Hospital Hazards

Tuesday, March 19, 2013 // Uncategorized

Here is an interesting article from the Wall Street Journal on the hazards of being discharged from the hospital.  The “transition of care” is a popular term and a hot topic with hospitals and physicians who are going to be penalized for patients that are readmitted.

  • Updated March 15, 2013, 4:14 p.m. ET

The Hazards of Leaving the Hospital

The days and weeks after patients are sent home can be dangerous. Here’s how to avoid being readmitted.

After being discharged from the hospital, patients may feel relief—and a false sense of security that they are home free.

Instead, studies show, patients are vulnerable to a wide range of adverse health events and complications, and they often end up back in the hospital within weeks. Annually, nearly one-fifth of Medicare patients—about 2.6 million older adults—end up readmitted within 30 days, a problem so costly that the federal health program now penalizes hospitals for any readmission deemed to be preventable for heart attack, pneumonia and In a report in the New England Journal of Medicine in January, Harlan Krumholz, a Yale University researcher, identified the condition as “post-hospital syndrome” that might derive as much from the physical and emotional stress patients experience in the hospital as from lingering effects of the original illness.
Hospital Lag

Among those stressors is disturbed sleep from the constant noise and activity in the hospital, leaving patients fuzzy, fatigued and confused, like an extreme case of jet lag. Patients may become malnourished from being unable to take food by mouth and suffer from pain and other discomforts that are never adequately addressed.

Being in bed for any prolonged period can leave patients with little muscle strength, making them vulnerable to falls and accidents. They may be too weak or listless to comply with discharge instructions, and the immune system may still be compromised, opening the door to infections.

Dr. Krumholz advises patients to first recognize that they are vulnerable. “Patients should know they may have survived a major illness, but upon leaving the hospital they now are entering a period in which they are susceptible to a wide range of health problems that could be severe enough to require another hospitalization,” he says.

Recovery Time

Patients shouldn’t underestimate the time they need to recover, he warns. “This is a time of convalescence when you need your rest and nutrition and physical activity and social support.” It’s important to avoid contact with people who are sick—including cute grandchildren with runny noses—and activities like driving.

Mental health is important, as well. Individuals newly released from the hospital who are experiencing stress or wrestling with big decisions should seek help or simply put matters on hold. And don’t feel bad if “you don’t remember all that was told you in the hospital,” Dr. Krumholz adds; a person’s ability to concentrate is frequently impaired after a hospital stay.

But it is also important to have contact with doctors or nurses soon after discharge to review instructions and report any new health problems. Fortunately, many hospitals have special programs to help, including house-call services that send a nurse, doctor or pharmacist home to check on patients and provide follow-up care after discharge.

One Step at a Time

The University of California, San Francisco, offers house calls and a special program for heart-failure patients, who have the highest rates of re-hospitalization. Staffers educate patients about managing their disease and medications and make house calls if necessary to check on patients and troubleshoot problems. In 2009, 25% of heart-failure patients were readmitted within 30 days; with the program in place last year, only 10% were readmitted.

Walter Park, who had a heart attack last October and had multiple organ failure during a seven-week hospital stay at UCSF, says that after returning home he was “weak as a kitten” and spent months trying to rebuild muscle strength and stamina. Mr. Park, a retired director of a nonprofit agency who also takes multiple medications for AIDS, says the heart-failure team sent a home health nurse who visited three times a week at first to help with medications and monitor his weight and blood pressure, two important measures for heart-failure patients.

A physical therapist also came to the house and helped him with a daunting task: walking up a steep San Francisco hill to the bus stop.

“I was very discouraged, but I realize it is a very long process to recover,” Mr. Park says. The UCSF team “really keeps me on track,” he adds, and knowing they will be checking his progress helps give him the motivation to stick to his regimen. Recently he was able to climb the steps at Golden Gate Park.

Ms. Landro is an assistant managing editor for The Wall Street Journal and writes the paper’s Informed Patient column. She can be reached at [email protected].


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