NEJM: Post-Hospital Syndrome

SPM member Marge Benham-Hutchins (see her December post) spotted this item. It’s a vital point for patient and family awareness, leading to patient engagement – patients as responsible drivers of their health. I added the italics below.

From a recent Perspectives essay in the New England Journal:

“To promote successful recovery after a hospitalization, health care professionals often focus on issues related to the acute illness that precipitated the hospitalization. Their disproportionate attention to the hospitalization’s cause, however, may be misdirected. Patients who were recently hospitalized are not only recovering from their acute illness; they also experience a period of generalized risk for a range of adverse health events.”

Well-known Yale professor Harlan Krumholz MD discusses an important emerging topic, Post-Hospital Syndrome – that time when patients are vulnerable due to the hospitalization itself, not the illness that precipitated the hospitalization. To me this is an excellent example of why patients, and/or their family, should have access to their records during hospitalization.

The site also has an audio interview with Dr. Krumholz, in which he describes how this idea evolved. Lots of good additional information.

Note from Dave – Krumholz’s editorial discusses the many ways people can be adversely affected by the hospital stay, and near the end says: (emphasis added)

At a minimum, we should assess a patient’s condition at discharge by soliciting details far beyond those related to the initial illness.

As we determine readiness for transition from the inpatient setting, we should be aware of functional disabilities, both cognitive and physical, and align care and support appropriately. We should also use risk-mitigation strategies that stretch beyond the cause of the initial hospitalization and seek to prevent infections, metabolic disorders, falls, trauma, and the gamut of events that commonly occur during this period of generalized risk.

Don’t you wish every patient received this kind of advice at discharge, or even at admission, for planning purposes?  Well, now you have it – and you can cite the NEJM.  Thanks, Marge.


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4 Responses to “NEJM: Post-Hospital Syndrome”

  1. This NEJM perspective is important, but what’s strange is that the author doesn’t mention a known, evidence-based approach which helps protect against post-hospital syndrome in older adults.

    It’s called an ACE (Acute Care for Elders) Unit. These are specially designed hospital wards, staffed by specially trained multidisciplinary teams, that do a much better job of helping older adults get through a hospitalization.

    For more on ACE units, see the June 2012 Health Affairs article “Acute Care For Elders Units Produced Shorter Hospital Stays At Lower Cost While Maintaining Patients’ Functional Status.”

    More and more hospitals are setting up ACE units; older patients should consider looking for hospitals who have them.

  2. art rosenzweig says:

    great article. When my wife was discharged after a medical episode causing a (non-serious) crash, the release report was quite detailed, but no mention of whether others depended on her at home, no proposal to connect her with transportation opportunities, continuing gym, appointment with COA. Not serious, but it took us months to take advantage of COA transportation. (WE’re 83) She gets many rides from neighbors, but I get none.

    • e-Patient Dave says:

      That’s a valuable addition, Art. I hope Dr. Krumholz sees it.

      Amazing how simple it SHOULD be to fix some things… Might you have a chance to bring this to their attention? It would be interesting to see what they say –

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