24 July 2013

Hospitals Set People Up for Readmissions

Some call it hospital readmissions and others name it post-hospital syndrome. Either way, most patients have little control over the situation and hospitals are actually setting up patients for this. Some claim that hospitals are doing this on purpose and others say it is part of our health uncaring system. The following are some of the major causes bringing people back to the hospital:

#1. Sleep deprivation and at the same time a disruption of normal circadian rhythms. Hospitals are noisy, and lights are always on at some level. This means melatonin production is minimal. Even if you fall asleep, a nurse or nurse's aide is always there to wake you for blood pressure measurement, to draw blood, give you a medication, or an injection, so you can forget sound REM sleep. This disruption can be debilitating, and the sleep deprivation can adversely affect metabolism, cognitive performance, physical functioning and coordination, immune function, normal blood clotting mechanisms, and cardiac risk. Yet, the hospital won't consider your feelings.

#2. Poor nourishment. Hospital food by most standards is poor and essentially lacking in taste, nutritional value, and what is called building blocks to help the patient heal and repair the body. Dietitians think they are doing right by providing an unreasonable ratio of carbohydrates, fat, and protein that is supposed to provide sufficient calories. Many patients are unable to eat because of fasting requirements before procedures while other patients have a loss of appetite after surgery, or because the food is so unappetizing. Generally, one-fifth of hospitalized patients over the age of 64 consume less than 50 percent of the nutrients recommended to maintain their energy requirements.

#3. Pain and discomfort. This is one of the more serious problems of being in the hospital. Either you are over medicated or under-medicated. This is a problem for many hospital patients. This can lead to sleep disorders, mood disturbances, and impaired cognitive functioning. Chronic low-level pain is also known to negatively impact immune and metabolic function. In addition, pain medications can further compromise cognitive function. Patients are often given sedating painkillers or other medications that can leave them confused, or even delirious, especially in the unfamiliar surroundings of a hospital

#4. Dealing with a baffling array of mentally challenging situations. Hospitalized patients often meet a variety of health care professionals, but they are given little time to learn their names or understand their roles. Schedules are often unpredictable, and in-patients who are already under stress, information overload can be stressful in and of itself and may even provoke confusion. These stressors of hospitalization can cause delirium, which is associated with increased risk after discharge. Patients in this state of mind are in no condition to understand discharge instructions, such as how to keep wounds clean or when to take medications. It is easy to see how these patients can quickly deteriorate and need to be readmitted.

#5. Medications. As mentioned in #3 above, medications can alter cognition and physical function. In addition, medications to treat symptoms can negatively affect the early recovery period. Sedatives, especially benzodiazepines, are commonly prescribed and may become part of the discharge regimen. Unfortunately, under-sedation can cause accelerated breakdown of body tissue, immunosuppression, a propensity to form blood clots, and increased sympathetic nervous system activity, which can lead to increases in blood pressure and heart rate and decreases in food digestion. Over-sedation, on the other hand, can dull the senses and impair cognitive function and judgment and may also lead to post-traumatic stress disorder.

#6. Financial stress. According to a study published in 2009 in the American Journal of Medicine, medical bills result in 60 percent of U.S. Bankruptcies. Even more frightening is the fact that 75 percent of these bankrupt families had health insurance and still went bankrupt. And these numbers have only gotten worse since the recession fully kicked in, most of which took place subsequent to the study collecting its data. That kind of stress can negatively affect all kinds of physical and health problems.

#7. Extended bed rest can weaken patients' muscles and bones. In effect, hospitalized patients commonly become "deconditioned," so recently discharged patients often have impaired stamina, coordination, and strength, which place them at greater risk for accidents and falls. These limitations may also diminish their ability to comply with post-discharge instructions - not to mention the fact that the capacity to resume basic activities or attend a follow-up appointment can be affected.

#8. Discharge instructions are not always complete and often not fully explained. For the elderly, this can be a confusing time and too often the discharging physician hands this off to a nurse and she is not prepared to give instructions. What a mess this can be. I watched a nurse do her best, but she was not given all the necessary papers and even after two phone calls could not finish. In addition, for the elderly, they may not be in any condition to understand and still be under mild sedation that has not wore off completely. And without a ride, the patient is expected to drive?

#9. For the elderly, often no instructions are given to their caregivers. This is where the elderly are most often discriminated against. I have witnessed nurses cut off caregivers who had proper documentation, such as medical power of attorney and even full power of attorney, by just saying that HIPAA did not permit them to discuss this with them and walk away. Often this means that the patient and the caregiver were not given any instructions about home care and instructions to see the patient's medical provider. Some caregivers learn the hard way and others figure out that certain things need attention and that the patient needs to see their doctor.

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