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Higher trauma of hospitalization associated with higher rates of readmissions and ED visits following discharge
Question clinique
Do the disturbances in sleep, mobility, nutrition, and mood associated with hospitalization increase the risk of readmissions and emergency department visits following discharge?
L’Essentiel
Self-reported disturbances in sleep, mobility, nutrition, and mood are common in hospitalized patients. This trauma of hospitalization is associated with higher rates of 30-day readmissions and emergency department (ED) visits. 2b
Référence
Plan de l'etude: Cohort (prospective)
Financement: Government
Cadre: Inpatient (any location) with outpatient follow-up
Sommaire
Trauma of hospitalization is defined as disturbances in sleep, mobility, nutrition, and mood occurring during a hospital stay. To assess the effect of this trauma on 30-day readmissions or ED visits, these investigators enrolled 207 patients admitted to internal medicine wards for at least 48 hours with a plan for discharge to home. Patients with intensive care unit admissions, cognitive impairment, terminal illness, or those who were anticipated to be unable to complete the 30-day follow-up survey were excluded. The patients were surveyed on the day of or day prior to discharge to assess their sleep, mobility, nutrition, and mood during the entire hospital stay using standardized questionnaires. Patients were divided into tertiles based on the number of these 4 domains in which they experienced a disturbance. Those in the highest tertile (disturbances in 3 or 4 domains) were considered to have high trauma of hospitalization and were hypothesized to be at greatest risk of readmission or ED visit. Men composed 60% of the cohort, the mean age was 60 years, and approximately half the group had a Charlson Comorbidity Index score of zero (indicating a low severity of illness). Overall, 78% of patients reported mobility disturbance, 55% reported nutrition disturbance, 36% reported sleep disturbance, and 23% reported mood disturbance. Thirty percent of the cohort were in the highest tertile, thus considered to have experienced high trauma of hospitalization. In a propensity-matched cohort, high trauma of hospitalization was associated with a greater risk of 30-day readmissions or ED visits (38% vs 20%; odds ratio 2.47; 95% CI 1.11 - 5.73; P = .03). This finding was confirmed in multiple sensitivity analyses. Additionally, a dose-response relationship was noted with longer lengths of stay and increased rates of high trauma.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Commentaires
Trauma of hospitalization
This limited review of a highly selected patient cohort points to a need for more detailed studies on the trauma of hospitalization. There may be significant confounding factors that modify the experience of a hospitalized individual. Factors such as age,family interactions, social programs , hospital location, design and staffing, are a few that come into mind. A well designed prospective study with rigorous controls and well standardized metrics could help to elucidate the extent of the problem. The results would be helpful for the planning, design, construction and staffing of new facilities and the provision of early interventional strategies to ease or prevent this adverse experience.