blame us for doing our jobs well.
And frankly, if your doctors deem you sick enough to be in the hospital under 24/7 surveillance, getting a full 8 hours of uninterrupted rest just isn't a top priority.
24
No one suggested turning hospitals into spas. The data described here show that sleep disruptions adversely impact health outcomes. Isn’t doing a good job as a nurse helping to make people healthier by the time they leave the hospital? Some of that monitoring is not necessary for some patients, and needlessly adds risk.
73
@K We aren't blaming YOU, we're talking about how medical care in general is organized and carried out in hospitals. The beeping machinery, blaring loudspeakers, flashing lights, check-ins that are done without much thought to whether or not they're really necessary, and even the cleaning of the hospital all contribute to poor sleep when sleeping is one of the primary needs for the body to heal. I had an appendectomy 17 years ago, and sleep was what I needed, but could barely get, in the hospital. In fact, I was woken up by a nurse on 9/11 (yes, THAT 9/11) so I could see what was happening on TV. Horrific, and certainly not therapeutic. Somewhat off topic, but it was the lack of understanding that maybe this was not appropriate to subject a recovering patient to, that has stuck with me and was a metaphor for all the unnecessary intrusions I (and others, for sure) was subjected to during my "recovery." Yes, I was grateful that I had a successful surgery, but the aftermath in the hospital was a lesson in what not to do to provide CARE.
38
@K
I had a "happy" hospital stay- pregnancy/delivery.
The checking of my vitals every 1 to 2 hours throughout the night left me exhausted. With all the monitoring and technological development (like smart wrist watches) there must be a better way to check vitals and eliminate or reduce sleep disruptions.
So rather than finding arguments for "no change" is better let's focus on "how to change"- we all would benefit.
28
Back in 2016, I had to have a kidney removed because of a tumor that was fortunately benign. At that time (July), the air conditioning in the hospital had failed and in the process of replacement. I and another man were squeezed into a room intended for one.
The worst thing was the constant noise at night with electronic alarms ringing every few minutes. I noted that one of these indicated that the batteries of a device were fully charged. Then there was staff talking loudly or laughing out loud in the corridor. One morning a doctor came in and berated me for sleeping in the daytime and insisted that I be in a chair rather than in the bed. When I returned home, I fell into bed at 2 pm and slept for 5 hours.
33
While I have not had a hospital stay in years, I well remember my last one, just overnight after I fainted, so they could monitor my non-existent heart problem. They put me near the nurse's station which was very noisy, then brought in another patient near the window whom they monitored frequently, waking me each time. It was horrible. And it turns out they could have monitored my heart outpatient, but they didn't offer me that option. Next time, I will ask more questions.
15
His suggestions (change medication schedule for each patient, let patient decide when tasks will be done that warrant interrupting sleep) would be great if nurses didn’t have 7-8 patients to care for each shift and, this would require adjusting possibly 100 medication administration times. It is simply unrealistic to expect that kind of a la carte care in a setting in which the shrinking number of nurses have such a burden of patient care and the ever-growing list of paperwork and charting they are required to do or suffer the consequences.
To have that level of care would require staffing levels that are a fantasy in US hospitals.
Also, hospitals mandate and electronically track the number of times (and duration of each stay) the nurse and patient care technicians must physically check on patients during a shift. Hint: Someone must be in that room every hour with the electronic footprint on their tracking device to prove it. Or face the consequences. In part, that defends against the many, many allegations from family and patients that “we never saw anyone in here all night.” Each time the door opens on a mandated round, it is probably going to wake someone up.
Yes hospitals don’t let you sleep. It is, oddly enough, by design.
20
Having been an adult patient, kept awake almost nightly, by noise, meds, and bright lights, and having been a pediatrician who did his best, with his nurses, to keep lights out and wards quiet, I cannot agree with you at all.
26
@Laura I actually know patients from your area who died after stays in your hospitals.
8
One of the worst "innovations" in hospitals was to allow televisions and unlimited visiting hours in shared rooms, in addition to the usual sleep disruptions due to nurses' procedures. A room-mate who watches tv until 2 am with the sound full on and no head-phones is a prescription for sleeplessness. A room-mate with midnight visitors also robs the patient of sleep.
The hospitals have invented a kaleidoscope of sleep-depriving mechanisms, not just the inhumane nursing schedules. The administrators don't care about the patients.
63
@Rodrick Wallace Modern hospitals have private rooms, but it's true that older hospitals in medium and large cities don't. I've had the same problem--visitors, not TV.
11
@Barbara: I don't know. Swedish is one of the top hospitals in Seattle, very modern, many top specialists and they *still* have shared rooms. I got housed for heart problems in a room with a senile woman with pneumonia who coughed all night -- and I was stuck there next to her for three days. It's not just bad for noise, it's bad for patient health.
12
@Rodrick Wallace Televisions without mandatory headphones should be banned. I was in the ICU for ten days & never watched the one in my room, but was kept awake by the blaring tv from across the hall.
11
The article discusses noise as harmful to sleep, but close behind noise is light. I've stayed overnight in a hospital only once, but I was astonished that it wasn't possible to get my room very dark. Sure I could turn off the lights in my room, but there was a glass door to the corridor, which was floodlit. There were curtains between my bed and the corridor, but they were thin and translucent, and didn't reach all the way to the floor or ceiling. It didn't seem to have occurred to anyone that darkness was conducive to sleep and thus healing.
38
@Dave M
Besides earplugs, as uncomfortable as these might be, my "going to hospital" kit includes an eye mask. I only worry that I might sleep so well that I get transferred to the morgue! (Not likely to happen...)
1
I have a chronic health problem that hospitalizes me at least once a year. I dread each time I feel the initial symptoms. In addition to the wake-ups and noise created by the staff, there is the problem of roommates. The hospital I go to has tiny rooms and there is often barely a foot between beds that are separated by a thin curtain. My roommates moan, call out to nurses, have loud cellphone conversations, won't use earphones for their tv, and have a huge amount of visitors who stay all day and evening and take over the room. Neither they nor the nurses ever consider what this does to me, who is usually trying to sleep or read behind the curtain. I am left to flee out into the hallway and find a stray gurney to sit on and cry.
40
@rimabird I agree that 100% hospital rooms should be private. If someone gets lonely, they can have a visitor come one, because that visitor wouldn't be bothering anyone.
It's absurd to expect adults to share rooms with complete strangers, who are not at their best and who tend to act like children, without regard for the person sharing their sound-space.
27
@rimabird All I can offer is that you are not alone. I have lain on the floor in a store room because it was the only quiet place.
2
During my three day hospitalization for surgery in February 2016 I was constantly awakened for tests and found it irritating, as well as the BP cuff going on and off. Then, there was the noise and lights, despite the dimming of the latter. And that was just the recovery room in the midst of all that activity and hooked up to tubes and medication lines. Apparently, a bed shortage kept me in the recovery room longer than necessary. I was finally moved to a semi private room on the last night and awakened there as well but not as often. A strange bed and city lights lightened my sleep.
10
@Agnes Fleming
Another thing that Cousins cited was the taking of blood every few hours,there is no reason for it & it is weakening.
5
@rick baldwin
How can you say there was no need? What were they monitoring, e.g., blood loss, sepsis, cardiac markers, etc.?
Cannot believe it took a doctor who was a patient to realize how disruptive all that poking and prodding is. As a mother and one who has many hospital stays myself, sleep and rest help heal.
23
Hospitals are not only disruptive environments for patients but also for the people who work their. I’ve been an anesthesiologist for over 20 years. Intensive care units and operating rooms have become increasingly noisy with endless motors, pumps, alarms, and buzzing lights. It is sensory overload. Hospitals sound and feel like what they actually are, modern day factories.
40
The problem is that from the hospital's perspective, the patient is a problem to be dealt with, not the customer because nearly all the hospital's revenue comes from third party payer's not the patient. So, although most hospital employees are competent and do their job, patient satisfaction is not a relevant metric to their job.
Compare one's hospital stay with a stay at a good hotel where nearly every employee from desk clerk to housekeeper understand that the guest experience is an important part of their job.
Eliminate insurance and give patients the power of the consumer, and the hospital experience will improve.
5
@Mac
Actually, the “patient satisfaction” scores control almost every aspect of reimbursement these days.
3
@Laura Oh really? Just where does that figure in the amount of Medicare or Medicaid reimbursement? It is possible that some private insurers take patient satisfaction into account (since the arrangements are not public and concealed even from the insured), but I have never had my private insurer ask about my satisfaction when getting hospital care.
And just when does anyone ask about patient satisfaction? I have never noticed a hospital making such an inquiry.
Again, compare this with a typical hotel stay.
1
@Mac I did get a patient satisfaction survey letter last year after a broken ankle.
1
I have only been hospitalized twice; once for 5 days in 2012, 1 day in 2018. Based on the comments here I had no idea how good I had it. I had a private room. Staff didn't interrupt my sleep between 11pm and 5am. Six consecutive hours of sleep isn't great...but it's livable.
The food improved remarkably between 2012 and 2018. In 2018 I was able to order an appetizing meal from a menu. In 2012 I was served Jell-O with my lunch. Aside from school lunches as a child I don't think I had seen a bowl of Jell-O since the mid-1980s.
7
@Joe Bob the III
A good,tasty meal is also very important to recovery.
6
Any hospital administrators or health care personnel reading this article who can actually comment on why these disruptive practices still continue in hospitals, despite all the evidence that they are terrible for patients' recovery?
It seems like people have been complaining about this for decades but it's still going on.
Any answers from people who run these institutions?
14
@S As a nurse who works nights, I would be delighted to not wake you up to do things that I find to be generally unnecessary, like vital signs on a stable patient or labs that could wait until after the patient is awake. However, I do not have the power to do so. Per law and my nursing license, I am required to follow physician orders that specify how often vital signs are done and when labs are drawn. I do my best to try to stretch things to make sure my patients get as much sleep as possible, but there is only so much I can do if the MDs aren't willing to change the orders.
When I speak to physicians about delaying lab draws until later in the morning, they tell me that they have to have the information for morning rounds with the day team (who doesn't end up rounding until 1100).
On the other hand, unfortunately there are times that it is necessary to check on a patient frequently overnight to ensure their condition hasn't changed (immediately after surgery, certain medical conditions, etc). At those times I try to explain to families that I will be in frequently and it is for the safety of their child.
23
@S, They. Don't. Care.
7
Currently in Rehab Hospital where they have changed medication times to let me get uninterrupted sleep. After a good nights sleep the next day of PT and OT go well and my overall Heath seems better.
11
When you’re hospitalized, the staff figures, you have all day to sleep; they don’t.
5
How wonderful that this is finally brought to the attention of the public, and hopefully to all hospital administrators! I had surgery to remove a cancerous tumor, and for the next three nights, I was NEVER allowed to sleep the whole night through, what with being interrupted three times each night. There is NO reason to do this, it's so cruel and harmful to patients, who are just trying to get the most beneficial bottom-line to basic health care: SLEEP!!
Even in the gulags of old Russia, prisoners were never woken up from sleeping...why do these hospital fascists feel the need??
13
Recently when at an ER there was one particular nurse who I could hear coming a mile away with the hard clickety-clacking of her wooden clogs. Ought to be restricted. Soft soled shoes only or at least rubber on the soles of these terribly annoying clogs. I swear she made them louder than they should have sounded. I've worn them and know it was intentional noise or an attention getting thing going on. She was a lousy nurse too.
24
Could not agree more. The body needs sleep after surgery or if your just sick. Why do they have some night nurse wake you up every 45 minutes to take your temp.?
10
As my husband lay helpless in his hospital bed after suffering a massive hemmhoragic stroke, unable to speak or move, the constant LOUD beeping of the many machines he was connected to, seemed especially cruel. No one came for him until some prescribed time, or worse, when the beeping signaled something wrong, it was often up to me to get him help. The memory of my beautiful brilliant engineer husband, stuck in decorticate posture, dark circles from discomfort haunts me to this day, 7 years later. Hospital administrators and healthy advocates: is a solvable problem! The solution for my husband was to arrange for his discharge to a residential hospice where he finally experienced quiet and a peaceful journey to his passing.
40
I had major cancer surgery at Univ of Michigan 5 years ago and again a year ago. First time I developed ‘ICU psychosis’ from the sleep disruption every hour or two; my wife actually yelled at them to leave me alone. Second time was night and day better, I actually was able to get 4 straight hours of sleep at a time which made all the difference.
40
I think it's hilarious that Yale is an example here... I had both of my kids there, and with my first, after laboring for 24 hours I was rushed into an emergency c-section in the middle of the night. After that I had postpartum complications and was attempting to breastfeed, which they are supposed to encourage at all costs. Not to mention that my room basically had a revolving door for anyone and everyone! I ended up not sleeping for 5 nights straight, and my mental health was declining so bad that my husband was getting very worried, but he was reassured by the hospital staff that my experience is normal. Welp, that night, after being kept up basically all night by the staff, they left me to "get some sleep"; my baby cried, I picked him up, sat on the edge of the bed and about 20 seconds later, nodded off and dropped my baby on the floor. Per their policy they had to take him to the NICU for observation for 24 hours and treated me like I was trying to commit murder. My son is fine, but it was a truly horrible experience.
With my second I opted for a repeat c-section and chose not to breastfeed because of what I previously went through. The nurses reluctantly took my child every night so I could put on a face mask and headphones to get 6 hours of sleep overnight! It was great for me!
28
@Jane What year were your kids born? My second was born at Yale New Haven Hospital, and the entire experience was absolutely awful. I had a hard time extracting my baby from the nursery--they were out of space on the maternity ward and put me on a medical ward but wouldn't send him with me. My husband finally demanded the baby (our pediatrician had cleared him to leave hours earlier) so we could leave. I'd been waiting in a wheelchair in a broom closet--seriously.
6
I have several chronic diseases & am a Cancer survivor. I have been disabled 16 years. The last 16 years I have been in & out of hospitals way too numerous times. I'm Sick of hospitals! The last week of October I was in the hospital for 4 days. It was a nightmare. I had a severe case of Colitis & Stomach Flu. Unfortunately, I had two emergencies in the hospital. So on the first day an emergency occurred. The nurse set an alarm on my bed they didn't want me to get out of the bed. Plus a nurse was in my room every hour, 24/7. It was a little annoying however, the staff was terrific & gave lots of TLC! Yes, lots of noise, bedding is horrible (you want to go home immediately) plus everything that others pointed out.
4
Yes, sleep is restorative to healing. The other issue as hospitals deal with elderly patient populations more frequently are advance directive instructions. My mother was admitted with a CVA complicated by Coumadin therapy. She spent weeks in a comatose state with a very grave prognosis. There were disagreements in the family as to who could legally make her medical decisions since she Did not have informed consent or any medical or financial directives in place before admission.
It was unacceptable that this clearly incapacitated patient was able to sign health care proxies and durable power of attorney documents upon transfer to long term care facility.... which set off a family estrangement of which we can never recover.
Financial exploitation all round and such suffering she endured for 8 years.
6
Anyone who has spent at least a few nights in a hospital or has had a friend or family member do this already knows this. Why it's taken this long for hospital administrators and doctors to even begin to realize or care about this is incomprehensible. Oh wait, these are the same empathy-challenged, self-serving administrators and doctors that argued, until just recently, that having residents working brutally long shifts and brutally high numbers of hours each week was, somehow, a good thing. The medical industry in our country obviously still has a long way to go to truly appreciate that patients are people, and not just the recipients of medical procedures and a source of revenue.
34
I have perhaps the dubious distinction of having both worked in hospitals and to have slept a total of 3 weeks next to relatives while they were hospitalized, including a week in the intensive care unit. The reason I was able to do so was the hospitals my relatives stayed in all had a large number of private rooms with sofas convertible to beds and one family member was allowed to stay overnight.These rooms did cut down on a lot of outside noise so helped with sleep. On the other hand, I agree that medical regimens could be adjusted to decrease nightly disruptions for more stable patients. And makers of medical monitoring devices could help by including sensing devices to alert staff remotely without sound. We were awaken often by IV devices beeping/ buzzing because there was a kink in the tube or medications had finished. Some mechanical ventilators - which help patients breathe - are also quite loud.
8
@ms
Remember when car alarms were the scourge of anyone whose bedroom window overlooked a street? I always wished the car alarm would only go off in the apartment of the car owner, since they were the one who could silence it, not wake up an entire block of people who had no power to silence the racket.
It makes sense that hospital machine alarms should alert the staff at the nurses' station, not the patient, or that the alert is a silent light above the outside of the patient's door, so it gets the attention only of those who can do something about it, and lets those who can, sleep in peace.
9
The beeping. Every time one of the infusions ends it beeps. If you are on 3-4 different IV's , it will beep every other hour. You have then to call the nurse to turn it off as it does not beep at their station, only in the patients room. Why not change it to blinking lights? My husband was at the hospital for 16 days and it almost drove him nuts.
47
Letting patients sleep is just one more form of
Primum non nocere i.e. FIRST DO NO HARM!
Both as a patient ( for 4 days [2018], 6 days [1996] , 7 Days [1957]
and as a Physician (since 1971
I have always tried to get caregivers to back off and let me sleep.
14
I have had the misfortune of spending a lot of time hospitalized in the last five years. The list of things that keep a patient from resting are endless.
Blood draws and other checks done separately or over-frequently, nurses handing over and taking over their charge at the change of shifts, numerous cleaning and maintenance staff... Strong perfumes, noisy jewellery and footwear, crazy mobile ringtones...
The most amazing disturbances that I have experienced: nurse singing in the ICU to keep herself engaged, staff peddling their religion (entrust your soul to XYZ and he'll make you better).
Better scheduling and guidelines for staff can easily fix much of the above.
26
The patient is at the bottom of the totem pole in a hospital. I was hospitalized years ago for a broken leg. Despite having been in the hospital for only about 18 hrs at this point, and with no bleeding or fluid discharge, a nurse took great joy in waking me at 6:00am the following morning and forcing me to walk the hallways on crutches so they could change my bedsheets. Then, the vitals checks, the testing of the televisions, waking me to ask how i was doing, dropping things on tile floors... I could not wait to get out.
28
I had a heart attack in March. A stent was inserted into one of my arteries. Later that day I told the nurses I felt great and would like to go home. "Oh no, Mr. Davis. Your heart could stop or start fibrillating. You need to stay in the hospital." I told them the reason I don't like to stay in hospitals is because I never sleep well. "You are in here every three hours, checking my vital signs or slapping a cuff on my arm to take my blood pressure. If you'll leave me alone, I'll stay." The nurse said she would talk to her supervisor. She came back in a few minutes and said, "O.K. If you'll accept responsibility for whatever happens to you during the night, we'll leave you alone. We do need to keep a heart monitor on your chest." That was fine with me; the monitor was unobtrusive--I hardly knew it was on me. They put a Do Not Disturb sign on my door. That night I fell asleep around 10:00 and woke up at 8:00 the next morning. Ahh.... I slept like a rock and felt great.
40
Well, its about time. After my sister's open heart surgery, I really thought the recovery was going to kill her. They WOULD NOT let her sleep.
27
All I can say about this article is "like duh!" So obvious. Who the heck wants to be woken up every hour so they can take your blood pressure?
10
@bob
No one. On the flip side, at least at our hospital, the only people who get woken up every hour (vs every 8, or every 4 hours if on telemetry) are people for whom it is important.
1
Two huge noisemakers; alarms from malfunctioning equipment sounding for ten minutes before anyone bothers to go check and nurses making plans for lunch with another nurse who is fifty feet away. The nurses' station itself is a big source of noise and incidentally a wealth of patient information spoken loudly in violation of HIPAA regulations.
Many, if not most, blood draws, which can cause anemia in a long term patient, are not necessary and are another source of patient annoyance while keeping the hospital lab in business. The biggest affront is being forced to share a room with a sick stranger. Not only is it noisy and unrestful, it is a source of contagion as is the hospital itself. Stay a few days and you will catch some nosocomial infection.
The patient is the customer and should be accommodated. The medical staff are the employees who should be accommodating the customers. Medicine is a business and people should be demanding better service.
26
@S.L. I speak as a veteran of several surgeries & three hospitals -- nursing staff are universally overworked & underpaid. The majority of the ones I've relied on have been fabulous. The question of, shall we say, infrastructural support , is critical. As you say -- malfunctioning monitoring machines that breakdown and scream in the night, whether for 1 minute or 10. Furniture - bedding, seating, rollaway tables -- that would be an embarassment at a yard sale. These failures fall on an administration whose members should be made to endure a night in the hospital.
12
@S.L.
Ah yes, the customer is always right. Did you know patient-directed treatment is less effective than doctor-directed? Did you know the things that determine a patient's happiness are parking and food, not cure or quality of care? The customer is right, except when the customer gets sicker or doesn't get better or has a complication. Then it is all the doctor's fault.
If the customer is right, then the customer should have at least 50% blame.
3
@Dr. Meh I sure don't want to be treated by a doctor who doesn't understand that decent food and sleep are important for health. Luckily all my current doctors would agree with that assessment.
1
Finally, some focus is being aimed at what I consider a serious issue.
Last June I spent almost the entire month in hospital for two surgeries & post-operative recovery. My sleep deficit began with what seemed to be overwhelming noise from beeping monitors, staff talking loudly in hallways, floor cleaning machines in the morning hours. After 3 or 4 days, all these noise sources receded into "white noise" as I adjusted to my environment. However. the real sleep disruptions began soon after my surgeries & throughout my recovery period. Vital signs monitored every four hours, " meals" brought at 7:30 am , blood work samples at 6 am, IV pump alarms activated without reason & most often, at least 5 minutes before staff arrived to turn it off. At times, it all felt like some form of "torture"..
To be fair & balanced, the actual care by medical staff was of a very high standard but surely there could be much needed & critical changes made that would permit real rest.
I was so happy to get home to my own bed to sleep as long as needed & to eat real food again.
19
After being exhausted bringing a baby into the world they also wanted to do rounds with students at 6 AM. I said, no and had a sign put on my door, and the doctor in charge had the audacity to say, Well, you're in a teaching hospital. And I said, yeah, but I'm paying, so they can come back at my convenience.
46
@mleyes
A teaching hospital must ask for your permission and if you say no honor that.
20
@eve They didn't ask or explain that I could refuse the first morning--just came right in. It was on the second and third mornings I refused--again not because anyone had told me I could, but I just figured that I'm the "paying client." One resident actually did come back later in the day to talk to me--he wanted to know more about using acupuncture in conjunction with the birth--and I was happy to chat with him, while already awake.
16
@mleyes
Great. We'll come back at 5 or 6 PM when we're done with all of our other patients. We're not coming running to your bedside when we have no information (you denied our exam) and we're busy. Please enjoy 12 hours of sitting around, mad that we're not bowing to your schedule. I have 25 patients. It's easy for me to prioritize them.
2
The night after stent placement my sleep was interrupted 15 times. Most of this was entirely unnecessary. Vital signs, blood draws, weights, medications can and must be coordinated to limit this kind of disruption. It cannot be acceptable to deprive sick and recovering patients of rest. Too often, patients need to leave the hospital to recover.
Like too many other aspects of modern medicine, this system is designed for staff benefit, and ignores the needs of the patients.
34
The worst part of a night at the hospital, in addition to the intrusions at the patient's bedside, may be the noise level outside the patient's door. Nurses and orderlies chatting and laughing at full volume are also insensitive (and unacceptable) intrusions
31
Just home from five days in the hospital to treat a relatively minor knee infection. I did not get to sleep through a single night and was often woken three or four times a night (vitals, blood draws, etc.). I completely agree with the thrust of this article - there is some good advice here - for example, if it is necessary to wake a patient, make sure that all procedures are done at the same time - it just requires the RNs and RNAs to co-ordinate. Have to say, though, that the nurses and nursing assistants were spectacularly kind and thoughtful - they just work in a dumb system.
14
@Andy
There is no "system". Health "care" should and can be given to and paid for all IF our focus in this country were on basic human/citizen needs rather than gaining ever more market share and profit. One's wrist watch can now measure, store , and download your blood pressure, pulse and pulse oximetry: why all the expensive devices on poles?
If Amazon and UPS can figure out logistics, why can't hospitals do the same for coordinated care AND rest? As a fortunate survivor of cardiac bypass and removal of blood clots on both sides of my brain and innumerable sleepless nights in the hospital "recovering" I can honestly say, these improvements are long overdue. Thank goodness my fears of acute dementia/brain fog were unfounded; just a case of severe sleep deprivation, courtesy of hospital policy and procedures. It is time to rewrite those manuals.
12
I travel by train a lot and always choose Amtrak's "Quiet Car," which makes a big difference when passengers choose to be in an environment that doesn't allow to use cellphones or carrying on conversations with seat-mates.
How about a "Quiet Floor" hospital policy as a general policy? When I was recently hospitalized I brought custom-made earplugs, eyeshades, and a white noise machine with me -- but still my sleep was disrupted by those pesky beeping machines, cleaning staff, hospital employees' conversations, along with the frequent poking and prodding tests.
Rubber floors sounds like an excellent idea. So does all employees wearing rubber soled shoes -- the click of high heels can also wake you up.
Combining the pain and discomfort of post-op time with hospital-caused sleep deprivation increases the length of recovery time, making patients more miserable than they need to be.
If ALL floors strived to be "Quiet Floors" -- not just at night, but in general -- that would be a good start, and patients would be so grateful.
13
As a sleep deprived obstetric patient, they would wake me to nurse the baby -which was great -but then wake me between feedings to change my bed linens. I offered to do it myself for more sleep but they didn't change their routine.
7
The mistake is to cling to the musty old Victorian-era notion that a hospital is a place to recover one's health. Remove any idea of "health" from your concept of hospitals. The hospital is a business that performs procedures and monitoring on human bodies. It is like an auto mechanic's shop. A hospital patient is the human version of a broken-down car, which is to be fixed and then moved out when its income-generating potential is exhausted. No one cares if you can't sleep, except that you might become an annoyance (complaining, etc) so that's what sedatives are for. Sleep deprivation is bad for your health? Yes, so are most things about hospitals: the food, the forced immobility, the infection risks, the lack of a normal day/night cycle, etc. Unfortunately if you need the services of a hospital, you have to sacrifice your health for the privilege.
38
Finally there is some attention to this matter! I also think emergency rooms should have discreet sections. Not all crises are the same in nature, and patients should be protected from seeing each other whenever possible.
5
A year ago I had surgery at Unity Hospital in a suburb of Rochester, NY, and it was the best hospital experience I have had. All rooms are private, so there are no roommates or their visitors to disturb you. Anytime I needed a nurse, I buzzed and someone came immediately. Best of all, I was allowed to sleep. And amazingly, the food wasn't half bad. I think at least this one hospital gets it.
i
17
We recently installed a system in a local hospital's Surgery ward where we were able to localize nurse call sounds and reduce noise for patients by 75% from that system. I had patients (and nurses) thanking me in the days after we installed as we continued to test our system. That was very rewarding as we didn't realize how big the noise problem was for these patients who are trying to recover after surgery. Nurses often commented that with the old system they would hear the nurse call sounds in their head as they tried to fall asleep each night - what a nightmare!
17
"It’s an environment that, all too often, seems set up for everyone else’s convenience but the patient’s."
"All too often", or by design? Patients, after all, are a captive audience, and don't bill by the hour.
8
As a doctor who has been a patient, I can attest to the harm caused by sleep disruption. There is no need for a lot of the overnight wakings, and the ICU, in particular, is toxic. One can either develop delirium from sedating medications or from sleep deprivation without the meds.
The last straw, for me, occurred after I had just gotten to sleep following my minor surgical procedure day. Wound checks, BP checks I could understand, but then the TV rental person WOKE ME UP to see if I wanted to rent the equipment.
I have tried, in my small way, to see that patients are allowed to rest, but major institutional changes are also needed.
76
TV when I didn’t want it was a major problem. TV even from the next room with the door kept open even when I pleaded for quiet was disruptive and insulting. Nurses didn’t really need to gossip outside my room. The hallway had become their socializing area. Not quiet at all!
22
@mignon Hey! Nothing is more important than getting your TV service going.
3
My mom graduated from nursing school in 1938 and struggled against the erosion of patient care in the face of administrative demands and technology over her 45 year career.
Rest is vital to healing. Modern hospitals can be the worst place to do either.
7
My husband had his aortic valve replaced via open heart surgery 18 months ago. Because he has type 2 diabetes he was monitored by a an endocrinologist . That physician ordered finger stick blood tests every hour around the clock for 5 straight days. When I questioned him he stated it was necessary to control my husband’s blood sugar. This kind of inhumane treatment does not allow for the rest my husband so badly needed.
The nurses were very apologetic but they had orders to follow. My husband was too sick to lodge a complaint. Our heart surgeon told us he had complained about this practice as well and nothing was done. The endocrinologist was paid for his daily visits which lasted less then two minutes. We refused to return for follow up with that doctor.
36
@Linda Sullivan
I'm surprised they didn't realize patients are allowed to refuse any medical procedure.
3
They don't let you sleep,, and yet, for everything, they charge you $1,000,000,000,000,000,000,000 for everything.
Just wonderful....... {sarcasm}
5
2 weeks ago I had bariatric surgery, a "sleeve" procedure where they basically cut out 3/4ths of your stomach. I was in an excellent teaching hospital in Massachusetts where every concern seemed to be given for my care but sleep or even rest. Although my surgeon had prescribed morphine and oxycontin for pain the first afternoon/night after surgery the nurses decided that due to the "opioid crisis" I should only get one of the meds, not both as prescribed, even though I have no history of dependency and they all knew I had to sit upright all night concentrating on breathing through the pain like I was in labor. Vitals were checked every 2 hours, blood work every four. The room was very large and spacious but I had to share it with a different patient every day I was there. To accommodate visitors and patients "needs" they have a policy of open visitation by as many people as one would like up until 11:00 p.m. and no designated quite times. I had to put up with one room mate having a 5 hour birthday party with 8 visitors who treated my room like a pub, another who had to FaceTime on speaker phone her every relative evertytime her meds kicked in and an older woman who had 6 grandchildren all under the age of 7 visit for a bored out of their minds afternoon. Not once was I offered a sleeping pill, and it was only after 2 days of begging was I given my regularly prescribed anti-anxiety meds. It was hell.
32
@Roxanne Pearls 10 years ago I was hospitalized with an infected gall bladder, an extremely painful illness. I was lucky enough to have a private room with the door closed, but instead of having too many visits by hospital personnel, they would inevitably show up very late for my medication - I was receiving injections of Dilaudid every 4 to 6 hours. I spent much of that 6 day stay in pain because I would ring for pain meds and no one would answer. On one occasion my dose was late by 6 hours, during which time I lay on my bed crying with pain. I could hear nurses talking and laughing outside my door, but no one came until the next shift.
21
@Roxanne Pearls I am a nurse and I empathize with you. With that said, morphine, particularly postoperatively, is administered intravenously as a breaththrough pain medication. Oxycontin is a long-acting opioid that will not provide you with pain relief in, say 30-60 minutes after administration. Instead, it provides an hourly "trickle" of pain relief usually over a 12-hour period. Both of these medications are typically used in addition to a short-acting pain medication like oxycodone. While I would have administered both the morphine and oxycontin, it is important for you to realize that a primary adverse effect of opioids is respiratory depression. As an obese individual, you were already at an increased risk for sleep apnea.
All of this is to say that I'd be happy to let you sleep from 10p-6a, BUT don't you OR your family or friends complain IF you're found not breathing at 6a. Bedside nursing has become a lose/lose situation in 2018. It's no wonder that very few bedside nurses like their jobs.
1
In this era of astronomical health care costs, common sense has left the room. I was last year in ICU for eleven days following a colonoscopy that result in a punctured colon, not only were my meds so screwed up by the “computer” generating dispersal of said meds but the “ nurses were so ill trained as to be waking me at 1:00 AM to give me a sleeping pill which I had been taking for eighteen years following a botched retina reattachment that resulted in the loss of vision in my right eye. To add insult to injury other medications that I had been taking for Eighteen years as a result of the same botched procedure were denied me that could have had serious ramifications had my friend who happens to be the head of Psychiatry and Drug Rehab at this South Florida Hospital had not intervened. Our system is so broken as to be absolutely frightening not only costing us double that of other advanced nations but with shockingly bad results. The Wall Street dominated Health Care Industry like so much else in America is designed for maximizing profits for management and shareholders while abandoning both physicians and patients, another real and ongoing chapter in America’s decline.
6
Totally agree!!
I just spent two days in a hospital after prostate surgery. At night, I joked with the nurses that hospitals are NOT a place where you can actually sleep. Best thing is to get out of the hospital ASAP!!
5
I had a 7-day stay in a hospital following major surgery. I was unable to get more than an hour's sleep at a time because of almost round the clock visiting hours, kids yelling and running up and down the halls, loud TVs, and employees intent on making as much racket as possible from 11 pm through 5 am. After the fourth day I begged my surgeon to release me. I just wanted to go home and sleep.
12
My one horrible overnight was an experience I still remember. Woke up every few hours but actually no ever asleep. Biggest problem? The constant chatter and conversation by the night crews socializing.
12
The MBAs with manufacturing models must be removed from healthcare delivery. Systems that maximize efficiency are not individualized for specific patient needs. The assembly line cannot be the approach to providing care to hospitalized patients- who increasingly are acutely ill or recovering from surgery that defies 'same day' centers.
Nurses should be assigned through a patient's stay so there is some continuity with clinical observation beyond the digital record. Sheets & gowns should be changed so RNs can see the patient's skin- check for rashes and sores. Single rooms should be the design in future in-patient settings so sleep & infections can be controlled. Treatment by strangers must be recognized as fodder for error & waste. Contact between in-patient clinicians (hospitalists, NPs & PAs) and out patient MDs must be mandated.
6
Same old same old and unlikely to change any time soon unfortunately as the "rut" is too deep. Given that it's late 2018 one would think that every single one of those endlessly beeping alarms that everyone ignores could be done away with. Simply connect them all to a monitoring station at the central nursing desk where they immediately report to a person at that desk and action can be taken. Alarming in the room is beyond silly.
10
IC Psychosis is both real and harmful. Somehow, IC units need to figure out how to let patients sleep. The level of noise (talking, alarms, other patients going nuts) is unreal. This is a major problem, and greatly impairs the ability of those in ICU's to heal.
11
my father was in an ICU when i went to visit. upon entering the rm. there was a very shrill, loud, alarm coming from a bed in the 4 person rm. i asked 'how long has this been ringing'? one and a 1/2 hrs!!! all the nurses were sitting at the nurse's station in front of their computers- where they now spend 50% of their time as opposed to the 1/2 hr they used to get at the end of a shift to chart- a pet peeve of mine and huge decline in Pt. care- their excuse for not dealing w/ the alarm, " we haven't been inserviced for the new bed" ??? new beds come along all the time and only a few things change. it is not rocket science.
so i walked over to the bed, flipped up the control panel at the foot of the bed, and pushed the " alarm off" button. the relief on the Pt's faces was noticeable.
it was criminal that these nurses subjected the Pt's to this noise torture. to what end, prove their ignorance and total lack of caring ?
another new source of noise in Hosp's is the loud clicking of high heels down the long corridors. this is not a nightclub. upper management and Med. fellows.
final note- please, no perfumes or heavy scents should be worn to any Med. establishment.
28
@scootter1956
Oh yes please! No strong perfumes, jangling jewellery, clackity-click heels... One of the nurses in the ICU, when I was admitted, would sing to keep herself engaged!
5
Yes, Yes,......Please
My 17 year old son had a severe traumatic brain injury....
4 months in ICU,
3 months in acute brain trauma,
8 months extended brain trauma..
He survived when few thought that possible so thank you but
the constant noise, sleep interruptions, etc were a nightmare.
9
Just left ICU and the nurse break room next to my room with a door that slammed. I finally got up with my IVs and monitors and put a trash can in the door opening....and got caught and got in trouble....BUT the noise stopped.
6
I would say give every patient some kind of ear plugs. But that just masks the problem and allows it to continue. And of course it's not just hospital noise and scheduling, this is just one symptom of the greater overall problem, which is that the patient's convenience is dead last in our healthcare system's priorities. For instance I remember when it was the norm to have blood drawn and urine samples left at your doctors office, whereas now all lab tests involve a separate trip to a lab, with appointment of course, and no doubt in a completely different part of town. Is it really that hard to have someone on hand in a doctor's office who can draw blood and hand out plastic cups? Sheesh.
4
@A.I. There are probably laboratory regulations the clinics have to follow. Some may be overly onerous but others are there for specific reasons, e.g. to decrease biohazard risk, to assure the blood gets to the lab on time for an accurate results. Also, some offices with in-house labs overly order labs, to the detriment of the patients' health (too many false positives) and wallet. So there are some financial laws to safeguard that as well.
3
@ms
No, let’s not be silly. This has changed because more money can be extracted from the bill payers (patients and taxpayers) by chopping every procedure up into as many pieces as possible, with every piece billed separately.
1
Don't forget the "misery multiplier of two": the patient next to you has similar wakeup tortures but at a different time - try that for 8 days straight and all hope is gone. To add insult to misery during these 8 days the real treatment, including a doctor saying "how are you," took less than an hour.
8
Over the years I have unfortunately had a few lengthy hospitalizations, the most recent was in Europe. There were some very interesting cultural differences, but i definitely slept reasonably well almost every night. They weren’t perfect on coordinating the night visits to my room, but certainly much better than my US experiences.
There were no patient transfers into my room on the night shift, that was my pet peeve in the US. It happens quite often for billing reasons.
No beeping IV machines - I was on plenty of IVs, but they used gravity for administration. The nurses could change or add bags without waking me. When the bag was empty there was no alarm, the larger saline solution bags were changed before they ran completely dry, and the IV meds ran until they were dry. They did fiddle with them quite a bit, but certainly no more than the IV pump machines.
For night meds and vitals they were coordinated for my roommate and myself.
The TV sound was available only with headphones.
The European hospital had a more structured schedule than I liked, but there was the wonderful benefit of more sleep.
10
And can we talk about the financial incentives to dispense laxatives, at many times their cost, rather than include fresh salads and fruits in the meals that are part of the daily rates? The least healthy food I have ever eaten was in hospitals.
25
@Nancy You think a serving of lettuce is sufficient to overcome the amount of constipation from granny's on-demand oxycodone/dilaudid habit? HAH.
1
@Dr. Meh not all of us are grannies with dilaudid habits. I was 28 years old when I had leg surgery and was reluctant to take even an aspirin under normal circumstances. A little effort to follow the food pyramid that we are lectured about the rest of the time would have been fabulous.
2
It boggles me that women who just labored for hours (sometimes for days), finally delivered a healthy baby, are doing great health-wise, waking to care for the newborn every 2-3 hours, are then awakened consistently between caring for the newborn for tests. Which means 0 hours of sleep. I gave birth to my first three children in this kind of hospitalized setting, in a state where practicing midwivery was illegal. (That basically forced every woman to give birth in a hospital in that state.) For my fourth child, we moved to a state where there are birthing centers with practicing midwives. The experience was drastically different...hardly any night-time interruptions apart from the newborn.
11
My father spent two months in the hospital. One month was in the ICU and the next month in a more relaxed setting. The nurses took excellent of him. But because, even back in those days (1984), there wasn't a enough staff present, my father still found himself relieving himself in bed. I came to visit him and he was miserable and confused. The confusion was because of the brain abscess, the misery because he was dirty and uncomfortable. The nurses tried to blame him and shame him. I let them know I'd found him that way and he had the buzzer in his hand.
The real problem back then is the same as it is now: staff cuts so that the MBA CEO can earn his cut even though he doesn't understand what the patients need. One more case: a friend of mine had a double mastectomy. One of her arms was hurting so much that taking blood pressure on that arm was agony. She put a sign on that arm telling doctors and nurses NOT to take blood pressure from that arm. They did anyway.
The biggest problem people have recovering is relaxing and letting time heal them. It is the height of idiocy to insist that every patient, whether they need it or not, be checked and awakened every 4 hours a night. It can be very difficult to get to sleep when you're uncomfortable. And those shaking beds to keep clots in the lower leg from developing: they kept my mother awake and more anxious than she needed to be.
5
Sound muffling floors? What a waste of money! A patient will have troubled sleep no matter what: pain, new environment, being hooked up to machines, etc. But let's be intellectually honest about why patients aren't allowed proper sleep in hospitals.
The MDs awaken patients in the early morning so they can get to their 1st surgery or outpatient clinic on time. They often rush through these morning assessments (why even do it beyond liability and billing concerns?) and as a patient, one is so exhausted that they cannot give accurate info to the questions MD.
I've seen nurses awaken patients to pull out catheters at 5:30am because they want to do it on "their shift" before the 7am nurse comes in.
The bad practice starts at med school level, when residents and med students gather outside patients rooms in the early morning to loudly discuss the patient cases (and their social lives)with their facilitators, all the time awakening the tired patients.
If my descriptions are detailed, you can likely guess why. We have 8 MDs in my family. Everyone sadly admits that a patient's sleep is not a priority compared to the convenience and unfortunately, at times, financial interests, of the health care providers. Sadly, this is healthcare in a nutshell these days.
Next topic: patient's hospital food...
33
@Nlinden Don't want your Foley catheter removed at 0530? Take THAT up with the physician! THEY order that!
2
@Nlinden
Foley catheter removal at that hour is likely to help support patient discharge in morning... If I was a patient and not to be discharged that day and I was asleep, I would request it be done later in morning.
5 day stay following heart surgery. Managed to get 12 hours of reasonable sleep. The source of noise was the early morning snapping shut of the three ring binders containing patient records just outside my room. On my last day I was so sleep deprived I was shaking uncontrollably while showering. As is common when I stay in a hospital I have a sheet of paper over the clock, time becomes irrelevant.
6
This, to me, is a health care crisis. I was recently in the hospital for 9 weeks. I was constantly being awaken in the night to check vitals, but I was hooked up to monitors that could have given them that same information at the nurse's station. I was awakened at 5AM to take the day's medications, even though many of them were "take with food" and breakfast would not be for 3 more hours. I had a roommate who left the TV blaring all night. The mattress was so uncomfortable I was getting backaches that I had never had before. Basically, the lack of rest kept me sicker, longer, and at higher cost.
What modern medicine does not understand at all is that rest and sleep have substantial healing power. Surely technology has advanced enough that this is possible, so why hasn't it? It's a health care crisis. Solve it now! Before I ever have to be in a hospital again.
17
I listened to an informative CBC radio program detailing all the issues at hospitals that interfere with a patient's sleep and thorough analysis of the effects on blood pressure, wound healing, length of hospital stay, etc. The monitoring equipment can be quieted by means of the same engineering used for the space program for very little money. Nursing stations are notoriously loud and staff needs to be retrained to consider the ways they contribute to disturbing a patient's recovery. Bring back the road signs asking for quiet in a hospital zone and enforce them. No one patient should control the volume of a tv in a shared room simply because they paid for it. Allow patients to use sound cancelling headphones to assist in sleep. The Mayo Clinic manages to get test results within hours and not days which limits the time patients have to be in the hospital. Unlimited visitor hours can also be a great disturbance for a roommate trying to sleep -- as well as someone who snores loudly.
10
When my mother was in the hospital post-stroke one of her main complaints was the lights on all night, which got me wondering why they couldn't use night-vision cameras for keeping an eye on patients.
1
So the doctors for their convenience wanted to see patients at 6 AM. With lots of students in tow. So they wanted info on blood weight etc.
so at 2AM a nurse wheels in a cart to take four vials of blood and, get this, a scale to weigh me. Drags me out of bed with all the tubes and wires hanging and clanging. Then takes blood for ten minutes. All for the doctor’s schedule. I’d been in icu for a couple of days and was on some painkiller that caused hallucinations. Nightmares. Boy did I need sleep. But the good side, I could ask for ice cream.
The bed shook every 45 minutes and there was this machine that dispenses meds and started ringing when it was empty. The nurses called it Big Ben. They were too busy waking up other patients to turn it off. After a few days one nurse tried to show me how to turn it off when it started. Why have the thing in the first place if you are going to ignore it?
What all this does is motivate the patient to get out of there. Won’t go into my thoughts when I asked about the hallucinations and they said it was the meds. In college the rule was to warn someone if you dosed them. Not that I did, but I knew the social rule.
9
It makes a hard time even harder. Why did New York Presbyterian wake my mother at 4am to offer her a sponge bath nearly every day throughout her 5 week stay, despite her refusing every time and repeatedly telling them not to, and not offer her a bath at any other time of the day? Why must rounds be at 6:30 when they know a family member wants to be present and the patient wants a family member to be present but a 6:30 round, that doesn't even reliably happen, is brutal on everyone?
If the patient's door is closed to block out the light and sound of the hallway, and there is no medical need to leave the door open, why do all the staff seem completely incapable of simply closing the door behind them?
Why are patients in shared rooms permitted to leave the TV on blaring all night for a week before anyone offers them headphones and reminds them that their roommate needs sleep?
I think it is a fundamental lack of care for a person. Sure, you'll check off every box on checking vital signs and drawing blood, but in the end you're not serving the patient's needs.
103
Rounds are early because they set the plan for the day. For example, if a patient needs a test which requires extra preparation, nursing staff need to know ahead of time. Or if a patient needs to be discharged, they need to be checked on early to assure they are still safe to go and medications, transportation, etc needs to be arranged.
I understand your frustration as a family member though. My schedule allowed me to stay in the hospital with family while they were sick and I caught every AM round.
One way to resolve might be to have staff record a 1-2 minute voice message for family daily that family members can dial into anytime to hear updates.This can even be integrated into hospital workflow: in some hospitals, nurses already voice record notes for each other and physicians orally present at AM rounds. This might even help workflow as nurses do not have to stop what they are doing to answer family calls if the recorded information adequately answers the family's questions.
9
@Susan I believe leaving the door open might have something to do with fears of sexual misconduct. I was in the hospital when there was a repeated malfunction of the fire alarm system. When the alarm sounded, the doors were dutifully closed and I could sleep. However, that did not long last and the open doors and noises came again.
2
@ms No, spending even less time interacting personally is not the answer. The hospital is staffed round the clock. Tests are done round the clock- who cares about waking a patient up at 3 am for an MRI? This is habit and convenience, it is not necessary, and it's time hospitals made a better effort.
3
I recently checked into a world-renowned hospital for what was supposed to be a one day in-and-out procedure where I promptly picked up an infection that kept me there for five more days during which time I rarely got an uninterrupted hour of sleep.
The final bill, most of which was picked up by insurance, came to more than $35,000.
There is method in the madness of hospitals that pass along infections and deprive you of sleep, and that method is commonly referred to as good business.
32
The hospital almost didn't discharge me because of their noise.
I had an procedure at one of Boston's top orthopedic hospitals, two years ago. One day post, PT got me up and had me walking the hallway. They said "You'll go home tomorrow".
That night, no sleep because of the constant noise and interruptoins. The next day, my balance was deteriorating and walking suffered; nobody could understand why. So they kept me another (sleepless) night. Third day I could barely walk to the room's door. I also could hardly assemble a coherent thought.
Fortunately, I'd been texting my son -- a paramedic -- during the whole ordeal. He put together a timeline of the texts, showing not only the complaints about sleeplessness, but also the deteriorating grammar and spelling.
He presented this to my doctor, insisting they shut the door and leave me alone for a night. After a long argument, the doctor so ordered.
I was able to walk the hallway the next day. And went home.
66
Noise canceling headphones would help, and red lighting should be evaluated. Red light doesn't disable the night vision cells, and is much less disturbing.
Hospital Environments would be an interesting project for a health care agency similar to DARPA (Defense Advance Research Project Agency).
4
Health insurers want to reduce health care costs, so they developed over 35 years ago the DRG payment methodology which creates powerful incentives for hospitals to reduce the number of days that you spend in a hospital. Insurers basically said that they do not want patients sleeping in the hospital: they said that they can sleep at home. That gave rise to the home health and the "long-term short-term hospital" sectors.
Scores of books have been written about the many flaws in the American medical care system.
5
Amen, amen, amen!!! I’ve seen so many loved ones exhausted by stays in the hospital that are supposed to be healing. The noise, the wake-ups, are a drag on the healing process, I’ve no doubt. Thank you for this article.
9
@Margaret
Indeed, Amen! Hallelujah! I recently spent three nights in the hospital to have surgery on a broken leg and it those were the longest nights I've ever spent with all of the many nurse visits, lights, beeping machines and noise in the hallway. I returned home exhausted and slept 14 hours straight - double my usual night's sleep.
Thank you for addressing this!
3
THE moment that patients sign a waiver to not sue the hospital is the moment that they will let us sleep.
Ask any post surgical nurse about the alcohol, foods and drugs patients sneak into hospitals and THEIR paper trail becomes needed because we are both litigious and too often refuse to be change agents in our own recovery.
7
@tillzen Patients already sign waivers not to sue or hold the hospital responsible. It doesn't stop them suing. And if they are sneaking food in it maybe because most of the hospital's food is unappetizing.
6
@tillzen Amen! This night nurse is happy to let you sleep from 10p-6a, but you need to sign SOMETHING that absolves me from any responsibility in the event that you're found, say, not breathing at 6a. Patients cannot have their cake and eat it too.
3
This is equally true for assisted living and long term care facilities. My father is currently staying in an assisted living facility. They insist on drawing blood at 5 or 6 AM, sometimes waking him if he has managed to fall asleep, despite knowing that is rarely able to get any sleep at all. The rationale for the early blood draw.....so that the results are on the doctor's desk when the doctor arrives.
9
There seems to be a complete lack of common sense in hospitals. My elderly parents had a few hospital stays and their sleep was constantly interrupted by nurses being paged over the PA system. I repeatedly asked why they couldn't text the particular nurse, or give them each a pager.
It took a decade for White Plains Hospital to figure this out and implement inexpensive technology that we've had since the 1980s.
12
We've come a long way (and I'm joking) since the father of medicine, Hippocrates, with his oath, "First, do no harm"
advocated using common sense for healing: Fresh air, water therapy, rest, letting food be thy medicine, cleanliness, sunshine... pretty much the opposite of what patients experience in today's hospitals.
I remember when I was 14 and hospitalized for a month after a ruptured appendix, the old Victorian-era Tompkins County Hospital in Ithaca, NY, had a large solarium. It was a giant sitting room with distinct areas decorated with elegant sofas, tables and lamps, and comfy chairs for families to visit patients in a non-institutional salon-type setting. It had huge windows and French doors that led outside to a garden lawn. Patients could sit in the sunshine, with fresh air from the open windows, and were actually allowed to walk outside with a family member or nurse! We need these experiences and settings in our hospitals today, to recover and stay healthy.
29
I find it disturbing that this problem is discussed as an awakening. Every comment to this article outlines what patients have endured in a hospital. I suppose every doctor and every nurse should spend three consecutive nights as a patient. Perhaps the experience would shed light on the need for change.
54
@Kathleen I think that heads of hospitals and insurance companies could use a few days too, since they are the ones calling the shots. Simple things like sleep and solarium would go a long way towards quicker recoveries without relapses at home.
8
@Kathleen That sounds like a vacation. I spent three consecutive nights as a doctor treating 15-70 patients, rushing around, handling crises, and not getting a wink of sleep.
Brilliant common sense reporting that's long overdue. Plz send to every hospital administrator in the country -- along with all the comments -- stat! One suggestion to add: I was at NYC's Roosevelt Hospital and my roommate blared her TV all night, every night, even though she passed out cold at 9 pm and slept through the night. When I asked the nurses if they could shut if off at, say, midnight, they said no, it was her TV and she could play it as long and loud as she wished. Again, where's the common sense?
64
@dawn The nurse's reply is truly nonsensical! I might understand if the patient's roommate was using headphones - then only the glowing light would be a bother. But there are laws preventing loud noise at night in many different scenarios; why should a hospital be different? Goofy nurse needs to spend a few nights in a hospital with tv-playing-roommate. Problem solved forever.
10
While I was in hospital, a man was yelling at his wife. The head nurse was telling him to leave. The wife was weeping profusely. The noise and drama were too much. I got up, hobbled painfully to my door and closed it. The quiet was an astounding relief.
4
Not sure what hospital the guy in the picture is not being allowed to sleep in, but I could sleep just fine in the hospital on a bed like that.
1
Amazing this is only now being figured out. Worse in psyhiatric hospitals where one is woken by “checks” during the night every half hour; these patients need sleep to recover, but are slowly made “crazier” by sleep deprivation.
6
@Kathy Gray When I was hospitalized for bipolar, they did checks where they didn't wake us and the Unit didn't have the P.A. system on. The common area also had a wide selection of comfort food to eat.
This was back in 2005 and it was a small unit. The hospital shut it down a few years later.
1
@Kathy Gray When I was hospitalized for bipolar, they did checks where they didn't wake us and the Unit didn't have the P.A. system on. The common area also had a wide selection of comfort food to eat.
This was back in 2005 and it was a small unit. The hospital shut it down a few years later.
But I would also like to say that checks are absolutely necessary in psychiatric wards. People aren't there because they're stable. No matter how strict the rules, people who want to hurt themselves will find a way, or they can be in a crises mode without telling anyone. Checks alleviate those situations.
@Kathy Gray. Yikes. first time I've heard of this. Are the psychiatric hospitals aware that sleep deprivation was used in war time for torture? I could understand staff looking through a window in the door on a regular basis, but to wake the patient?!? Criminal.
3
“Unnecessary noise is the most cruel abuse of care which can be inflicted on either the sick or the well.”
— Florence Nightingale
119
@June
And to think that Florence Nightingale started her work back in the 1950s--oh, wait-- that was the 1850s...
I thought the human big brain allowed us to evolve faster than that.
2
Send this article to every hospital in this country.
28
It would be a weird, strange quiet world in a hospital if we took away all the bells and whistles.
In fact, your care would be greatly diminished without the beeps, alarms and other annoying noises that alert the staff to replace your calibrated and timed medication, your need for ice chips or to straighten your sheets or to assist you to the bathroom.
Staff isn't psychic, your use of a call bell ( noise) is essential to your care.
Unfortunately everyone hears it. Not just the staff.
When patients are admitted in the middle of the night, they aren't ignored till morning, at the risk of disturbing others, we care for everyone at all hours. ( more noise).
5
@Susan While the staff may need to hear alarms, every patient on the floor doesn't. Staff could wear earpieces, and/or the alarms could be confined to a separate communications hub out of hearing range. Silent indicator lights outside of rooms are also an option. Just because something has always been done a certain way, because of lack of imagination and insight from the medical community, doesn't mean it shouldn't be changed for the better. I would welcome that "weird, strange quiet world".
14
@Susan
As I said above the alarm would ring for hours. And alarms coming from all the rooms were just plain ignored. A nurse after a few days showed me the stop button. Once I dislodged some wire and after a while a nurse came in and said the basement had reported I wasnt breathing for the last ten minutes. Why not come in earlier I Asked? She said that was usually a false alarm.
7
@John Neumann
John I applaud your solutions, but aside from the nurses station, there are no special hubs to corral noise traffic.
In order " hear" a silent call bell, you would have to be able to see around a corner.
I think hospitals should offer ear plugs and eye masks.
That's start.
1
I recently spent 2 weeks in a hospital for acute appendicitis. Every thing noted in this article is true. Sleep is impossible. Daily wake up was at 4am for blood tests. One night the cleaning crew decided it would be a good idea to come in my room, kick buckets around, and laugh up a big party, AT MIDNIGHT.
If nothing else I wish they would think through all the monitor beeping and alarms. What are they really for, and aren't they 99% useless?
35
In the 1980's I was hospitalized after an emergency appendectomy. I was in pain and needed sleep. When I complained to one of the aides about the noise and she said to me, with a chuckle and a sense of irony, "Oh, if you wanted quiet you came to the wrong place."
4
Totally true. The healing power of sleep is ignored. The health professionals are unsympathetic because most of them are sleep-deprived themselves.
5
Having recently been hospitalized with a life-threatening condition, I can speak intelligently to this problem. The hospital isn't a place for rest. With the incessant interruptions, some of which are, in fact, necessary and others that can obviously wait until later in the day, and a mind-shatteringly loud level of noise at shift change, no patient can sleep properly.
The lack of proper rest created several deficits in my recovery and when I was finally allowed to go home, I was clearly in a weaker state than if I'd had more sleep.
I'd also like to state that I was worried about picking up an infection in the hospital. Sleep is imperative to the proper functioning of the immune system. This fact alone should be at the forefront of this subject.
This brief article is more important than I think anyone realizes. Thank you to the writer and the New York Times for addressing this problem.
57
As a physician it would drive me insane when hospitalists would order reams of blood tests that they “had to have” first thing in the morning. Patients began to get woken up at five in the morning. Most of the blood work was redundant and the hospitalist was in the hospital for the entire day! Why did they need the blood results so early. There is genuine lack of humanity in medicine and it breaks my heart!
39
A sick, injured, or recovering person should encouraged to sleep as much as possible, and should not be awakened for anything unless it is critical.
To me this is self evident, and anyone in the health industry who does not believe should be retrained or reassigned. Sleep is a critical part of recovery.
Why this hasn't been standard procedure for the last 100 years is a complete mystery.
29
As a nursing student (later to realize this was not the path for me), I was appalled at the amount of time we were expected to interrupt patients during their recovery periods. It seemed like there was a lot of room for improvement here. Nurses are already way too busy, and if they were allowed to let their patients rest, everyone might be happier, fostering a better healing environment.
I had been hospitalized 25 years ago for an overnight hospital stay and I clearly remember being woken in the middle of the night by a nurse practically shouting as she entered my room and threw all the lights on. It was shocking and very disorienting. I never forgot it and this article just brought all of that right back. I hope the medical community is paying attention and able to improve this problem.
15
How about disabling the volume on roommates’ TVs and handing out mandatory earphones? There’s nothing worse than coming out of surgery and having to listen to another patient’s TV show, separated only by a curtain
25
@Kris R,
Yet another reason why all hospital rooms should be private.
11
When my husband had his aortic valve replaced in 2016, I worked with his nurses and nursing assistants to make us a team to make sure he could sleep. One of the issues I faced was a frequently used exit door that was right next to his room. The door was constantly opened and closed with no effort made to close it gently. I finally posted my own sign on both sides of the door to remind people using it to be careful how they close it. It is something that the hospital should have recognized and fixed with a different closing mechanism. While article focuses on sleep, patients also need to be aware of possible delirium/hallucinations from surgery. The patient believes he is losing his mind so he won’t tell anyone that it is happening. This trama is awful—they are in extreme terror from the visions, they are afraid they have lost their mind forever, and afraid to tell anyone—it is hell. This hell can be avoided if patients are told that this can happen, it’s temporary, and medications can help them in the moment.
15
I have hypertension, had spinal cord surgery December 2015, at University California, San Francisco, was sleep deprived, had a heart attack 36 hours later, meds were randomly distributed and changed, blood thinner had been stopped; so, yes, SLEEP is critical to LIFE after serious surgeries.
11
This is true for adults and for children. After a C-section they kept bringing in the baby so I can bond. But they didn't consider that I had been up for 36 hours in labor before the surgery. How is it they are asking a patient recovering from major surgery to take care of another patient, the newborn?
And recently my almost two year old was hospitalized for four nights with sepsis with unknown cause. Even in pediatrics there was no consideration for sleep routine. A very sick child who was used to sleeping 12 hours overnight and a nap, was getting none of it. Some of the nurses would barge in middle of the night turning on lights. And last night before I considered taking her and me home against medical advice, a random surgeon came into our room turning on lights and shouting some patient's name. Rather than checking with nurses, he just walked into every room in the pediatrics unit looking for someone.
How can they NOT see that this is not good medicine?
123
Yes! Patients and their advocates need to be much more assertive in this regard (and in general). Many years ago, I was in the hospital for eight days for a knee procedure that today would be done arthroscopically, with no hospital stay at all. By the fifth day, I was so fed up with being awakened at 6 a.m. for rounds, I told the attending physician that if it happened again, someone was going to have a full bedpan thrown at them (I was perfectly serious about that.) Lo and behold, it didn't happen again.
9
Weopine: As bad as the frequent disruptions to sleep, the noise and light, being subjected to many hospitals' almost food-like substances is not conducive to a smooth recovery.
4
I forgot to mention an incident this spring when I was hospitalized, at a different teaching hospital, for a mini stroke. The nurse told me that she would need to wake me during the night to have an MRI taken. Apparently the demand for MRIs was greater than this radiology unit could handle without being open on the weekend.
The hospital had chosen to wake patients hospitalized during the week in the middle of the night to avoid the cost of keeping the MRI unit open on the weekends.
Luckily I was not seriously ailing, but others ... You can only imagine.
16
Totally true. When I was hospitalized for an infection, my private cubicle was right near the machine that monitored those that were hooked up to heart monitors. It rang loud and clear every minute or two. Not because someone was in distress, but just ‘normal’ monitoring. I asked the nurse about it, and she said they could maybe turn it down (didn’t help, and I wear hearing aids and didn’t have them in!). I had to put in wax ear plugs in order to try to get any sleep. The hospital provided cheap little sponge earplugs which were useless.
A neighbor who is a surgeon stopped by to see me and she said you couldn’t really get any sleep in a hospital (she was sympathetic and in agreement with me, but powerless to do anything). I mentioned the air seemed very dry and she said that the hospital kept the humidity low. Supposedly to control bacteria.
This all on top of the constant taking of vitals and blood.
A 94 year old friend of mine recently had the same experience when she was hospitalized. No rest!
6
"This is not a place of rest,"one nurse told me, in response to my complaints. If nothing else, a five day stay in University of Penn Hospital gave me the incentive to do everything I can to stay out of there.
Hospitalized for a lung collapse, I had to share a room with an old man, nearly deaf, who was extremely talkative and loud. He was an avid reader, but the transport staff had lost his glasses, so the tv was constantly on. Zombies, football, and QVC at nearly full blast (they disabled the volume limiter).
I begged for a private room, begged for a chance to sleep for a few hours. For three nights, it never came. Not even foam inserts under sound dampening earphones could quell the constant noise.
The youngish nursing staff were racing around, polite but oblivious. When I did need them, they were slow to attend. The rest of the time, night and day, not one hour went by without glaring lights, booming voices, beeping machines (often as soon as the person who silenced them left the room) and the blood takers and vitals checkers , who suited themselves.
Second only to the deaf old guy, the banter and loud laughter from the nearby nurse station was the worst source of noise.
My final night, a senior nurse took me to a quiet, private room, dimmed the lights, and gave me a back massage. She somehow got the staff to limit interruptions. I slept for the first time in days.
How could she do it? "They're getting rid of me", she said, "I'm old school and I'm the last one."
166
@Allen
The "old deaf guy" has a disability. Do you mock paraplegics or the blind? Folks with Parkinson's? Or are we the only ones who are fair game?
1
@Allen Blame the physicians. They order all of those "interruptions." Oh, and this registered nurse with a graduate degree in infectious diseases and microbiology won't EVER be giving a patient a massage. I'd make more money and have less stress as a massage therapist!
1
@A Little Grumpy
That fact someone has a disability does not give them a free pass to torture others. If there are people who need constant loud noises in a place where people are supposed to be recovering from illness, those people need to be in a room by themselves so they don't disturb others.
All TV should be watched with head phones only and turned off at a reasonable hour so the light does not impact the other patient.
28
Thank you for this article. My wife was hospitalized for 3 weeks in October, at 2 different hospitals. Because of the noise and commotion, I wanted to get her home as soon as possible, but couldn't because one of the conditions she was treated for wasn't amenable to home treatment. She was completely drained when she got home, as was I, having spent 8-10 hours daily with her. Even as a visitor, I couldn't relax for a second even when she was napping. Buzzers, workers slamming doors as they restocked closets, the meal service calling every 15 minutes starting around 2:30 to get her dinner order, etc. The second hospital had signs all over that 2-4 p.m. was quiet time, but most of the staff ignored them. I'm sure all of this made her recovery both in the hospital and at home exponentially harder. The hospital staff worked very hard at treating her, explaining procedures, and making us physically comfortable. Maybe too hard. The question of noise and interrupted rest doesn't seem at all to be recognized.
31
It is concerning that ambient noise and frequent interruptions in a patient's sleep is still a thing in 2018. Hospitals used to be dead silent (pun intended) while I was a child. I have been in hospitals taking care of my mother and the main complaints were about noise caused by nurses (banging furniture, drawers, equipment, doors, loud talking). Excessive light from bright ceiling light fixtures. After a week in the hospital, my mother returned home recovered from her illness but stressed out by noise and interruptions in her sleep.
34
The future you seek is NOW at Ochsner Health Care System in New Orleans. Innovation Ochsner has recognized , tested, and implemented changes to address the very problems you point out.
Go to : https://www.ochsner.org/io/optimal-hospital
1
This is a terrible problem that is just starting to be recognized. I was impressed during a recent, short hospital stay when I was put in a private room and my requests to keep the door closed where honored. But the big thing was that other than the "IV Done" alarm, all the alarms were at the nurse's station, where somebody could do something about them, and not in my room. Think about it, the patient has no power to turn the alarms off, or to react in a meaningful way to them, only the staff can do that. Why should the patient have to hear them?
114
@John V Kjellman
Nursing should be able to set the IV pump to shift to a flush mode that will allow them time to return to disconnect you from the pump. Also, for continuous fluids, many nurses will note the time needed to replenish the bag so the pump does not alarm. --The pump may also alarm for other reasons, e.g., if the IV end is blocked per a bent patient arm (this can alert the patient to unbend the arm or the nurse to come in and remind the patient to do so).
Ah, ha. And hoe muc( do these ‘disturbances’ cost? And how do the prices compare to the same tests done on the outside.
Chaching, chaching ... it’s all the hospitals think of, and they feed executive bonuses.
2
And those damn beeping monitors that would periodically disconnect and blast an alarm. They were ignored by the nurses (I think they were monitored at a desk up front anyway). As many have noted, small single rooms are so much better and didn't really take any extra space. The damn TVs, the lights. The variable temperatures. Add crazy patients screaming in the middle of the night. no fun.
32
@spike: Agreed. In 2018, there is no need for those devices to beep in the patient's room. Instead, have them set off an alarm at the nurse's station, or send a text to a nurse. It's often beeping because a drip has finished. No emergency.
4
Couldn't agree more! I spent a couple nights in the hospital this summer with my daughter who was recovering from a C-section and the interruptions were ridiculous! I became the gatekeeper, shooing well meaning nurses away throughout the night to allow my daughter some much needed rest (especially after a dozen hours of labor!). Surely her temp and vitals could be monitored remotely for a few hours with all of the high tech machinery they use.
17
This is within the professional scope of professional nursing - not medicine,not administration, not lab and therapy services, housekeeping, etc.
Nurses are accountable for promoting and protecting rest and sleep across all practice settings (by license, standards of care and practice and by professional ethics). This has been usurped by the other services and overlords listed above.
Nursing has the practice authority and responsibility to take it back and assure that patients are allowed to recover.
Lab and diagnostic test results are routinely scheduled for the convenience of physicians and prescribers. This practice is archaic, doesn't result in safer or more efficient patient care, and it needs to stop.
Patients should be asked what their normal rest and sleep hours are at home, and those should be baked into the care plan and respected by ALL staff - professional, technical and support.
Patients who are sleep deprived are being abused, and this needs to be addressed by credentialers, state boards of medicine/nursing, and payers.
In the past, nursing stations were enclosed rooms, and hospitals should retrofit them to accomplish noise elimination from them. They're communication hubs, and they need to be sonically isolated from patient areas.
Retired critical care nurse, educator and administrator who is appalled at the degradation of the helping professions
131
Please start writing opinion articles, a book, put on the pressure. We need more experts like you who call it what it is - abuse - and give power to nurses to protect us. I was in and out of hospitals for several years and am now terrified of them. I need sinus surgery but I would rather live with the pain.
14
@aek
You aren't including some patients, e.g., oncology patients who sometimes require daily and sometimes twice daily transfusions of platelets, red blood cells, electrolytes, etc. More and more procedures are being shifted to outpatient. For those patients that are deemed to need inpatient status, labs can be used to review surgical patients status and allow for care adjustments or discharge, e.g., check for signs of infection, bleeding, renal or liver damage, etc.
I agree with grouping of cares. I think nurses, providers, pharmacists, etc., can all work to support this. I think your dismissal of labs and vital signs checks for today's inpatients is short-sighted and concerning.
1
On one of my too-many trips to the hospital - one of the top hospitals in the nation -- I began to hallucinate after being sleep deprived for three days. Crazy. An angelic nurse took pity on me and coordinated things, but it should never have gotten to that point to begin with. Now I make sure this doesn't happen again. Ever.
12
I welcome this article. It always seemed incredible to me how disruptive the nights were in hospitals, treating you like a piece of wood! The lack of consideration for the patient’s rest and comfort was totally lacking, turning the overhead lights on at 2AM, 4AM, etc. It’s like you are not a person, just a biological specimen.
64
@Julie N. This registered nurse would be THRILLED to draw the blood of the increasing number of "challenging" and disrespectful patients in the pitch black IN. A. HEARTBEAT. :)
2
@Dsalcoda
Any nurse turning on the overhead lights at 2AM, 4AM is the one being disrepectful and callous.
And any patient "challenging" the same is not being disrepectful but appropriately insisting on proper behavior from the nurses caring for him/her.
3
@Julie N.
I think most night nurses try to work in dim light when possible. On the other hand, if a blood draw is needed, light is important. Light is also helpful for staff to better see the patient (and patient condition) especially if one is concerned about status changes that may require intervention.
Hospitals need to listen to their patients, and need to ask "how did we do" after they go home. Their approval rates need to be published, and yes, they need to be quieter, the food needs to be actually healthy, and there needs to be far more help for the fearful and ignorant patient.
Oh, by the way, we also need the European model of national health care, where they listen to patients needs and don't toss the poor out into the street.
Hugh Massengill, Eugene Oregon
18
@Hugh Massengill
Excellent proposal, provided the "How did we do?" questionnaire asks the right questions. Recently, after an overnight stay (completely sleepless) following surgery, I received a questionnaire that asked me a lot about cleanliness and politeness, but nothing about how many times I was awakened by staff during the night (5, if I remember correctly, although it's possible that ones of those times was only from noise at the nursing station and not a tech coming to take my temperature or give me a pill.)
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@New York Crank Yes. New York Presbyterian sent a survey all about meaningless nonsense. Okay. Guess you don't care about patient experience, got it.
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My mother used to complain during hospital stays that the nurses would wake her up to give her a sleeping pill.
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And then there is waking you up at FOUR AM every day to weigh you, get BP and temperature “so the doctor has them when he does his rounds” - several hours later.
Next time I am just going to refuse that baloney done for everyone else’s convenience but mine.
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@Anonymous They draw your blood at 4AM...and the blood of another 300 patients as well. Would you like to be sitting around until 7AM, 8AM, 9AM as results roll in? Would you like all surgeries to start at 9AM and go so late that your family leaves? The doctor has them so the doctor can make decisions to keep you from dying.
Remove that responsibility and we'll leave you alone.
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Once, with a wrist injury that required surgery, I complained that the frequent visits of personnel, the conversations between nurses and other patients and the public square clamor in the halls were keeping me awake and driving me nuts. So they said they'd give me something to help me sleep. The idiots.
So, when no one was looking, I sneaked off to the visitor's lounge and slept peacefully all night on the couch.
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@Rea Tarr I actually had to do the same thing one night when I was roomed with an incredibly needy patient who kept kinking her IV making it beep, which the nurses never came and turned off, among many other intrusions. I managed to get out of bed, hobble down the hall to the waiting room, leaning on my IV pole and went to sleep (passed out from exhaustion) on a too short, faux leather couch. The nurses didn't even notice I was gone until they realized my breakfast was sitting at an empty bed for some time.
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@Roxanne Pearls
What do you think of the failure to pass nurse ratio laws in Massachusetts?
No news here. Hospitals are managed for our convenience as physicians. We are a demanding lot. Imagine coming to morning rounds without the latest lab results?
If you want to recuperate from surgery start your journey by using an outpatient surgery center whenever possible. If you are really really sick, we’ll then, start rating hospitals by their interest in your well being as a person rather than by the perception of the “best doctors.”
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My 80 year old mother was recently hospitalized for a fall that broke her leg. The disruptions and constant noise were terrible. She actually got a bed sore on her heel from sheets that were too starched and she's a diabetic - a serious issue. Many of these disruptions are absolutely unnecessary and serve no one but the hospital accounting office where the more times they disrupt the patient, the more money they make. It's a sick, sadistic system driven by one motive: profit. So of course the patient is actually secondary.
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@Mike L that is not how hospitals bill. They bill by procedures done by md, physician assistants and nurse practitioners. They do not get more money if the nurse takes your vitals 3 vs. 6 times per day.
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2 am, after a 24 hour labor, lightly dozing, awakened by a nurse who insisted I really needed and wanted a narcotic pain pill which I had already turned down twice. I finally took the darn thing just to get her to go away and leave me alone!
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A doctor described to me the condition a patient endures while trying to recover as "hospital induced psychosis".
It should be called a crime.
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While I understand the drive behind your comment, the term specifically refers to people who become mentally unhinged from reality while in the hospital and not necessarily fatigue, mild confusion, disorientation due to lack of sleep. Also, sleep deprivation is not the only cause of hospital-induced psychosis: medications, constipation, lack of movement/ natural light, etc can also contribute.
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it makes sense to me. One of the dumbest things I heard of was when my sister was recovering from cancer surgery she told me the nurses would wake her up to give her a sleeping pill.
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A major disruption in sleep is when you have to share a room with another patient. Not only is your sleep disrupted for your tests, but also for you room-mate's tests.
Not only that, you frequently can't catch up during the day because of you room-mate's visitors. You can inform your own visitors about when it is time to leave, but are helpless with regards to your room-mate's visitors.
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Some noise in hospitals is unavoidable.
When I was still in practice as a surgeon, I gave my postoperative patients earplugs.
It's a simple solution that should be adopted more widely.
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@Charley Darwin
That's thoughtful, but not everyone can wear earplugs. I not only find them physically uncomfortable, but they also induce a certain level of claustrophobia.
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When I spent a nigt in the hospital with my husband, following a fairly basic procedure that went smoothly, he was repeated woken up for check-ins. On one occasion, the nurse woke him up to take pain pills and when he told her he was having no pain, she insisted on taking his temperature, which was normal. She then stormed out of the room. The next morning, the surgeon chuckled and told my husband that it was okay for him to refuse an unwanted pain med and that the nurse had indeed charted that he was "a difficult patient."
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@ellen portman
And how would she know his temperature was normal if she did not check it? Post-procedure patients are at higher risk for infection and sepsis. The nurse administering pain pills was doing so per physician orders. The vital sign check post-procedure would have been ordered by the physician and/or per a minimum set by the unit/institutional policy. Refusal is allowed, but from reading these comments, I don't think many understand the rationale for the checks. --On the other hand, I do think that hospitals should do things to group cares and support sleep.
Patient Care Aides provide the bulk of direct care for patients.
During the night, patients may be restless, confused, in pain, symptomatic , all of which staff addresses to keep the floor " quiet".
Other patients prefer to sleep with their
TVs on, just like at home. (more noise)
As a night worker, it seems to me there are more patients who prefer the din of activity and attention, than getting the actual rest that they need.
We close doors, dim lights, talk low and try to minimize interruption of sleep.
My point being is that it's not a quiet atmosphere to begin with.
Even if the staff is diligently quiet,
Machines that monitor, will beep.
Confused patients cry out, and those who need assistance ring their bells, some more frequently than others.
Humans are not always quiet.
We may wake you up because your blood pressure has been really high or too low.
Same with your temp or blood sugar.
No, its important enough that it can't wait.
Hospitals give 24 hour care, provide monitoring and personal assistance by Patient Care Aides, Nurses and Technicians.
We don't rest, were busy taking care of you..
Lastly, contrary to the writers statement, opioids are strictly prescribed for pain.
Melatonin,
counting sheep and relaxation techniques are prescibed for sleeplessness.
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@Missy
Because counting sheep and relaxation technique really work for trying to fall asleep...said no one ever.
How about psychiatric patients who's recover from psychosis/mania/etc? Sleep is highly critical to their stabilization and recovery, and they should not be disturbed by anything other than to take their medication. Obviously, certain patients who are at risk at harming themselves are different, but let's not act like "counting sheep" or something as weak as melatonin a real solution for patients who are truly restless.
They need real sleep agents and quiet.
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@Missy
Actually, melatonin is not a sedative, but is used to reset circadian rhythms, but that’s a longer term project. Sleeping meds usually come from the benzodiazepine family.
With only a little retrofitting and the use of modern communication all of the alarms and data can be routed to a computer out of the patient room (WiFi, Bluetooth, etc.)
How many times hav I pushed the call button in vain! At times I’ve even crawled out of a hospital bed only to find the nurses laughing and chattering around the call station, oblivious to alarms and calls!
Sure some patients need close monitoring of BP, but they are usually hooked up to continuous monitors. The average patient does not need to be awakened every couple of hours.
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Undoubtfully sleep isn’t important for patients who are in the hospital. Those measures are working only for an inpatient units. For emergency departments it won’t work. There are admitted patients in EDs who aren’t waiting for room assignments sometimes as long as 48-96 hours. Solution required for those patients.
I have a sense that all the excess monitoring is done in order to fix blame if anything goes wrong. "It didn't happen on my watch, see the readings?" Some adjustments in schedules could help a lot. Once when I was hospitalized on antibiotic drip because of infection from spider bite, one antibiotic was given every 12 hours, at noon and midnight. 7 a.m. and 7 p.m. would have been a better schedule.
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@Jonathan
Umm...that antibiotic was probably started ASAP per your infection (and that set its timing... Subsequent timing could have been titrated back some over time, but consider that some antibiotics may have negative impacts on organs, e.g., kidneys...
1
Another thing that would help would be small private rooms for everyone. NY Presbyterian did this for certain surgeries and it made a world of difference to our son.
16
My labor pains started on a Friday at 11 a.m. All through Friday. The pains never stopped. Every fifteen minutes like clockwork. All night long. All through Saturday. All through Sunday. The labor pains never once stopped. (These were not Braxton Hicks. They were the real thing.) Every fifteen minutes. Maybe every ten.
I. Did. Not. Sleep.
When I was finally admitted after midnight Monday morning, it was a mercy admission because I still wasn't progressing.
Sometime around seven a.m. Monday morning, I finally dozed off. A few minutes later the resident woke me up to introduce himself and to tell me:
"This is going to be tiring. Be sure to get some sleep."
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@A Little Grumpy
So true! I had the same experience - twice with both my daughters delivery!
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@A Little Grumpy
I hope your reply to that resident was one he will never forget!
3
This is an important article. I've been tracking sleep, activity and heartrate on my new Apple Watch, and am amazed at how connected they are.
When I sleep well, the following day is more easily active and heartrate dip lower at night and resting heartrate better during the day. My mood and energy reflect this. In a hospital setting, I would heal better.
We all know this, but restful sleep is the backbone of a good day. This needs to be better studies and quantified, and become part of the care protocol.
20
It always amazes me that hospitals are so inconsiderate of the obvious need for rest and recovery.
It isn't only the constant false alarms and the poorly-scheduled tests. Why the hell do rooms have blaring TV's that don't allow a patient just out of surgery or suffering from a serious illness to doze? If someone wants to watch TV in a double room, they should be given earphones.
And then there's the problem of senile people who make their roommate's lives miserable. These people should be placed in separate rooms.
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My hospital instructs its radiology department night shift team to chip away at the following morning’s routine schedule by doing as many of those exams as possible in advance. This means that solely for the purpose of efficient staffing, patients are woken up during the wee hours of the morning for routine x-ray and ultrasound exams - not because the studies are urgent, but because that is when the technologist is available.
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My favorite experience in the hospital is the 4 a.m. blood draw, along with the constant flow of strangers into one's room in the middle of the night - not conducive to getting any sleep at all. Each person then leaves the door open, letting in light and noise. I once counted that, in a 4 day hospital stay, I got 8 hours of sleep. Needless to say, it took a week at home to catch up. If everyone knows this problem exists, why can't it be fixed?
190
While an important point the article misses two key drivers of this phenomenon. The first is the nature of hospital work flow. For data to be available for morning round (which often occur at 6:00 AM or earlier at a busy hospital such as the one Dr. Ubel practices at, labs have to be collected around 3:00 AM to allow sufficient time for the hospital laboratory to process them so care decisions can be made for the upcoming day. A second major point missed is why we are ordering so many tests in the first place, even on low risk patients as mentioned by the author. The culture of “if I miss something I will get sued” pervades American medicine and results in us erring on the side of a “more is more” approach to diagnostic and surveillance tests.
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@Dan T.
Everything you write is accurate, but I'm objecting to this component:
"For data to be available for morning round (which often occur at 6:00 AM or earlier at a busy hospital such as the one Dr. Ubel practices at, labs have to be collected around 3:00 AM to allow sufficient time for the hospital laboratory to process them so care decisions can be made for the upcoming day."
In this sentence, the patient isn't mentioned, nor is s/he considered as anything other than a data source object. Patient care needs to be prioritized over this. Rounds times can be changed. Difficult to turn the ship, absolutely, but it can and must be done.
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@Dan T.
This does not acount for the housekeeping staff that come in slamming metal flip-top wastebaskets to empty them, or turning on bathroom lights to get additional ones, nor does it account for the bored desk staff and other bored personnel from other depratments that come to visit them and talk and laugh like they are outside in a crowded park in the daytime. Totally insensitive and oblivious to where they actually are.
12
Should the morning rounds be scheduled later? I mean,the reason is to see what changes occur over night. Might that make sense after a nights sleep. Labs? Take at seven. Rounds at 9 or ten. Why three hours instead of one hour to process? Not automated?
Doctors could see patients who need to get to work at 6 am. The great surgeon, D Danes of rural Idaho, usually a quarter plastic each year at Stanford, opened his doors at 6 am. First come, first served, except for emergencies. I remember a 4th of July with the great Dr Lee of China, the first to do microsurgery back in 1966 when he successfully removed a toe to make a thumb for a woman.
A woman came in about 6 am on the 4th to have a baby a bit ahead of time. Both plastic surgeons, Danes and Lee, were beaming when they got back to the morning festivities. They had the pure joy of delivering a new baby.
Why do doctors shut the clinics on the weekends? There are plenty of young, hungry doctors, half retired, and some Jewish or Muslim who would fill in. Many people risk their low paying jobs and rent to have a doctor visit. Especially construction workers at the lower levels. Back to the union hall.
When I had a massive heart attack complicated by compartment syndrome it was on a three day holiday, Memorial Day 2012. Only two hospitals in the Seattle had open cardio labs for stent and for clearing blockages. One had 5 patients waiting.
The other was the UW. I got in1 hr 19 min the last lab. A 32 yr old doctor died waiting.
3
Nurses always seem to try their best, but net is they are overworked. Doctors leave orders for type blood work, and how often, as well as a dosage of drugs and how often. Point being, from a base of requirements the list mushrooms into several disciplines from various departments being involved. Further point, all this organization has no consideration for the patient. Add sharing a room and your neighbor is subjected to his or her schedules. I found, plan on being sleep deprived, and losing weight. IV drip machines are forever beeping for a refill or need to be reset.
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@Dan Green
If the nurses were always trying to do their best the nurse's station wouldn't be the focal point of so much of the noise.
6
Around 30 years ago I read an article addressing this same issue. And another such article around 20 years ago. And again around 10 years ago. In another 50 years, we'll be likely reading a similar article proposing such reforms.
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@Unconvinced
Same observation: this is not on the radar of administrators, and CFOs obviously. Maybe not quite accepted by Drs. - and thr risk management people -- who are ancious to show that instructions are clear and rigidly followed. Imagine a hospital that advertised ( they ALL advertise now) that "Here, we promise not to wake you from a sound sleep!"
14
The only reform needed is earplugs.
1
@Charley Darwin Earplugs don't work. I've tried them all.
10
Having for years witnessed exhausted patients in the hospital, I have complained about this same issue. I have felt that, after handwashing, it’s likely the least expensive most important thing we can do to help our patients recuperate.
248
Yes! I was recently admitted to local hospital to treat a severe infection. After three sleepless nights, I signed myself out. The combination of crazy patients screaming at the nurses all night, the mindless din at the nurses station, the constant monitoring and blood draws was just too much. I gave up. One thing I did learn was that I could call the administrator on-call to get moved to a different room. That helped a little but not enough to warrant another sleepless night.
I was at the the same hospital a few months later for a surgical procedure and had a nice private room so I thought things might work out better. Then I discovered they now employed these inflatable mattresses that automatically expand and contract every few minutes. They’re supposed to help prevent blood clots from forming but the constant noise drove me crazy. I had to unplug it, the noise was so bad but then it totally deflated so it was like sleeping on plastic covered metal.
All this to say that hospitals can be clueless about patient comfort. I know patient safety is always a big concern. Maybe patient sanity can be added to the Joint Commission check list for upcoming years?
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@JayZee
The mattress you describe is to prevent pressure ulcers. Sequential compression devices applied to the legs are a common mechanical means of preventing blood clots in post-surgical and other types of patients.
In two hospital stays several years ago, my surgeon saw to it that I had a nice, large room. But it was at the busy end of the corridor. A room at the other end would likely have been marginally quieter, though still with the unending interruptions.
6
As a recent hospital patient, I can attest to the fact that "get some reset" in a hospital is an oxymoron. For me one of the greatest impediments to rest was simply the temperature. The room was far too cold and the thermostat could not be adjusted. I wore a coat and my family was also cold while visiting. Obviously, excessive heat is conducive to bateria, but why is is that the emergency room ran out of blankets, the patients were so cold. this seems too happen everywhere.
Additionally, something as simple as offering an egg crate mattress to someone in a compromised or frail condition can go a long way in providing comfort, as can the mentioned solutions of coordinating glucose, blood pressure, and medication checks.
Perhaps rather than simply writing guidelines, hospital administration needs to implement a solution and the "sleep on it."
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