Preventing Post-hospital Syndrome

By Michael Young

Recent Center for Medicare & Medicaid regulations incentivizing reductions in 30-day hospital readmission rates have prompted a flurry of research into how clinicians and administrators can optimize patient health following hospital discharge.  Preventable hospital readmissions in the U.S. are estimated to account for up to $15 billion in annual healthcare spending.  In considering this problem, many analysts and innovators have focused on deficiencies in transitional care as a root cause of many preventable readmissions.  While efforts to improve transitional care carry considerable promise, they tend to leave relatively underexplored a determinant of readmissions of equal if not paramount importance: the inpatient experience itself.

Writing in this week’s JAMA, Allan Detsky and Harlan Krumholz propose seven key interventions that can enhance patients’ hospital experiences and in so doing may portend improvements in patient health following discharge.

Detsky and Krumholz observe that “patients who leave the hospital have their physiological balance disrupted and are subsequently susceptible to a broad range of acute medical problems.” Contributing to this disruption are familiar features of hospital settings, including the “depersonalizing and stressful hospital atmosphere that exposes patients to incessant loud noises, a lack of privacy, awakenings in the middle of the night, and examinations by strangers who fail to identify themselves.. [leading to a] transient vulnerability that has been characterized as “posthospital syndrome.”  By mitigating these stressors and by paying more attention to patients’ overall wellbeing during hospital stays, Detsky and Krumholz contend that readmissions and post-discharge adverse events can be substantially reduced.

Toward these ends, they suggest that healthcare providers make efforts to encourage patient engagement in physical and social activities within the hospital setting; promote adequate rest and nutrition; discourage depersonalizing qualities of the hospital environment; build realistic expectations (e.g., by providing patients with daily schedules); curtail unnecessary procedures, lab tests and medication alterations; and furnish unambiguous post-discharge plans (e.g., “[p]atients should be clearly informed about who will take ownership over their care once they leave the hospital. The phrase ‘Someone will call you …’ should be replaced with ‘I will call you and here is how you can find me if you need me.'”)

As a medical student about to embark on my clinical years, these suggestions reveal actionable insights into the role I can play as a member of the care team to meaningfully influence patients’ experiences and outcomes.  Research has shown that medical students often struggle with understanding the scope of their roles and responsibilities on the wards.  Perhaps one way for medical educators to help ease this transition would be to explicitly assign responsibilities within the specific domains Detsky and Krumholz delineate.  Empowering medical students to enhance inpatient experiences in these ways may thus serve to improve medical students’ transitions from classroom to clinic while at the same time promoting safe and successful patient transitions out of hospital settings.

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