HOSPITAL: Each day of hospitalization is 3% more risk of readmission

 In the United States, the total cost of readmissions is estimated at more than 25 billion dollars per year. Reducing re-hospitalization rates is a priority challenge for all healthcare systems. By revealing that each day spent in the hospital "increases" the risk of readmission by 2.9%, particularly in rural areas and by detailing the risk factors for readmission, this study conducted in rural Appalachia will to better prevent the risk and reduce the considerable health costs associated with these repeated hospitalizations. The data is presented in the Chest Journal and at the 2018 CHEST Congress annual meeting.  

 

It is indeed one of the savings axes of the American healthcare system, with interventions such as the Hospital Readmission Reduction Program which, within the framework of the Affordable Care Act, penalizes hospitals presenting higher readmission rates. Analysis of data from this specific rural area reveals that health facilities in the region, like many rural areas, have higher readmission rates than the national average. Thus, the hospitals of the "territories" find themselves penalized compared to the large university hospitals.

 

The study followed 15,500 patients admitted to hospitals in Appalachia from January 2014 to October 2017. The researchers took into account a whole series of variables such as length of stay, age, gender, the "payer" of the health care, month/day/time discharged, smoking or smoking cessation, medication taken upon discharge, and a range of co-morbid diagnoses such as diabetes, hypertension, chronic renal failure, and psychiatric disorders.

The analysis concludes that each day spent in hospital is associated with a 2.0% increase in the risk of readmission: thus, among the significant findings,

• patients discharged more quickly are less likely to be readmitted than those discharged after a prolonged hospital stay;
• patients discharged before 1 p.m. are less likely to be readmitted than those discharged after 1 p.m.;
• former smokers are more likely to be re-admitted than non-smokers and smokers in the process of quitting;
• patients with concurrent diagnosis of COPD, type 2 diabetes, hypertension, psychiatric disorders and chronic renal failure have a higher risk of readmission.

 

The major factors of readmission to hospital in this rural area appear to be the increase in the duration of hospitalization and smoking. However, the study does not mean that the duration of hospitalization should be reduced at all costs. However, on reading these initial data, it is already possible to better target the prevention of the risk of re-hospitalization, and, in practice, to work on reducing the length of stay, when patients leave before 1 p.m. , smoking cessation in smokers and better monitoring of patients with certain comorbidities.

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HOSPITAL: Exposure to noise, a real nuisance for patients

This expert opinion piece from King's College London, published in the British Medical Journal, points to 'noise pollution' in hospitals as a growing problem and a barrier to successful patient recovery. Sound exposure levels regularly exceed international recommendations and, "even in intensive care units, which care for the most vulnerable patients, it is not uncommon to experience noise levels above 100 dB, equivalent to loud music with headphones.

Lead author Dr Andreas Xyrichis recalls that noise in hospitals has already been documented as a barrier to communication between staff, a source of error, stress, irritation and fatigue for physicians and caregivers, with a negative impact on the quality and safety of care. High noise levels and noise-induced stress have negative effects on staff performance and well-being, can contribute to burnout, but not only.

 

Patient experiences are for the first time also taken into account , and the team emphasizes that environmental noise also affects patients' ability to rest, heal and recover. In the patient, exposure to noise is indeed linked "to the development of psychosis, in particular in the ICU, to increased stress induced by hospitalization, to increased sensitivity to pain, to hypertension, or even the onset of mental health problems.

 

Sleep, a key to recovery: hospital noises obviously have disruptive consequences on sleep and technical noises, from trolleys in particular, have a greater negative effect on awakening than human voices. Recovery after hospitalization is also compromised. Thus, in patients treated during noisy periods, the incidence of rehospitalization is higher than in patients treated in a quieter hospital environment.

 

Patients testify: they report - according to the authors, themselves hospital workers - that hospital noise can have a cumulative effect on their hospital experience. Patients hospitalized for several nights feel trapped and stressed, which promotes requests for premature discharge from the hospital and an increased risk of trauma and readmission.

 

Urgent measures to take:

• Accurate methods of assessing sound levels, when noise is often incorrectly associated with high sound pressure levels. Branches, for example, may record low sound pressure levels when the sin environment is actually noisy. Reduce sources of noise in hospitals: alarms, televisions, trolleys, ring phones, conversations of staff, visitors and patients. But beware, some noises are also experienced as positive, such as the noise of the catering service or the ringing of a mobile in a situation of isolation. It is therefore important to also review the different forms of noise perception by patients.
• Better inform patients and families about likely noise levels during admissions. But staff education is also necessary to foster a culture that views noise reduction as an integral part of safe, quality health care.
• Provide earplugs as needed, install acoustic treatment panels, and implement educational initiatives and noise reduction protocols.

 

Until now, patients have been seen as passive victims of hospital noise rather than active participants in its reduction. It is essential that future solutions emphasize patient involvement.

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