Hospital, heal thyself

Many years from now we may look back at a three-page perspectives article and say: Of course, it is so obvious. But just as the campaign to reduce inhospital infections by integrating hand-washing protocols into caregivers’ practice required time to grow from idea to action, a hypothesis proposed in this week’s New England Journal of Medicine by Yale cardiologist Harlan M. Krumholz may be decades away from reducing hospital readmissions.

In an interview with Cardiovascular Business, Krumholz coined the term “post-hospital syndrome” and its tag, “an acquired, transient condition of generalized risk” to help the medical community consider the consequences (such as readmissions) of practices that affect patients who are admitted for acute illnesses. From the hospital and physician’s perspective, some of these practices may seem to be mere inconveniences such as disrupting the patient’s sleep, rescheduling tests and withholding food and liquids in preparation for procedures.

Add to that what the patient may perceive as a revolving door of doctors, nurses and other hospital staff serving as his or her care team, new medications, pain and discomfort, deconditioning because they are bed-bound—all in the context of recovering from a life-threatening condition. Each of these stressors chips away at the patient’s hematologic, immunologic and metabolic systems, making him or her susceptible to adverse events at discharge.

“Rather than tell a patient you are better and you can go home, we should say you are through phase one. We’ve gotten you through the most life-threatening piece but you are in a dangerous period here and you have not recovered,” Krumholz said. “We have to be vigilant to be sure you are safe. Try to protect yourself.”

He also emphasized that the first line of duty is to treat the condition that initiated the index admission. But if hospitals then were to reduce or eliminate the stressors that cumulatively may lead to “post-hospital syndrome,” would it improve outcomes and reduce readmissions?

Hand-washing seems like an obvious solution to an avoidable problem, but it wasn’t made routine without evidence. Krumholz also is calling for research to test his hypothesis. “How do we make this less destructive and more healing?” he asks. “Will this make people less susceptible to these problems?”

What are your thoughts? Should we and can we change hospital practices, and if so, how? Feel free to email ideas or concerns.

Candace Stuart

Cardiovascular Business, editor