Patients at risk for readmission during 'transient period' after discharge

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New research from the Yale School of Medicine adds to the evidence that the "transient period" after leaving the hospital puts patients at high risk for readmissions.

Yale researchers reviewed more than 3 million discharges of Medicare patients and found readmissions remained frequent throughout the month after hospitalization, as well as came from a wide range of medical conditions, regardless of age, sex or race, according to the study in this week's Journal of the American Medical Association.

For example, only 35.2 percent of heart failure patients had readmissions for the same condition, while only 22.4 of patients initially hospitalized for pneumonia came back with the same problem.

Because most readmitted Medicare patients were treated for a different illness than what caused the initial hospitalization, patients have heightened vulnerability to various illnesses during the entire 30-day post-discharge period, according to the research announcement.

The study builds on previous research that warned hospitals of a similar threat sending older patients back to their facilities--post-hospital syndrome. The New England Journal of Medicine article attributes stressors that occur during the hospitalization and early recovery period for sending nearly one in five seniors back to the hospital within 30 days of discharge, but with a completely different illness than the original admitting diagnosis.

Given such findings, hospitals should focus efforts to reduce 30-day readmissions on a broad spectrum of diagnoses and sustain them for the full month after discharge, according to the Yale researchers.

"Interventions that are specific to particular diseases or time periods may only address a fraction of patients at risk for rehospitalization," lead author Kumar Dharmarajan, a visiting scholar at the Yale School of Medicine and cardiology fellow at Columbia University Medical Center, said Tuesday in a statement. "We need to be more holistic in our approach."

To prevent post-hospital syndrome, broad-based, holistic interventions should target sleep disruptions, pain and nutritional deficiencies.

For more:
- here's the JAMA abstract  
- here's the Yale announcement

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