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Hospital Discharge: One of the Most Dangerous Periods for Patients

Kimberley Fowler
By Kimberley FowlerSeptember 7, 2016
Hospital Discharge: One of the Most Dangerous Periods for Patients

For Canadian seniors in hospitals, transitioning back home should be a time of relief, not one of concern. Although it seems counter intuitive, in terms of health, the 30 days after a hospital stay are one of the riskiest times for seniors.

Learn more about why a hospital discharge is one of the most dangerous periods for patients.

Hospital Discharge Risks

The issue is a complex one, but can be boiled down to a handful of factors related to problems within the health care system. These factors include:

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  • Early hospital release and inefficient discharge policies
  • Gaps in patient and caregiver education
  • Poor continuity of care and communication between health providers
  • Seniors taking medication inappropriately (or being given the wrong medication)

According to a report by the Newfoundland and Labrador Senior Resource Centre, “with regard to discharge planning, it is known that to provide optimal service for seniors there needs to be a coordinated and collaborative effort among attending physicians and hospital and long-term-care facility administrators and staff. Yet, even the most clinically efficient hospitals have been found to have inefficient discharge practices.”

In a cash-strapped health care system, many hospitals are increasing ambulatory care and outpatient services which puts increased pressure on the patient, family and home care providers to deliver post-surgery care. In a recent study by Northwestern University, Dr. De Oliveria Jr. noted that:

“When patients are sent home on the same day, a lot is required of them to take care of themselves, and it’s beyond the capability of a lot of older individuals… [because] they have to administer opioids and monitor themselves for emergency problems such as bleeding or infection.”

The study found that early discharge has the greatest impact on seniors, causing serious risks to their health. “Patients 65 and older who have ambulatory surgery are much more likely to be readmitted to the hospital within 30 days than younger patients, regardless of their health before surgery… the likely cause, based on previous research, is difficulty understanding medication dosing and discharge instructions, as well as cognitive impairment among older patients.”

Surprisingly, hospital risks are extremely high for Canadians of all ages. Dr. Rob Robson, former head of the Winnipeg Region Health Authority’s patient-safety unit told The National Post that “one in 13 people coming into the hospital will experience some kind of adverse event — and that’s a conservative estimate.” For seniors, the risk is greater. Northwestern University found that “over a 30-day period, seniors were 54 percent more likely to be readmitted to the hospital compared to patients younger than 65 years, after accounting for differences in other medical problems.”

The Northwestern study found that the risk of readmission to hospital is high for seniors, not because of poor health, but because of age. “Age was the biggest factor associated with readmission and complications. It’s not because they are sicker, it’s because they are older and have trouble understanding their discharge instructions and medication dosing, which often are not clearly explained.” The report by the Newfoundland and Labrador Senior Resource Centre supported these findings, suggesting that:

Seniors are “at increased risk for poor outcomes during the transition process particularly when the move is into a long term care facility,” which is a scenario faced by many Canadian seniors and their families.

The report found that when moving from hospital to a long term care facility, “the stress of the transition may be exacerbated by a breakdown in communication between formal and informal providers of care, poor continuity of care, limited access to services, inadequate patient and caregiver education and other gaps in care experienced by seniors and their families during and post discharge.”

How to Protect Seniors from Discharge Risks

For seniors and their families, most of the factors that increase the risk of hospital readmission discussed here are out of their immediate control. So, what can be done to protect a senior’s health once they’ve been released from hospital?

The best advice is to stay vigilant, ask a lot of questions and make sure you have the information that you need — especially when several health care providers are involved. Some tips include:

  • Ask for copies of pertinent medical information — this will make it easier to communicate clear information to different health care teams, nursing staff who may visit the senior at home, and staff at the senior’s nursing home, retirement community or long term care community.
  • Double check medications and dosage instructions with your doctor, pharmacist and home care or nursing home teams. Your goal is to make sure that everyone is on the same page, the medication is accurate and that it’s being taken regularly as it should be.
  • Do you know who to call if you have a question or something goes wrong? Do you have access to specialists and surgeons or should you call your family doctor?
  • Ensure that discharge instructions are clear and are shared with everyone who is caring for the senior. If something isn’t clear, then ask for more information. This includes small concerns like changing dressing as well as larger issues like warning signs or side effects to be aware of.
  • If there is an emergency situation after hours or you can’t get a hold of your doctor, remember to bring all medical information and medication with you when you go to a walk in clinic or hospital emergency room.

By ensuring that you are properly educated, asking the right questions and coordinating communication with all health care providers, you can help to reduce the risk of senior readmission or other serious side effects after a hospital discharge.

Have you experienced a hospital discharge? How did you keep your senior loved one safe during this dangerous period? Share your stories with us in the comments below.

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Kimberley Fowler
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Kimberley Fowler

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