​Complications that arise after hospital discharge, the so-called post-hospital syndrome, may be a major reason behind high rates of hospital readmission among older patients, according to an August 3, 2018, article in the New York Times. According to the author, about 18% of discharged Medicare beneficiaries in 2016 were readmitted within 30 days. The term post-hospital syndrome was coined by a Yale University cardiologist in 2013. He noticed that patients would come in with a condition like heart failure or pneumonia and then be readmitted with an unrelated condition, such as internal bleeding or injuries from a fall. The cardiologist posited that hospital discharge marks the start of a 60- to 90-day period during which patients are particularly vulnerable to readmission. Post-hospital syndrome is still just a hypothesis, the Times author noted, but research supports its validity. The author contends that one way to avoid the syndrome may be by making hospitals "less destabilizing and more conducive to healing." This could include enabling older adults to wear their own clothes, get out of bed for walks, and eat enough to maintain weight. Hospitals should also reconsider drawing blood before dawn; "We should never wake a sleeping patient unless there's a compelling reason, and that reason shouldn't be our own convenience," the Yale cardiologist was quoted as saying. The article was framed by the story of a woman in her 80s, who had mild cognitive impairment but lived independently before being hospitalized for four days for pain management due to a vertebral compression fracture. After discharge, "the stress and disruptions of hospitalization — interrupted sleep, weight loss, mild delirium, deconditioning caused by days in bed — left her disoriented and weakened." She lost 15 pounds over two months, began wandering at night, and was hospitalized three times during the ensuing year. After that, the woman had to move in with her daughter, losing her independence.

HRC Recommends: Reducing avoidable hospitalizations is important, and not just because of Medicare and Medicaid readmission incentives or penalties. Efforts to reduce readmissions may include measures to ensure high-quality, evidence-based care throughout the patient's stay; comprehensive discharge planning and teaching; and effective coordination and communication with other healthcare providers.