If you or a loved one have ever been hospitalized, you know that the primary focus of the hospital team is on diagnosing and treating the condition that put you in the hospital in the first place. The medical team works to treat a patient’s condition until the patient has improved enough to continue treatment and recovery out of the hospital.

But recent findings have brought attention to an important issue that doesn’t strike until after you’ve left the hospital — post-hospital syndrome.

What is post-hospital syndrome?

Post-hospital syndrome can be defined as a period of vulnerability lasting up to seven weeks after a patient is discharged from the hospital. This period of vulnerability leaves people at increased risk for rehospitalization from a diverse range of conditions, which are often separate from the original cause of hospital admission. Some patients even face an increased risk of death during this period.

Post-hospital syndrome is caused, in part, by ongoing effects of the original illness. For example, someone who has been hospitalized for pneumonia may experience lingering fatigue, reduced strength, foggy thinking, or constipation after leaving the hospital.

But while providing needed treatment, hospitalization also wreaks havoc on a patient’s physical and emotional stability, and these disruptions also contribute to post-hospital syndrome. During hospitalization, for example, a patient is likely to encounter changes to their diet, routine, sleep patterns, and activity level, and experience stress and medication-induced side effects.

Minimizing the effects of post-hospital syndrome

Fortunately, there are things that patients and their loved ones can do, both during hospitalization and after discharge, to prevent or at least minimize the effects of post-hospital syndrome:

• All hands on deck. Think of hospitalization as an emergency. Whenever possible, enlist a family member, friend, or colleague as an advocate to help with care and support while you are hospitalized.
• Get names. After admission, request a list of doctors, nurses, therapists, and social workers caring for you. This will allow you and your advocate to communicate more effectively with those in charge of your care.
• Plan meeting times. Ask when your doctors, physical therapists, and social workers will be discussing your case and working with you so that your advocate can be included in discussions about care. If it is important that certain family members or friends are present for such meetings, communicate this to your team ahead of time.
• Keep a medication list. Have a current list of your medications available and bring it to the hospital when admitted. After admission, regularly review your current and hospital medication lists with your doctors. This will help to eliminate medication errors and prevent potentially harmful side effects.
• Bring your equipment. If you regularly use hearing aids, dentures, eyeglasses, or mobility aids, such as a cane or walker, take them with you to the hospital, or have them delivered once hospitalized. Make certain they are labeled and kept in a safe, accessible location during your hospital stay.
• Stick to your routine. Whenever possible, maintain a daily routine that closely mirrors your life outside the hospital. For example, if you always have a caffeinated beverage every morning, followed by a bowel movement, make sure you order caffeine for breakfast and make time to move your bowels. Informing the clinical staff of your daily routine is important.
• Keep moving. After being cleared by your medical team, spend as little time in your hospital bed as possible. Lying in bed all day leads to reduced blood flow, muscle loss and weakness. Walk around the unit with a nurse, friend, or aide, as much as you are able, multiple times during the day. Spend time out of bed, sitting upright in a chair while eating meals, watching TV, and reading.
• Rest at the right time. Avoid extended sleep during the day when possible. Try to stay awake until close to your normal bedtime, in order to promote and maintain your body’s natural circadian rhythm.
• Request quiet nights. Request that all medications be given before bed, and ask your nurse or doctor not to wake you for nighttime vitals checks or blood draws. If there is a disruption, do not hesitate to ask nurses to reduce noise, or request earplugs.
• Seek out natural light. Request a room with a bed next to the window when available. Exposure to natural light helps maintain a normal sleep/wake cycle.
• Maintain your normal diet. If you require special dietary accommodations, such as low salt, lactose free, gluten free, or vegetarian, inform your doctors and nurses, and reconfirm these requirements when you order meals.
• Plan ahead for hospitalization. If you have a chronic health condition (heart failure, cancer, dementia, Parkinson’s disease, or difficulty walking, for example), create an “in case of hospitalization plan” with your doctor. This will essentially be a personalized version of the issues discussed here. It is important to think ahead to optimize ways for your hospitalization to go smoothly and reduce the risk and severity of post-hospital syndrome.
• Health care proxy. Assign a trusted advocate (relative or friend) as your health care proxy. This person has the legal standing to communicate your health care preferences to your medical team, in the event that you are unable to do so yourself. Discuss your medical care preferences with your health care proxy in advance.
• Ensure continuity. Before leaving the hospital, confirm you have timely follow-up appointments scheduled with your primary care doctor and appropriate specialists.

It may not be possible to eliminate all of the causes of post-hospital syndrome. But attention to the risk factors during hospitalization may significantly reduce the likelihood of difficulties after hospitalization.

Follow me on Twitter  @jwhymanMD

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