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Toxic Hospital Practices May Fuel Readmissions

Cheryl Clark, for HealthLeaders Media, October 3, 2013

And extremely important and do-able is that hospital teams can avoid waking people up in the middle of the night for tests or bathing or vital signs if they can be reasonably performed during waking hours.

What person who has spent any time as an inpatient, only to be discharged dazed and confused, like they haven't slept in weeks after being poked and prodded at all hours of the night, wouldn't appreciate that?

Smart hospitals are starting to do just that, to see what impact "sleep protocols" might have, Krumholz and Pandharipande tell me. I'm anxious to hear.

Krumholz thinks hospitals and policy experts, including himself, have not spent enough time working to understand how to make these transitions better for their patients who can't be expected to do what they're told when the hospital experience has disoriented their lives to this extent.

Hospitals, of course, are unhappy with being blamed for readmissions. They're now in a performance period for reimbursement cuts of up to 3% of their Medicare base DRG payments if their readmission rates are significantly higher than expected. Many hospital leaders don't think they can control, nor should they control, what happens to a patient once he or she leaves the hospital grounds.

"I feel bad for hospitals," Krumholz says. "For once they're going to have to really focus on making the transition easier for patients, and maybe create a healing environment that's more supportive. I know that's a hardship.

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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.