Disruptions of Patients During Hospitalization Raise Readmission Risk

Health systems and hospitals can adopt effective strategies to address disruptions of patient sleep, mobility, nutrition, and mood.

Trauma of hospitalization such as disruptions in sleep, mobility, nutrition, and mood are associated with increased risk of readmission and ER visits after discharge, recent research shows.

Evidence is mounting that negative patient experiences during hospitalization can hinder rather than encourage recovery from illness. A 2013 study linked hospitalization to physiologic disturbances that make patients vulnerable to new or recurrent illnesses after discharge. In addition to patient suffering, readmissions and ER visits after discharge increase cost of care significantly.

This month in JAMA Internal Medicine, researchers found that a high degree of hospital disruption was associated with a 15.8% greater absolute risk of readmission or emergency department visits after discharge.

"The trauma of hospitalization, characterized by disturbances in sleep, mobility, nutrition, and mood, was common among medical inpatients and appeared to be associated with a markedly greater risk of 30-day readmission or ED visit," the researchers wrote.

The study featured 207 patients and focused on four metrics: sleep, mobility, nutrition, and mood. Patients who experienced disturbances in at least three of the metrics were categorized as high trauma. Nearly 30% of patients were listed in the high trauma category.

Trauma of hospitalization has multiple negative impacts on inpatients, the researchers wrote. For example, mobility disruption during hospitalization has been linked to loss of independence, persistent functional decline, and increased risk of readmission.

Easing trauma of hospitalization
 

The lead author of the research, Shail Rawal, MD, MPH, told HealthLeaders that there are effective strategies to address trauma of hospitalization, particularly if interventions target multiple sources of disruption.

"Our findings suggest that most people experience disturbances in more than one domain, and that the cumulative effect of disturbances has a greater impact on outcomes than disturbance in one domain alone. For this reason, we hypothesize that a multimodal approach to addressing disturbances in sleep, mobility, nutrition, and mood would be more effective than efforts targeting a single domain," said Rawal, a staff physician at Toronto Western Hospital in Canada.

Rawal, who is also an assistant professor in the Department of Medicine at University of Toronto, said there are interventions for all four of the hospital disruptions examined in her team's research.

• Interventions to improve sleep in a hospital include reducing night-time alarms and other noise, dimming ambient light, and minimizing overnight disruptions such as unnecessary assessment of vital signs. There is also evidence to support the use of eye-masks, earplugs, white noise machines, and warm blankets.
   
• Given that hospitalized patients often spend most of their time in bed or in their room, getting patients out of bed on a scheduled basis can reduce disturbances in mobility. Serving meals in a communal setting or organizing other ward-based activities for patients can also help improve mobility.
   
• Disturbances in nutrition can be reduced by ensuring that patients are assessed by a dietician, minimizing interruptions to meals, and assisting patients who are unable to feed themselves. Patients can also be encouraged to bring in comforting food from home.
   
• Interventions to improve mood in the hospital have not been well-studied but could center on efforts to reduce uncertainty. Interventions include providing patients with an orientation to the hospital, a daily schedule of activities, and a clear list of team members and their roles.