Wednesday, January 16, 2013

Once in Hospital, You May Become Sick from Other Causes
Patients who were recently hospitalized are not only recovering from their acute illness; they also experience a period of generalized risk for a range of adverse health events.
Harlan M. Krumholz, MD, “Post-Hospital Syndrome – An Acquired , Transient Condition of Generalized Risk, NEJM, January 10, 2013
The sick soon come to understand that they live in a different world from that of the well and that the two cannot communicate.
Jessamyn West (1907-1985). American Poet and Novelist
January 17, 2013-  About 20% of patients discharged from the hospital are readmitted within 30 days.  This has caused great consternation among Medicare bureaucrats.  They have decided there must be something wrong with what occurred during hospitalization or with  discharge orders or post-hospital care. Therefore paymehnts for hospitals with high rates of readmissions are being docked for faulty care within the hospital for the disease that brought them there, or for  discharge orders or for not arranging for hospital-care.
As it turns out,   discharged patients are often more at risk for conditions other than their primary illness and that the main reason is often the psychological and physical shock and stress  of being in an  alien “toxic”  hospital environment.
In his NEJM article on “The Post-Hospital Syndrome, “ Dr. Harlan Krumholz of Yale listed these hospital psychological and physical  stresses
·         Sleep deprivation

·         Disruption of normal circadian rhythms

·         Under nourishment

·         Pain and discomfort

·         Mentally disturbing situations

·         Medications altering mind and body function

·         Deconditioning from bed rest and inactivity

·         Unpredictable erratic scheduling

·         Information overload

·         Confusion and delirium

·         Under sedation and over sedation

As a result of these stresses,  discharged patients may come down with health problems unrelated to the sickness that caused their hospitalization. 

Readmission due to primary cause for admission and other cause.

·         Heart failure,  37.0%, other cause, 63.0%

·         Pneumonia, 29.1%, other cause, 70.9%

·         COPD, 36.2%, other cause, 63.8%

·         Gastrointestinal problems, 21.1%, other cause, 78.9%
What to do about all of this?   Krumholz suggests “risk-mitigation” strategies, to prevent infections, metabolic disorders, falls, trauma, and other events that occur after hospitalization.   He emphasizes closer attention  reducing sleep deprivation , minimizing pain and stress, proper sedatives, reducing risk of confusion,  good nutrition, and physical and strength activities and exploring new approaches to making hospitalization less toxic and promoting safer passage from hospital to home.
Tweet:   Hospitalization for illnesses is a “toxic” experience, & 20%  are readmitted for causes related to what occurred during  their hospital stay.




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