Disturbances in hospital common among inpatients, linked to readmission

Many inpatients experience disturbances in sleep, mobility, nutrition and mood during their hospital stays, according to findings published in JAMA Internal Medicine.

These disturbances were associated with an increased risk of 30-day readmission or ED visit after discharge.

“Improving patient experience and reducing readmissions are priorities for health care practitioners, patients and policymakers,” Shail Rawal, MD, MPH, from the department of medicine at the University of Toronto, and colleagues wrote. “A growing body of evidence suggests that patient experience in hospital may be associated with posthospital outcomes and the risk of readmission.”

Rawal and colleagues conducted a prospective cohort study to determine if trauma of hospitalization, characterized by patient-reported disturbance in sleep, mobility, nutrition and mood, increases the risk for readmission or ED visit within 30 days after hospital discharge. The researchers enrolled 207 adults (mean age, 60.3 years; 39.6% women) who were admitted to an internal medicine ward at one of two hospitals in Toronto for more than 2 days.

Before discharge, participants were asked about their sleep, mobility, nutrition and mood and responses were dichotomized as disturbance or no disturbance. Participants reporting disturbance in three or four of the domains were classified as having high trauma of hospitalization and those reporting disturbance in zero to two domains were classified as low trauma.

Overall, 36.2% of participants reported sleep disturbance (n = 75), 78.3% reported mobility disturbance (n = 162), 55.1% reported nutrition disturbance (n = 114) and 23.2% reported mood disturbance (n = 48). Most participants (92.8%) experienced disturbance in at least one domain. High trauma was prevalent in 29.5% of participants.

Participants with high trauma demonstrated a statistically significant greater absolute risk for readmission or ED visit than those with low trauma (37.7% vs. 21.9%). After adjusting for baseline characteristics (adjusted OR = 2.52; 95% CI, 1.24-5.17) and propensity score matching (OR = 2.47; 95%CI, 1.11-5.73), these results remained statistically significant.

“These findings suggest that multiple physiologic and emotional domains are disrupted in hospital, raising the question of whether a multimodal intervention could be effective in reducing the trauma of hospitalization, which should be an important goal in promoting person-centered care,” Rawal and colleagues concluded. “Furthermore, these findings suggest that such efforts may decrease readmissions.”

“Further study is required to validate these results and to develop and evaluate interventions aimed at reducing the trauma of hospitalization,” they added. “These findings suggest that aspects of hospital care may hinder rather than help patients recover from illness.” – by Alaina Tedesco

Disclosures : The authors report no relevant financial disclosures.