Wednesday, January 16, 2013

It's Easy to Get In, But Harder to Get Out: Post Hospital Syndrome or "PHS"

Bad for your health?
When the Disease Management Care Blog was told by the intern, the hospital social worker, the VP for Medical Affairs or the family that an inpatient "was ready for discharge," it had a favorite test to see if it was really true.  The DMCB would walk into its patient's room and ask her to do what she had easily done before she was admitted to the hospital: swing your legs out of bed, stand up and walk across the room.

The DMCB was impressed by how often elderly patients were unable to perform that simple but telling task.

Of course, the best approach was to not let the patient become that debilitated in the first place.  That's the point of Harlan Krumholz's article on "Post-Hospital Syndrome" that was recently published in the January 10 New England Journal.

In it, Dr. Krumholz shares an important secret: being in the hospital can result in starvation, sleep deprivation, muscular deconditioning, confusion and myriad poly-pharmacy side effects.  In fact, it's probably those issues, not the original medical problem that led to the hospitalization, that account for much of the infamous 20% 30-day readmission rate for Medicare beneficiaries.

Dr. Krumholz recommends that hospitals be more attentive to assuring better nutrition, provide a less noisy environment, promote early activity and keep the use of sedative, pain and hypnotic (i.e., sleeping pill) drugs to a minimum. The DMCB seconds that motion and suggests that many of its more savvy colleagues think of this as discharge planning that begins the minute the patient is admitted to the hospital.

And when patients are ready to go home, it's not a matter of continuing outpatient treatment for the initial diagnosis.  These patients need comprehensive assessment and planning.  While the author doesn't come out and say it, the DMCB will: these patients need nurse-led care planning and management that addresses the full spectrum of needs that are too often ignored by hospital personnel in the rush to collect on the DRG and minimize length of stay.

Last but not least, the DMCB recommends adoption of the term "post-hospital syndrome" and wonders if it may not deserve the "PHS" acronym.

Anyone who has ever witnessed a previously well person be unable to stand up and walk will know exactly what it means.

1 comment:

Jeff Sheridan said...

Having been hospitalized 3 times in the past year and a half, I can tell you that sleep deprivation is a major problem. Noise from the halls, roommates watching TV at 4am, vital signs in the middle of the night....

I worked night shift in a hospital for 5 years, and we did our best NOT to have to wake a patient unless absolutely necessary.

As for de-conditioning, I see that problem all of the time in my patients who have been hospitalized.

Your assessment (having the patient get out of bed) is great! I have not seen one doctor (when I was the patient) do that. Resident Physicians are taught many things, but it seems as though the basics are oftentimes overlooked.