A Hospital Discharge: One of the Most Dangerous Periods for Patients

Last Updated: November 2, 2018

A hospital stay can be a tumultuous time for seniors, but the real danger lies in the 30 days following a senior’s hospital discharge.

Learn more about how to reduce the risks of a hospital discharge in parents and senior loved ones.

A Hospital Discharge

Studies show that when it comes to hospital readmission, age, not health, is the biggest factor — seniors over the age of 65 are at the highest risk of being readmitted to the hospital.

How can healthcare professionals reduce this risk and ease a senior’s recovery? The first step is to understand why seniors are at risk and then ensure that internal processes are in place to help ease these risks.

The reasons that a senior’s health is most at risk after a stay in the hospital are interconnected and include poor transitional care, a premature hospital release and having difficulty understanding discharge instructions.

However, of these factors, medication is arguably the highest risk for seniors who have recently been discharged. Medication poses a broad problem for seniors who:

Are over medicated
Don’t understand how to take their medication
Refuse or forget to take their medication
Take the wrong medication due to an error in the health care continuum of care

Dr. Gildasio De Oliveira Jr. told Northwestern University’s Marla Paul that:

“Seniors, of whom 44% have low health literacy, may have difficulty understanding how medicine is prescribed and take too much or too little. Undertaking pain medication can lead to cardiovascular problems and poor healing of the wound, in addition to increased pain.”

Improper use of prescribed medication is a serious risk that seniors face after they are released from the hospital. However, a more dangerous problem is when the right medication is prescribed, but the wrong medication is administered.

Joyce Osler’s pharmacist made this fatal mistake — an error that her home health care nurses and family didn’t catch in time.

“Medications a pharmacy technician wrote down did not include metolazone [which was the medication her doctor prescribed]. Instead, it listed methotrexate, which can damage blood cell counts, organs and the lining of the mouth, stomach and intestines. The drug is so potent that the Institute for Safe Medication Practices includes it among eight ‘high-alert’ medications with consequences so ‘devastating’ that they warrant special safeguards against incorrect dispensing,” Kaiser Health News reports. These safeguards failed Osler, who was readmitted to hospital two weeks after her discharge. Osler died a few days later.

In Osler’s case, the human error made by her pharmacist caused her death, but the safeguards that are in place to prevent such tragedies failed because of poor coordination within the United States health care system.

“Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs,” Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore told Kaiser Health News. “The most risky transition is from hospital to home with the additional need for home care services,” she added.

Reducing the Risks of a Hospital Discharge

To provide seniors with proper care after surgery, all healthcare professionals involved in the continuum of care (including doctors, home care services and skilled nursing homes, etc.) need to be on the same page. Poor coordination amongst these groups can be life-threatening, as in Osler’s case.

Recent cost-cutting measures are certainly contributing to the risk faced by seniors released from the hospital. An increase in ambulatory and outpatient surgery is being experienced by hospitals across the United States. “Economic pressures to reduce health care costs have resulted in a 300% increase in ambulatory surgeries over the past decade. Now more than 70% of surgical procedures are performed in an outpatient setting, including more complex surgeries, such as hysterectomy, spine surgery and thyroid surgery. About nine million ambulatory surgeries annually are performed on patients 65 and older,” Paul reports.

Releasing senior patients from hospital too soon can contribute to their risk of readmission and cause serious complications including death. “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,” Dr. De Oliveira says. “They have to administer opioids and monitor themselves for emergency problems such as bleeding or infection.”

Seniors often have difficulty understanding surgical instructions, which also contributes to their risk of complications post-surgery. In a study currently underway at Northwestern University, “investigators noticed that a patient, who had had a lumpectomy, removed her sterile strips holding the wound together instead of just changing the gauze. She had to return to the surgeon. Another patient took four opioid pills an hour instead of four a day and ended up in the emergency room.”

Ultimately, it’s up to health care professionals to exercise diligence in their commitment to reduce the risk of readmission in their senior patients. To do this, it’s important to keep seniors who aren’t able to care for themselves post-surgery out of ambulatory care. “Before allowing patients to get ambulatory surgery, surgeons should verify if patients are able to take care of themselves at home and if they have support. If not, patients should be admitted to the hospital after surgery or have some type of formal support by a nurse to help them at home,” Dr. De Oliveira recommends.

It’s also critical that hospital caregivers provide clear, understandable discharge instructions to the senior patient and their healthcare team. In fact, Dr. De Oliveira suggests creating instructions especially designed for seniors and their families.

Who is responsible for coordinating senior care after a hospital discharge? When the answer is unclear caregivers and home health care teams need to step in to follow up with a patient’s surgeon, doctor and pharmacist to ensure the right medications are being taken properly and that after-care instructions are understood and being followed. In a fragmented health care system seniors are relying on their immediate caregivers to fill in the holes to reduce the risks they face once they’ve been released from the hospital.

What have you done to reduce the risks of a hospital discharge? We’d like to hear your tips in the comments below.

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