Post-Hospital Syndrome

| Posted On Jun 05, 2014 | By:

post-hospital syndromeA few years ago, my mother-in-law had a significant heart attack early one morning at home. She was transported to the emergency room near our town then helicoptered to a larger hospital for an emergency catheterization and treatment.  She ultimately made it out of the Cardiac Intensive Care Unit, graduated to a regular floor and was discharged to a rehabilitation hospital for a short stay.  Unfortunately, a week after being there, we got a middle-of-the-night call and were told she had experienced some bleeding and was being sent back to the hospital.  Fortunately, her stay was brief and she was again able to progress to the rehab hospital and eventually home.

She lived with us and was therefore under close supervision as she recuperated (closer than she wanted!)   My sons would walk loops around the neighborhood with her after school to make sure she did her “cardiac rehab.”  I managed her medications and follow-up appointments to make sure we lost nothing in translation.  My husband took her shopping to get her out of the house and to be more active.

She was doing well until about a month after her heart attack when she was become increasingly short of breath. Once again, she went back to the hospital.  This time she was experiencing heart failure, a common sequel after a large heart attack because the heart is not pumping at full capacity.

Nana Roshak was experiencing what we in healthcare call “complications” after her heart attack. She was also, I believe, experiencing “post-hospital syndrome.” 

In the January 10, 2013 edition of the New England Journal of Medicine, this syndrome is discussed and described in an article written by Dr.  Harlan Krumholz, entitled “Post-Hospital Syndrome: An Acquired, Transient Condition of Generalized Risk.”1

In the article, he describes the multiple ways in which the immediate post hospitalization phase can leave patients especially vulnerable beyond what they experience from the medical issue alone. Disrupted sleep, deconditioning, medications and their side effects, and the confusion of having to meet many new caregivers that constantly change are a few of the challenges hospitalized people face.  If you add advanced age, existing medical issues, language or culture barriers, or even an underlying anxiety or depression, it can be a clear recipe for disaster.

Often, the end result is re-admission, like with Nana Roshak. Dr. Krumholz writes, “Recognition of the post-hospital syndrome can provide the impetus for developing novel interventions to promote recovery.”  He goes on to conclude that “Attention to sleep, nutrition, activity, strength, and judicious symptom management may pay great dividends.”  The article is connected to reducing re-admissions, especially within the first 30 day period, but the lessons learned extend beyond reducing re-admissions.

In healthcare in general and at Harvard Vanguard specifically, we are starting to think about this more and to figure out how best we can identify those patients most at risk, anticipate what might be helpful to reduce the chances of post-hospitalization syndrome, and alert families and caregivers to this very real complication of a recent hospitalization. I know for sure there are families like mine who are pushing their loved ones to bounce back fast with the expectation that getting back to “normal” (that is, pre-hospitalization) is the best thing possible.  I really had an “aha” moment after reading Dr. Krumholz’s article. Looking back at my own family’s experience and my experience as a PCP for 20 years, it makes a lot of sense not only to anticipate and recognize post-hospitalization syndrome, but to communicate it more broadly to patients and their families and caregivers.

Would my mother-in-law’s experience have been different if we had been more aware of how vulnerable her hospitalization left her ? Probably not.  Her heart attack was large and had it not been for the time of day and quick EMT response, her outcome could have been different.  I do think, however, that we might have had different expectations about the speed of her recovery, might have had the boys walk her fewer laps, and might have focused more on healthy meals and sleep.  Knowing that there is an extra stress from just having been in the hospital with interrupted sleep, the endless parade of nurses and doctors, and the confinement to bed helps us all put recovery into perspective.

If you or a loved one is or has recently been hospitalized, talk with your caregivers about how best to improve the chances of a measured, positive recovery. Follow up closely with your PCP or specialist to help prevent early symptoms from worsening in the immediate post-hospital days and weeks.  Focus on some of the basics like getting back into activity slowly but surely, nutrition, sleep and simplification of treatment, at least for a while. 

1 Harlan M. Krumholz, MD, NEJM 2013; 358:100-102/January 10, 2013

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About Dr. Jennifer Childs-Roshak

Dr. Childs-Roshak joined Harvard Vanguard in 2012 as a primary care physician in Internal Medicine at our Kenmore practice. She is also site medical director of the Kenmore practice and serves as regional director of our Kenmore, Copley and Post Office Square locations. Prior to joining Harvard Vanguard, she worked at Milford Regional Medical Center, where she served as Medical Director of Quality. She has previously been VP of Medical Services at a community health center in Worcester, Mass. and served as a faculty physician at Maine Medical Center Family Practice Center. She is a graduate of Harvard University and received her medical degree from Temple University School of Medicine in Philadelphia. Dr. Childs-Roshak completed her internship and residency at Maine Medical Center in Portland, Maine and is board certified in family medicine. She also holds a Master’s of Business Administration from the Boston University School of Management. Having been a sandwich generation caretaker, she enjoys working with families who are navigating those waters. Outside of work, she enjoys skiing, hiking, sailing and traveling with her husband and two sons. Other interests include home renovation, theater and music, particularly the BSO.

Comments

  1. One additional condition which caused undue anxiety and stress for me, in my first and hopefully last admission, was having to share a room. With my “roommate” having a large number of visiting family members as well as continuous need for care during the evening, including an Emergency situation at midnight, I had no sleep at all, and was only offered “earplugs”.

    I have had no experience with semi-private rooms in over 50 years, and hope never to experience it again.

    Comment by c.m.Abel on July 16, 2014 at 12:38 pm

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