Toxic Hospital Practices May Fuel Readmissions

Cheryl Clark, for HealthLeaders Media , October 3, 2013

In the process of giving life-saving therapies, healthcare providers are often unaware that the dehydration, malnutrition, deconditioning, and information overload that happen during hospital stays may have long-term consequences to the cognitive function of vulnerable patients.

Harlan Krumholz, MD, director of the Center for Outcomes Research and Evaluation at Yale School of Medicine, says that while patients get their diagnosed illnesses treated during their hospital stays, some can leave the hospital a lot worse off than than how they came in.

He's calling this scenario "the hospitalization toxic." In a paper in the New England Journal of Medicine earlier this year, he called it "post-hospital syndrome."

See Also: ICU Delirium Linked to Post-Discharge Cognitive Decline

'Regardless of what it's called, the result is that these patients are weaker, more prone to infections, cognitively impaired, and seem more vulnerable, more susceptible to adverse events such as falls. "Nothing's quite working right. They're not thinking straight."

But hospital teams don't think about this. Case managers, clinicians, nurses, discharge planners, and physicians all tell the patients what to do next to keep them from being readmitted and to speed their recovery:

  • Here's how to take your medication.
  • See this doctor next Tuesday.
  • Eat less salt.

But patients don't hear a word and can't recall any of it the next day. "Their brains aren't working like they used to," Krumholz says.

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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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