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Sleep deprivation and starvation in hospitalised patients: how medical care can harm patients
  1. Tim Xu1,
  2. Elizabeth C Wick1,2,
  3. Martin A Makary1,2
  1. 1Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to Dr Martin Makary, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA; mmakary1{at}

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The field of patient safety has focused on acute adverse events. However, hospitalised patients face regular stressors, such as sleep deprivation and malnutrition, which frequently predispose them to other complications, yet are unlikely to be detected as preventable adverse events in chart-based studies. Unlike easy-to-measure patient safety events, such as retained foreign objects or catheter infections, sleep deprivation and malnutrition are more difficult to measure, as they are dynamic and occur with varying severity. Even a young, extremely healthy person at home without illness will become physiologically stressed and transiently immunocompromised after a mere 24 h of starvation and a poor night's sleep.1 These stressors alone can result in acne, fatigue, oral ulcers and impaired judgment—conditions that in the presence of illness can worsen or obscure the clinical picture being evaluated by clinicians. In frail patients, the stressors of sleep deprivation and malnutrition are magnified further, and, in conjunction with the stress of the patient's underlying medical condition, can overwhelm a patient's physiological reserve and lead to or worsen complications.2

Consider a 65-year-old woman who presents to the emergency department (ED) for pneumonia. She has not eaten or had anything to drink for a few days due to not feeling well. Because the doctors are unsure if the admitting doctor may want to perform a procedure, she is placed on nil per os (NPO) status until the admitting team can come to evaluate her. The patient waits in a noisy ED with devices beeping and people talking loudly outside her room, shared with another patient—a room she will stay in for an additional full day since the hospital ward is full. Including the time in the ED waiting room, and waiting for an admitting service to arrive, the patient spends nearly 12 h until she is seen by the trainee …

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