Association of the Trauma of Hospitalization With 30-Day Readmission or Emergency Department Visit

Abstract

IMPORTANCE Trauma of hospitalization refers to the depersonalizing and stressful experience of a hospital admission and is hypothesized to increase the risk of readmission after discharge. OBJECTIVES To characterize the trauma of hospitalization by measuring patient-reported disturbances in sleep, mobility, nutrition, and mood among medical inpatients, and to examine the association between these disturbances and the risk of unplanned return to hospital after discharge. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study enrolled participants between September 1, 2016, and September 1, 2017, at 2 academic hospitals in Toronto, Canada. Participants were adults admitted to the internal medicine ward for more than 48 hours. Participants were interviewed before discharge using a standardized questionnaire to assess sleep, mobility, nutrition, and mood. Responses for each domain were dichotomized as disturbance or no disturbance. Disturbance in 3 or 4 domains (the upper tertile) was considered high trauma of hospitalization, and disturbance in 0 to 2 domains (the lower 2 tertiles) was considered low trauma. MAIN OUTCOME AND MEASURES The primary outcome was readmission or emergency department visit within 30 days of discharge. The association between trauma of hospitalization and the primary outcome was examined using logistic regression, adjusted for age; sex; length of stay; Charlson Comorbidity Index Score; Laboratory-Based Acute Physiology Score; and baseline disturbances in sleep, mobility, nutrition, and mood. RESULTS A total of 207 patients participated, of whom 82 (39.6%) were women and 125 (60.4%) were men, with a mean (SD) age of 60.3 (16.8) years. Among the 207 participants, 75 (36.2%) reported sleep disturbance, 162 (78.3%) reported mobility disturbance, 114 (55.1%) reported nutrition disturbance, and 48 (23.2%) reported mood disturbance. Nearly all participants (192 [92.8%]) described a disturbance in at least 1 domain, and 61 participants (29.5%) had high trauma exposure. A statistically significant 15.8% greater absolute risk of readmission or emergency department visit was found in participants with high trauma (37.7%; 95% CI, 25.9%-51.1%) compared with those with low trauma (21.9%; 95% CI, 15.7%-29.7%), which remained statistically significant after adjusting for baseline characteristics (adjusted odds ratio, 2.52; 95% CI, 1.24-5.17; P = .01) and propensity score matching (odds ratio, 2.47; 95% CI, 1.11-5.73; P = .03). CONCLUSIONS AND RELEVANCE Disturbances in sleep, mobility, nutrition, and mood were common in medical inpatients; such trauma of hospitalization may be associated with a greater risk of 30-day readmission or emergency department visit after hospital discharge.

Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study

“…Delayed discharges have many negative impacts on patient safety, quality of care as well as health system utilization and costs. First, prolonged hospitalization increases risk for adverse outcomes including accelerated functional decline, delirium, pressure ulcers, nosocomial infections and falls [8–12]. Second, delayed discharge creates patient safety challenges by contributing to hospital overcrowding and reduced accessibility to finite acute care resources.…”

180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study

“…In addition, while we captured in-hospital complications, our dataset did not include other events in the hospital (eg, delirium, inadequate nutrition and prolonged immobility) that are more difficult to quantify but may also contribute to readmission risk. 3 4 30 Notably, a recent study by Rawal et al 30 of 207 medical inpatients found that those reporting disturbances in multiple domains of sleep, mobility, nutrition and mood were significantly more likely to be readmitted within 30 days than those reporting little or no disturbance, even after adjustment for age, sex, comorbidity burden, laboratory abnormalities and length of stay. To our knowledge, similar data have not been published for 180-day readmission, and further study is therefore needed to evaluate whether the hospital environment affects outcomes within this timeframe.…”

Melatonin Increasingly Used in Hospitalized Patients

“…Division of General Internal Medicine, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; 2 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 3 HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada; 4 Department of Pharmacy, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; 5 Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.…”