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Subscribe to RSSThe stress and chaos patients experience in the hospital may make them prone to a new illness -- and landing back in the hospital.
Nearly one in five seniors discharged from the hospital will be re-admitted within 30 days with a completely different ailment from the one that originally landed them in a hospital bed, according to a report published Wednesday in the New England Journal of Medicine.
The phenomenon has even been given a name: post-hospital syndrome.
The point of the new report “is not to trash hospitals,” says the author Dr. Harlan Krumholz, a cardiologist and a professor of medicine at the Yale School of Medicine. “But, it’s to say maybe we haven’t adequately recognized the potential toxicities that can occur during the course of a hospital stay.”
After a hospital stay, patients are often weak from lack of exercise, sleep deprivation or malnutrition. The first 30 days after discharge “are a transient period when the patient is at great risk and is susceptible to many things,” according to Krumholz, but patients are rarely informed how to take care of themselves.
“I kept watching people come back to the hospital with a variety of different problems,” Krumholz says. “I started thinking about what we might be doing in the hospital that weakened people, making them at greater risk when they went home.”
After scrutinizing Medicare data of almost 12 million people from 2003-2004, Krumholz found that the majority of patients being readmitted to the hospital had a different illness from their original diagnosis. Someone who had been treated for pneumonia might be back in the hospital with an infection, heart failure or wounds from a car accident or fall.
Letha Sandweiss was home from the hospital for barely a week when she fell on her way to the bathroom one night. She’s back in the hospital once more with a painful cracked rib.
“My legs buckled and I couldn’t get up,” Sandweiss says, from her bed at the Yale-New Haven Hospital. “I lay on the floor for four hours.”
Samdweiss, 80, was originally hospitalized for an infection and didn’t move around very much while there. She says her muscles felt weaker when she got back home.
Dr. Grace Jenq, an assistant professor of medicine and medical director of inpatient medicine at the hospital, says the nurses try to get patients moving. “It’s one of the things that doesn’t happen as much as we would like,” she says. “It’s not for lack of trying. The patients are usually pretty ill and a lot don’t want to get up. And when they get home they are very vulnerable for falls.”
Often it’s a matter of focus, Krumholz says.
“We tend to be in battlefield mode fighting the acute cause of admission,” Krumholz says. “And everything else is pushed to the side while we focus on that issue to the potential detriment of the patient’s overall well-being. Sleep, doesn’t matter when we’re dealing with your pneumonia.”
At a minimum, patients need counseling, Krumholz says. They might be warned, for example, that they’ll be a little foggy for the next few weeks, “so don’t drive a car and don’t make any important decisions,” he explains.
Along with that, hospitals need to make a greater effort to respect patients’ sleep schedules and to get them moving as soon as possible so they don’t lose so much muscle tone.
Not everyone agrees with Krumholz's diagnosis.
While being in the hospital is stressful and can contribute to a delay in recovery, Dr. Mark Williams, a professor and chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine acknowledges counters that the study “doesn’t seem to recognize the good that has been done for the patient.”
Still, Williams says, researchers should look for ways to better prepare patients for discharge. “A lot of them need physical therapy and occupational therapy,” he adds. “We need to figure out what is the right amount of support.”
Williams pointed out that the patients in the study were older and may have been the sickest ones.
But, Krumholz believes that his results have a much wider application.
"I think this problem affects everyone who is hospitalized to a variable extent," he says.
Related:
Your medical chart may soon log exercise, too
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Time to put these people on Obama`s death panel and do away with them pronto ! Give them a pill and send them home.
I have been hospitalized for a few weeks and came out of the hospital in worse shape than I went in - lack of sleep due to noise and intrusive timing of vitals, inability to move or exercise, and poor diet meant that I was exhausted and weak when I got home. Every other time, it was simply the inability to get a good night's sleep that meant that when I got home, I slept like the dead for about 24 hours.
Just being able to bar nurses doing vitals during the middle of the night would have gone a LONG way to feeling better when I finally left the hospital. And I am under 40....
I know from personal experience that medical facilities (hospitals, outpatient surgery centers, even individual doctors) are terribly remiss about informing patients about what to do in the recovery phase after they are discharged. It's like they assume you know this stuff because they know it and it is obvious to them (an assumption we all make from time to time). Nor are they very patient with questions you may have. Rush, rush, rush. NEXT PATIENT!!!
Very true. My FIL was hospitalized for two weeks this summer with severe pneumonia. Sleep deprivation seemed to be a big problem and the release instructions were minimal (I was present for those). It took about a week of sleep to catch up on his exhaustion.
There's nothing like being rushed out of the hospital after having been admitted. I recently went to a Syracuse-area hospital with cellulitis (originally thinking it was a bad case of the flu). I wasted no time getting there, given my complicated medical history. I can't afford taking any chances.
The ER kept me in their over-crowded waiting room forever. I had to beg for pain meds and finally got a shot of dilaudid (partly due to my hx of abdominal surgeries and pain). Got sent back to the waiting room. Had to beg for someone to help me get to the bathroom as I was very weak. Eventually got put into a room in the ER, but then had to beg to be allowed to use the phone.
I was diagnosed with cellulitis and kept for observation overnight. The infection improved tremendously overnight, so they claimed they could send me home the next day. While i didn't want to stay in the hospital, I have to wonder if they sent me home too soon. I'm still not 100% and am wondering if the antibiotic they put me on after being discharged is one reason I feel like crap.
I had to beg to see a minister. No one sent one to me. I begged for a breathing treatment as I have asthma...never got that either. They gave me dinner in my ER room that was stone cold. The next morning they put me on a liquid diet w/o explanation and I had to beg for a regular meal. They claimed they had orders for both a regular diet and a liquid one. They couldn't keep their facts straight.
This hospital supposedly has a good reputation and I've had relatives stay there. I don't want to go back but I've got no choice as my upcoming surgery will be done there as well.
Patients aren't seen as human beings. Just walking living dollar signs. Once we outlive our usefulness, we're rushed out the door. Gmab.
You sound whiny.
I was thinking the same thing, and with elderly ill parents and in-laws I'm used to hospitals and emergency rooms.
So because you wasted precious time making your own incorrect diagnosis, therefore becoming much sicker than you should have, it's the emergency room and hospital's fault for your troubles. If you have a complicated medical history and become ill, shouldn't you call the family doctor early on to avoid becoming so ill you require inpatient care?
Hmm, I'm a little more sympathetic, Diana. Your miserable ER experience doesn't sound that unusual, unfortunately. The ER is a tough place to be without a "helper"-a friend or family member who assists you with the little (but important) things and advocates for you. The staff usually just doesn't have the time.
"Sicker, quicker" is the theme for today's hospital stays. Patients aren't usually admitted unless they are quite ill, and are discharged home...less ill. It's tough on all of us- clinical hospital staff, patients, and caregivers after discharge.
So look at two areas: mobility and medicine. Mobility: the hospital bed is not your friend! Get out of it as often as you can-eat meals in the chair. Use the toilet or bedside commode instead of a bedpan or urinal. If ten minutes is all the "up" time you can tolerate, it's better than none. Get up again in 2 hours. For every day you spend in bed, add three to your recuperation time.
Medicine: you think your doctor is aware of all the meds you're taking? Maybe, but don't count on it, because chances are, at least three doctors are writing medication orders, and they aren't all looking at what the others are doing. Even if your PCP (primary care physician) is monitoring your med list daily, he/she probably isn't aware of all the interactions. Ask for and read the printed medication education sheets.
While patients are hospitalized, they also experience "delerium" - dementia-like symptoms. Each time my mother's been released from the hospital, she's mentally like a zombie. It takes her weeks to get back to where she was mentally before she was admitted.
How foolish.The plain fact of the matter is,people have many more problems than they used to.Many more problems than they have in europe for instance.As a nurse of almost 30 years i can tell you from experience people outlive their 'expiration date'.We do more for sicker people than other countries.How many diagnoses do your family members have? Need hemodialysis ?Doesn't happen over there like here.Have that AND heart disease?You're dying,though not here.People literally have laundry lists of medical problems and sometimes a dozen or two medications,doesn't happen in europe . Wait'll you get the health care we SHOULD be getting-more deaths,better statistics.Your mama doesn't get to have open heart 3x,5 new joints,copd,diabetes and renal failure,then bitch about it.Science long ago surpassed ethics in healthcare.This is the 21st century,guess what ethics is going to catch up,and you won't like it.Death panels-I crap on death panels.You ain't seen nothin yet,ingrates
Another nurse here giving my two cents...we are not miracle workers. There is not one patient who can understand the pressures of trying to take care of 6 or 7 patients at a time on a busy med-surg floor. Many, not all, patients (especially here in NY where Medicaid is rampant) expect us to "cure" them when their chronic poor lifestyle choices have finally caught up to them. We see the same patients admitted over and over with chronic diseases because they don't want to make the effort to live a healthy lifestyle of exercise, diet and cleanliness. If any of these medicaid patients had to pay for the numerous hospital admissions and ambulance transports themselves, I guarantee the numbers would be cut in half. Do you have idea how long it takes to open every one of your prepackaged 20+ medications you are taking? Multiply that times 6 times 3x a day! We all go into nursing with the compassion and idea of helping those in need. But we cannot fix the problems your unhealthy lifestyle has created. You want to smoke, your choice. You want to sit around eating bon-bons all day, your choice. I would much rather devote the majority of my time caring for that sweet little olderly patient who is now on comfort care because she has come to peace with the idea that her end is here and she would just like to pass peacefully. Not that we won't help those in critical need; that's our job. But please, people, take some responsibility for your lifestyle choices and don't expect the medical field to fix you when everything falls apart.
I hear you.
Have to agree with the other nurses posting. We've seen it all. From frail, ill 80's and 90 year olds living on their own, falling and having no one check on them for days, and then having family reunions in the ICU. Seriously, where were you people before? Why are you not caring for your parents better, much less yourselves? Now you're asking us for a beautician and podiatry to see your parent? You've got to be kidding me. Hospitals are NOT hotels. Patients, families, nurses, doctors, case managers, social workers, physical therapists, and nutritionists are all parts of a TEAM. You can't just lay in bed and become an infant while in the hospital, but the majority of people do. Then they bitch and bitch about the outcomes because they didn't pay attention during a teaching moment, or spend the time to find out more info, ask more questions, see if they can get more help and take an active part in the team that is working towards THEIR returning to being healthy.
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I had emergency surgery late in the evening of Nov. 1. The hospitalist came in Three days later and told me I would be going home that day, Sunday. I told her no, I was not going home. I had only been out of bed twice (the bed and bedside chair were both alarmed, so I couldn't even adjust myself in either without it sounding an alarm at the nurses' station. I was told this was because of Medicare rules. Ah, doc---I'm not on medicare. I am not going home. I won. Less than three weeks later, i was admitted to a hospital closer to home with an abscess and a staph infection. It was not a fun time.
You should have asked the doctor for physical therapy and asked for help from the staff to get up and get moving if you could not do it independently. Right away, too, not 3 days later. What did you think laying in bed for 3 days after surgery would do? Maybe you would not have gotten a staph infection if you had gone home sooner.
Hospitals are germy places. Just being in a hospital increases one's risk for infections.
Of course it does.People come from a hundred miles or more to our facility.Literally concentrating germs.They they let their babies crawl around on the floor,disobey infection controls,don't wash,etc
Hospitals KILL.
Many people also have PPP-piss poor protoplasm.In other words,serious genetic and BREEDING problems
Hospitals take absolute control of patients. This quote illustrates how patients are treated like objects and abused. "After a hospital stay, patients are weak from lack of exercise, sleep deprivation or malnutrition." These conditions are awful and people have to pay for them. Being either old or sick is a form of H3LL.
Stevador sweetie, although I agree that being hospitalized is awful, people (yes, we call people patients-it distinguishes them from staff and visitors, who are also people!) are weak and malnourished as a result of their illnesses or other conditions, not from being hospitalized. (notice I didn't include sleep-deprived in that sentence- sleep deprivation is most likely caused from hospital treatment) Nutrition is a very difficult area to address because patients who already feel like crap don't have much appetite. Add cultural food preferences, dietary restrictions, and the logistics of trying to feed a whole lot of people the correct food at the correct temperature in a short period of time, and it's almost impossible. Fever, wounds, infection, surgery-all of these increase the body's nutritional needs.
It seems, from reading these posts, that we all feel abused by the hospital system. Certainly the other nurses posting on this thread do! And after 30+ years of clinical nursing, I wish I could afford to hang up my stethoscope because I'm tired as hell, but I'd still rather be a nurse than a patient, so I try to keep up my energy and my patients' spirits.
Thank God for Dr. Krumholz. I'm tired of excuses. After three hospitals in three months, I was relieved to see his findings.
People of all ages enter hospitals for reasons such as my spine surgery. We are probably otherwise in good health or we wouldn't have qualifies for the surgery!
I haven't even touched on cases like a friend's husband who was DROPPED, and had to be rushed back into surgery.
We may spend weeks without seeing anyone wash hands. Staff doesn't alway check to see if we can reach our water. We are left for hours in rehab in wheelchairs that could have been adjusted for our height, but weren't. Pain. We are deprived of some exercises because the wheelchair brake jams and we can't operate it.
New computer device moniters flash in our eyes all night when no one is using them. A warning alarm screams if we move in our sleep off the trigger device (to keep us from getting out of bed.) There have been jokes for decades about "you can't get any sleep in the hospital."
It was time that this strong voice from Yale challenged us to do something about it.