Background: Hospital readmissions are increasingly observed and reported as quality indicators. The literature is critical of studies that use all cause readmission definitions, suggesting that not every readmission is related to the index admission diagnosis. However, hospitals are not a therapeutic environment. Patients are often kept on ”nothing by mouth” (NPO) status, subjected to testing at irregular hours, placed on bed rest, and discharged on new medications. Thus, patients may be more vulnerable to adverse outcomes at discharge; some have characterized this phenomenon as “post-hospital syndrome.” This study sought to compare these inpatient stressors (NPO status, after-hours testing, new medications, and bed rest) to patient outcomes (ED visits, readmissions).
Methods: A retrospective chart review of 100 randomly selected ACS patients referred to a cardiac transitional care program (BRIDGE) between 2014-2015 was conducted. Associations between hours NPO, number of new medications, number of tests at irregular hours (11pm-5am), prescribed bed rest and outcomes at 30 and 180 days were analyzed.
Results: Of 100 patients, 72% were male with a mean age of 65.87 ± 12.33 and a mean Charlson comorbidity score of 5.42 ± 2.58. Bed rest was prescribed for 69% of patients. The average patient was prescribed 4.43 new medications at discharge, underwent 4.37 tests at irregular hours, and spent 11.40 hours NPO. Median length of stay was 3 days (range: 0-18 days). Number of tests at irregular hours was positively correlated with readmission at 30 days (r=0.272, p=0.006), and 180 day ED visits (r=0.282, p=0.004) and readmissions (r=0.363, p<0.001). No other significant correlations were observed between inpatient stressors and outcomes.
Conclusions: NPO status and tests at irregular hours were correlated with negative short and longer-term outcomes. Efforts should be made to limit these inpatient stressors or to stabilize patients prior to discharge. Future research on post hospital syndrome is warranted to better understand potential longer-term relationships and to better plan for care transitions.