What is the Real Reason Behind Patient Readmissions?

by webadmin on January 15, 2013

Curbing 30-day patient readmissions is a large part of mastering the healthcare-reform environment, but what is causing these readmissions?

Most of the time, it’s assumed that a patient returns to the hospital for the same reason he or she was first admitted, but according to an article by Cheryl Clark at HealthLeaders Media, this may not always be the case. Instead, readmissions could be attributed to something Harlan Krumholz, MD, and author of an article in The New England Journal of Medicine, calls “post-hospital syndrome, an acquired condition of generalized risk.”

Krumholz believes “the syndrome…is making patients sick with a variety of other conditions after their primary illnesses are resolved, although it’s unclear why.” Beyond the usual reasons for readmissions (trauma, gastrointestinal conditions, heart failure, etc.), Krumholz charges that readmissions could also be the result of mysterious “allostatic and physiological stress that patients experience in the hospital just as they do from the lingering effects of the original acute illness.”

In other words, he feels that hospitalization must become “less toxic” if readmissions are ultimately going to be lowered.

Although Krumholz’s thesis may sound a bit off-kilter at first, he seems to have a point. For example, 63 percent of readmitted heart-failure patients aren’t readmitted for heart failure. Seventy-one percent of readmitted pneumonia patients aren’t readmitted for pneumonia. And 64 percent of chronic obstructive pulmonary disease patients aren’t readmitted for their original condition either.

Why then are they readmitted? Krumholz believes that “substantial stress during the experience of being a patient” is to blame.

“During hospitalization, patients are commonly deprived of sleep, experience disruption of normal circadian rhythms, are nourished poorly, have pain and discomfort, confront a baffling array of mentally challenging situations, receive medications that can alter cognition and physical function, and become deconditioned by bed rest or inactivity.”

If hospital teams aren’t focusing on a patient’s early recovery, then a readmission from that patient is almost expected, Krumholz believes. Sleep deprivation can result from the noisy hospital environment.  A patient’s diet and nutrition are given “limited attention,” and malnutrition can result, severely hampering the recovery and healing process.

He also points to information overload about a patient’s condition and overprescription and underprescription of medications as other possible causes behind post-hospital syndrome and subsequent readmissions.

So, how can a hospital focus on early recovery? Krumholz says the clinical team should “’solicit details far beyond those related to the initial illness’ and be aware of ‘functional disabilities, both cognitive and physical,’ to appropriately align care and support after hospitalization.’” Focusing on the causes of disruption in care is also a good place to start, he added.

What do you think of Krumholz’s theory and suggestions? Do you feel he has a point? What is your organization doing to curb readmissions and the disruption of a patient’s care and early-recovery period?

-by Pete Fernbaugh

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