Readmissions May be Triggered by 'Post-Hospital Syndrome'

Cheryl Clark, for HealthLeaders Media , January 15, 2013

As hospital teams zealously work to prevent 30-day readmissions, they may not realize that sometimes what brings patients back into their hospitals is not what brought them there in the first place.

Something else is going on. Writing in the New England Journal of Medicine, Harlan Krumholz, MD, calls it "post-hospital syndrome, an acquired transient condition of generalized risk."

The syndrome, he said, is making patients sick with a variety of other conditions after their primary illnesses are resolved, although it's unclear why.

In fact, hospital officials are aware that 20% of Medicare patients discharged from a hospital have a medical problem within the next 30 days that is so serious, they must be re-hospitalized.

Typical readmitting diagnoses include mental illness, gastrointestinal conditions, metabolic derangements, and trauma, as well as heart failure, pneumonia, and chronic obstructive pulmonary disease.

Krumholz postulates that readmissions not related to the index admission might be due as much to otherwise unexplained "allostatic and physiological stress that patients experience in the hospital just as they do from the lingering effects of the original acute illness."

And hospital teams need to work harder to explore "new approaches to making hospitalization less toxic."

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4 comments on "Readmissions May be Triggered by 'Post-Hospital Syndrome'"

Mary Mammarella (1/18/2013 at 12:31 PM)
This reminded me of an article I read some years ago about physicians who treated people who had been tortured and were trying to recover. I am NOT accusing anyone of torture, but rather suggesting there might be something to learn from those physicians. When you look at the items sited like sleep deprivation, nutrition, pain, etc., it is hard not to connect the patient's reaction to hospitalization to the reactions of released prisoners or victims of torture. Thanks for the article.

Sharon Del Favero (1/16/2013 at 1:18 PM)
A very good argument for a holistic approach to patient care which currently contradicts the "focus only on the admitting diagnosis". While methods of reimbursement see this focus as less costly I would challenge is it really in the big picture? each disease state impacts another if present within the same patient..... does it not?

debra reynolds (1/16/2013 at 11:37 AM)
Sleep deprivation, and feeling alone and out of control of your circumstances can be scary for patients. Healing happens when a patient is at at peace. Explain to the patients in their language and their pace the procedures, lag-times etc. Use volunteers to keep them company in their rooms, if they want one. A little courtesy can go a long way towards recovery.




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