Hospitals' emergency department and surgical protocols are in dire need of reform, and the status quo can worsen patients' conditions through malnutrition and sleep deprivation, argue researchers from Johns Hopkins Hospital.
The practice of instructing surgical patients to fast for up to 12 hours before surgery can seriously damage their health, writes lead author Martin Makary, M.D., a surgeon at Johns Hopkins and a patient safety expert, in a commentary published in BMJ Quality & Safety. For example, Makary and his team cite the hypothetical case of a 65-year-old woman who develops pneumonia, which drastically reduces her appetite even before she seeks treatment. If she were to go to the ED, staff would withhold food there as well in case invasive testing or procedures are necessary. If surgery is necessary, it will only add to the time she goes with little to no food or sleep.
Even healthy people are susceptible to weakened immune systems, fatigue and impaired judgment after 24 hours of insufficient sleep, Makary and his co-authors note. "Subject sick or elderly individuals to those same conditions and each next medical intervention becomes more dangerous as their illness takes a turn for the worse," the commentary states. The aging population and increasingly busy hospital environments have only made the problem worse, the authors add, and any resultant healing delays or complications hurt the hospital by increasing the likelihood of readmissions.
More up-to-date research, the authors write, shows that patients need only go without food for six to eight hours before surgery and drink for two hours. Johns Hopkins has implemented a system called Enhanced Recovery After Surgery for many patients. As part of the protocol, patients are given a carbohydrate-heavy drink a few hours before surgery, and precautions are taken to avoid the use of tubes, drains, post-operative fasting or narcotics for pain.
Many hospitals have prioritized making sleep easier for patients, FierceHealthcare previously reported, targeting potential disruptions and implementing facility-wide "quiet hours."
To learn more:
- read the commentary