2013-01-23-Patients-may-suffer-from-posthospital-syndrome_ST_U.xml
^$^For some elderly patients, a hospital stay may actually cause new health problems, making them sick enough to be readmitted within days or week of discharge, new research shows.
Nearly one in five hospitalized Medicare patients return to the hospital within 30 days.
Yet most of these patients return not because their previous illness has flared up, a study suggests, but because they have an entirely new problem that, in many cases, was caused by the trauma of being hospitalized.
Patients initially hospitalized for pneumonia, for example, may become so weakened after a hospital stay that they fall and fracture a bone, says cardiologist Harlan Krumholz, a professor at Yale School of Medicine, who has written two new papers on the subject.
"They come into the hospital with one thing, but they leave with another," says Krumholz, whose study of Medicare patients was published Tuesday in the Journal of the American Medical Association.
Krumholz calls the phenomenon "post-hospital syndrome," a temporary period of increased vulnerability to all sorts of risks, from falls to heart attacks.
The problem is not poor hospital care or medical mistakes but the routine difficulties of being a patient, Krumholz says. He also described post-hospital syndrome in a New England Journal of Medicine paper earlier this month.
For example, patients often don't sleep well in noisy, brightly lit hospital units. Nurses may interrupt their sleep to check vital signs or administer medication. Patients may not get enough to eat, especially if doctors order them to fast before procedures.
Patients often take sedating pain killers or other medications that can leave them confused or even delirious, especially in the unfamiliar surroundings of a hospital. Lastly, extended bed rest can weaken patients' muscles and bones, Krumholz says.
"When you go through what most people go through in a hospitalization, you are impaired," he says. Even "if you took a healthy person through this, they would still be in a period of susceptibility" to health problems.
Even patients who are usually in good mental health can become psychotic in the hospital from the combination of sleep deprivation, medications and stress, says physician Peter Pronovost, Johns Hopkins' senior vice president for patient safety and quality.
"Many ICU patients will say 'I thought the nurses were trying to kill me,'" Pronovost says.
Patients in such a state of mind are in no condition to understand discharge instructions, such as how to keep wounds clean or when to take medications, Pronovost says.
Krumholz says hospitals should try to address these problems, both before patients leave the hospital and in follow-up visits. In some cases, he says, it may be better for a patient to get a good block of sleep rather than be woken up at 3 a.m.
In analyzing why patients are readmitted, he says, "we haven't thought enough about the hospitalization, and how to make it less toxic, more healing and more soothing."
Some note that patients shouldn't be overly worried if they need to go to the hospital for a couple of days.
The problems Krumholz describes are more common among patients hospitalized for long periods, says David Shahian, research director for the Massachusetts General Hospital Center for Quality and Safety.
And though the problems are real, Shahian says, he's not sure "whether it's something that deserves the title of a syndrome."
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