Quality e-Newsletter
Intelligence Unit Special Reports Special Events Subscribe Sponsored Departments Follow Us

Twitter Facebook LinkedIn RSS

Toxic Hospital Practices May Fuel Readmissions

Cheryl Clark, for HealthLeaders Media, October 3, 2013

Validation
In Thursday's New England Journal of Medicine, Krumholz's theory got a boost from researchers at Vanderbilt University. Praktik Pandharipande, MD, and colleagues conducted a multi-center clinical trial of patients treated for respiratory failure or shock in intensive care units.

They found that delirium developed in 74% after their hospital stay. At three months after discharge, 40% had cognition scores 1.5 standard deviations below the mean scores for their age and educational levels, and similar to patients with a traumatic brain injury.

The big variable was the duration of delirium that the patients endured in the ICU, a not-infrequent occurrence in patients with long ICU episodes.

The longer the delirium persisted, Pandharipande says, the more likely the patient would suffer cognitive impairment, manifested by an inability to plan, or think, or organize, which clinicians refer to as "executive function." The effect was seen as long as one year after discharge.

Better Transitions Are Possible
The good news is that Pandharipande and Krumholz think that delirium is preventable to some extent. Instead of overusing sedatives, patients can be kept awake to keep them oriented and engaged with their surroundings so they aren't confused to the point of psychosis. Caregivers can use lighter sedatives. They haven't proven it yet, but it makes sense.

1 | 2 | 3 | 4 | 5

Comments are moderated. Please be patient.

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.