Centerfield

Of course they're dangerous places. Look how many people die in them!

More seriously, while really solid figures aren't available, iatrogenesis almost certainly kills more people in America than guns and car wrecks combined. One in three hospital complications are iatrogenic in origin, and sleep deprivation of hospitalization and the stress associated with same surely plays a role in that.

For whatever reason (I suspect a combination of tradition and revenue) hospitals seem all but impervious to useful change. And by useful, I mean seriously changing behaviors to the benefit of the patient. Way too much of what is done in hospitals is done for the benefit of the hospital or someone who works for or in the hospital. Patient centered activity would be nice.

Many docs, ob/gyns in particular, have office practices in addition to hospital duties. They check on patients early in the morning because they are trying to be at their offices by 8:30ish in order to see patients.

I dunno if there's a reason why the rest of the staff can't operate on a more patient centered schedule, though.

There is a lot above to potentially respond to but I will just touch on regular vital sign checks.

Hospitals today are not like days of yore. For the most part, the patients are much sicker than they were in the past. Many conditions and illnesses can be managed safely at home and as a physician I am know the dangers of treated the hospital as a resort. Multi-drug resistant bacteria, medication errors, accidents, etc. all play into the risk/benefit ratio of the hospital. We also live in a much more litigious society today, which is also going to affect care.

With that in mind, if you let some patients sleep for four-six hours then they might crump before you can respond quickly and effectively to what might arise. Discerning which patient will crash is sometimes possible. But I have seen unexpected findings pop up sometimes minutes after checking on a patient.

While I am not an OB/GYN and don't know the current specifics in the care of post-c-section babies, I can't imagine that you two would have been very happy if the baby had not been checked regularly and then something bad happened. The other option would be to have the child in the nursery while mom was checked less often.

Here too, if mom did have a slow bleed and it became an issue, say one or two hours from the next vitals check, then she might not wake up to tell you that her blood pressure is low. Once discovered, the problem then might be much more serious than if it was identified earlier.

In the good ole days patients were sometimes found cold and dead in the morning. Most of these deaths were probably unavoidable. But I can't help to think that by checking on patients regularly, we have prevented some of the avoidable deaths.

Yes, the hospital is a 'dangerous' place and modern medicine has lost some of its pampering nature. But neglecting patients also has its downsides and you need to consider that before signing any "once a night vitals waivers."

IME our local hospitals vary widely in their quality of care. One's ER (unfortunately, across town) is spotless, cheerful, never more than a few minutes wait; the other (a few blocks away) is a nightmare of confusion; the resident kept confusing us with the folks in the next examining room, which was scary. But that same nearby hospital's inpatient care is as close to "spa treatment" as you will ever find; the nurses go out of their way to make both the patient and the family comfortable (you can reach your nurse by cellphone 24/7, and they come within a minute or two), the facilities are not only clean and quiet but gorgeous; all the rooms in our wing were privates. We left feeling pampered. But similar surgery and follow-up ER treatment a few years back in yet another local hospital was truly awful on every level. It really pays to research your local hospitals BEFORE you need care, and try to pick docs who have privileges there.

Patients will often have vitals measured at about 0600, because that information has to be charted for the doctor when s/he arrives in an hour or so.

Frequent vitals - 2-hour intervals or less - are usually ordered based on the doctor's estimate of necessity; in a 2-day stay, it might not be possible to get a doctor to change that, but most will take the time to explain why an interval is thought necessary. For most patients, orders are for once in 8 hours.

Medications have their own schedule, usually based on the half-life of a particular dose and the amount/level needed for therapeutic effect. Too little, and the med doesn't work; too much and there can be nasty side-effects. And some medications require checking blood pressure or heart rate immediately before administration, even if vitals had been taken a few minutes before. Some should be taken with food, to avoid nausea or stomach irritation; some must NOT be taken with some foods, because food interferes with absorbing the med.

Sometimes IV tubing has to be changed, because successive medications are incompatible with one another (they're OK diluted in the blood, but can precipitate or clog the line if not given their own tubing). That will usually involve resetting the IV pump, with all the audible feedback that produces. Sometimes the amount of IV medication is relatively small, and the pump will alarm to announce that medication is complete, and it's time to Do Something.

It'd be nice if there were always time to explain things at the level of detail the patients and patients' families desire. As seems to be the case in your experience, that didn't happen as well as you would have liked.

As JohnS stated, communication would be wonderful. But then, the Phillipina nurse can't understand the Russian surgery assistant, and the 15 year-old orderly doesn't know squat about bacteria and why or even how to clean the bed area next to yours after the old man with a staff infection died. The lung-pump contents of said man were left in the receptacle mounted on the wall for two days.

The sharps container's foot-lever was broken, so why not just grab the lid with your hand? After three days, someone finally notices--because you politely asked them--you don't have an ice water pitcher, no washcloths, no soaps. Your doctors are playing swap-off, and neither speaks the others' language, so you're pretty much on your own. And if you're not smart enough to advocate for yourself, you'd do just as well to stay home.

All this happens in the "best" hospitals, and will continue to happen until patients complain coherently, constantly and completely until they are heard.

tsiroth said:
Many docs, ob/gyns in particular, have office practices in addition to hospital duties. They check on patients early in the morning because they are trying to be at their offices by 8:30ish in order to see patients.

...maybe it'd work out better if they saw their hospital patients last thing in the day instead of first? That'd also solve the prep problem also mentioned. Or lunchtime. So many fine possibilities other than first thing. In fact, the most considerate of my wife's doctors chose *late* morning to visit.

Matt wrote:
Hospitals today are not like days of yore. For the most part, the patients are much sicker than they were in the past.

I was awakened every four hours TWENTY YEARS AGO. This isn't new.

With that in mind, if you let some patients sleep for four-six hours then they might crump before you can respond quickly and effectively to what might arise. Discerning which patient will crash is sometimes possible. But I have seen unexpected findings pop up sometimes minutes after checking on a patient.

...yeah, and also even more patients can crump from being awakened every four hours. Tell me, whyis a routine and complication-free TONSILLECTOMY dangerous and crucially in need of four-hour monitoring? This Instapundit link contains some actual data about somebody who DID run a study and found bad results from current hospital practice.

Augh! Ms Joan, if you or anyone encounters conditions as you describe - and I do not doubt for a moment they exist - demand correction, loud and long. You are, or your insurance company is, paying for -much- better.

Tonsillectomy, regrettably, is not always 'routine and complication-free' - see http://www.emedicine.com/ent/topic315.htm

These days, 1 in 40,000 die from hemorrhage - not horrible odds, but bleeding out takes just a couple minutes. If that 4-hour wakeup 20 years ago was for tonsillectomy, I suspect the hemorrhage number may have been higher, and the interruptions appropriate. Not being there at the time, I have no way to know if that might be accurate.

Out of about the last five major visits to the hospital (I have two young kids so pregnancies and a pneumonia figure in there.), we had four Major Issues. The type that could have justified a call to the lawyer, or someone getting their teeth punched in.

Unfortunately, its the only local hospital.

However last major visit (a child's broken arm from his overconfidence with a school playyard device) went completely smoothly. And I've noticed that the local hospital has been putting up billboards extolling how wonderful they are. Maybe things have turned around. Maybe someone realized they were dangerous, and decided to fix things.

But next time I go to that hospital, I'm going to be walking in their primed like a hand grenade. Forget being reasonable, and giving them the benefit of the doubt. I'm going to insist they listen and fix my concerns, and if it requires threats and screaming, well so be it. They've come close to killing members of my family from their incompetence, and the possibility of negligent homicide deserves a strong response.

JohnS wrote:
These days, 1 in 40,000 die from hemorrhage.

And how many die from the heightened stress instead?

- not horrible odds, but bleeding out takes just a couple minutes.

Then wouldn't you have to check every minute to prevent it (e.g., basically continuously)? How many of those hemmorrhage deaths are prevented by checking every four hours? Less lives than are lost by the practice? Can you point us to any data?