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aedes t1_j1zanp5 wrote

To add to what others have said, and to make this more generalizable outside of just medicine...

Swapping out people who have been working a long time for fresh people is limited by two factors:

  1. The availability of fresh people. There are often alternate nurses available for a very long case. In some situations there may simply not be another surgeon available. This is part of the responsibility that comes from being in positions of leadership, or having a very specialized knowledge base and skill set. In times of “crises,” you may be working absurdly long hours for a very long time.

  2. Transitioning to a fresh team is associated with its own risks. The fresh team will be less familiar with what’s going on, and miscommunications about the situation may occur during the transition. A critical event that happens during the transition may also be disastrous due to unclear individual responsibilities and communication flow.

There have been scientific studies on patient outcomes with physicians working either very long shifts, or shorter shifts but with more “signovers” of care happening. There was no improvement in patient outcomes with shorter working hours, presumably because of the risks that occur due to care transitions.

Balancing the above points is something that must be done in many situations, not just medicine.

How does the military decide when to switch out troops in a war zone?

How should government deal with decision making during a prolonged and intense period of time?

Etc.

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YoureSpecial t1_j1znzcc wrote

IIRC the Navy did a couple studies after a rash of collisions and other ship casualties. The net result was to shorten the shifts in certain critical command/control positions - Officer of the Deck, Navigator, helmsman, Weapons Officer, etc.

The critical factors in all the casualties they investigated was that decision-making abilities and accuracy declined dramatically after a fairly low number of hours where these people were dealing with a state of constant information overload.

The shortened shifts flew in direct opposition to the prevailing “man up and deal with it” culture prevalent for so long. In the end, safety won out.

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PerspectivePure2169 t1_j22k3ar wrote

They haven't followed their own advice very well, because they still seem to be colliding and near missing ships pretty regularly.

Just had two in San Diego bay a short time ago.

I agree the watchstanding needs an overhaul or at least get it back to it was in eras our ships didn't burn down pierside or collide with freighters regularly.

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Tidorith t1_j25vo9s wrote

>IIRC the Navy did a couple studies after a rash of collisions and other ship casualties. The net result was to shorten the shifts in certain critical command/control positions - Officer of the Deck, Navigator, helmsman, Weapons Officer, etc.

Perhaps the takeaway really is that we need to invest significant resources into developing better procedures for hand offs that mitigate the negative consequences of them. Then we can shift the equilibrium closer to optimising for the first order effects of shift length itself.

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Fellainis_Elbows t1_j1zfigf wrote

You mean no benefit to longer hours. That’s how the study should be interpreted

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AnonymousWritings t1_j207vix wrote

No benefit to longer hours, except that shorter hours makes for a profession that is kinder to the people working in It and easier to convince people to join it. Good when we have healthcare worker shortages....

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aedes t1_j1zr8nj wrote

You might think I was referring to some of the NEJM papers that came out around 2018 comparing standard to “flexible” scheduling?

I was more talking about the older papers that came out in the first decade of the 2000s when duty hour restrictions first came into place... which compared old-school scheduling to duty-hour restrictions and found no difference in patient outcomes (or occasionally worse patient outcomes with restrictions in some of the surgical literature).

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coilycat t1_j1zphnl wrote

Could you explain the difference? Are you familiar with the studies being referenced? I am familiar with how the null hypothesis works, if that helps.

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zebediah49 t1_j1zrhqg wrote

They're saying that if the two are statistically indistinguishable, "there's no benefit to forcing staff to work long hours" is a 'better' way of phrasing it compared to "there's no benefit to not forcing staff to work long hours". The first implies that being good to your workers should be the default choice; the second the opposite.

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Sammystorm1 t1_j1zzy0g wrote

Handoffs is one of the highest areas for mistakes to happen. Medical professionals are taught to avoid them if possible

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