Toxic Hospital Practices May Fuel Readmissions

Cheryl Clark, for HealthLeaders Media , October 3, 2013

Misplaced Focus
A few years ago, Krumholz would describe this paradox to medical groups and get blank stares. But these days, it's "starting to be met with universal head-nodding," he says. "People embrace the idea as if a light has gone off, and they sort of recognize what they've been seeing in front of them all this time, but haven't been able to describe well."

That's because doctors' clinical perception has been clouded by the patient's history, and the focus has been on what led the patient to the initial hospitalization, and trying to get the acute symptoms resolved. Providers forget about this other thing that's been hovering right there in front of them. The elephant in the room—the "hospitalization toxic."

"When I call this the 'hospitalization toxic,' I don't mean that we're purposefully harming people or exposing people to anything, of course," he says.

"It's just that when we're in the process of trying to provide life-saving therapies, we're indifferent to the aggregate of what we cause the patient, which we consider minor inconveniences: Dehydration, malnutrition, deconditioning, information overload, dislocation, and chaotic scheduling." Then there are the medications and their cumulative effects.

"The aggregate of all that," he says, "is what causes patients to lose their equilibrium."

And that leads to patients getting readmitted. And of course hospitals and the physicians who treat their patients are increasingly concerned about preventing those.

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2 comments on "Toxic Hospital Practices May Fuel Readmissions"

Nadina Cole-Potter (10/7/2013 at 3:41 PM)
I saw this very thing when my brother was hospitalized in the ICU and Surgical ICU for over 10 weeks. Ultimately, he died after having multiple organs attacked by several different bacteria, one of them being MRSA. Here is the big picture issue: Not only is whatever acute illness that brings the patient to the hospital trauma (not just stres, but trauma), but every intervention, regardless of the outcome is trauma to the body. The article is correct about the compounding negative effects of all the pokes, sticks, medications, surgeries, IV's, tracheotomies, feeding tubes, ventilators, etc that seriously ill patients endure but the seriously specious effects of giving powerful anti-psychotic medications to patients with no history of psychosis. We saw a rational, intelligent, articulate, peaceful 68 y.o. man become characterized by medical staff as out of control and needing not only psychoactive medication but 4-point restraints. Under those circumstances, who wouldn't give up mentally and prefer to die?

Joy Coletti (10/3/2013 at 6:05 PM)
Being hospitalized is a stressful experience, especially if it involves surgery. High stress levels contribute to congnitive impairment, not to mention the impact stress has on the immune system. Anything hospitals can do to reduce a patient's stress levels will promote healing and postive outcomes.




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