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 Researchers examined data on 555 such people who were discharged
from hospitals back to nursing homes in 2016 and 2017. Some
residents were hospitalized and returned to nursing homes more than
once. Overall, there were 379 complications after 762 discharges..
More than half of the complications were related to poor residential
care resulting in preventable conditions like pressure ulcers, skin
tears and falls, the study found. Another 28% of adverse events
involved infections.
A total of 38% of the complications were serious, 7.4% were
life-threatening, and 2.1% were fatal.
About 70% of the adverse events were preventable, researchers report
in JAMA Internal Medicine.
"Adverse events are occurring due to transition related issues (such
as being released from the hospital too soon as well as
deconditioning requiring increased support from nursing home staff
including monitoring to prevent falls, turning in bed to
prevent/heal pressure ulcers, and gentler handling to prevent skin
tears," said Dr. Alok Kapoor, lead author of the study and a
researcher at the University of Massachusetts Medical School in
Worcester.
"Families should advocate for their loved ones and make sure they do
not leave the hospital too early," Kapoor said by email. "At the
same time many of these patients had multiple hospitalizations and
very poor prognoses suggesting that a more palliative approach
focused on comfort and quality of life may have avoided some
unnecessary trips to the emergency department and hospital."
Patients in the study were 82 years old on average when they were
discharged from hospitals. They were all residents at one of 32
nursing homes in Connecticut, Maine, Massachusetts, New Hampshire,
Rhode Island, and Vermont.
Four out of five patients had multiple chronic medical problems, and
almost three in four were taking 10 or more medications.
Almost one in five complications were already present the day
patients were discharged.
"Improved hospital care, with specific attention paid to minimizing
stressors for frail older adults, should help," said Dr. Kumar
Dharmarajan, chief scientific officer at Clover Health and a
researcher at Yale School of Medicine in New Haven, Connecticut, who
wasn't involved in the study.
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"In addition, since most adverse events happened in the week after
hospitalization, both hospitals and nursing homes should consider
dedicating additional resources to this highest risk period of
vulnerability to ensure that valuable information is not lost in
transition, patients are adequately monitored for new complications,
and treatments are instituted swiftly when needed," Dharmarajan said
by email.
One limitation of the study is that researchers lacked access to
patients' complete hospital records, the study team notes.
Researchers were also unable to look at the associations between
individual patient characteristics or care preferences and the risk
of complications.
"The majority of nursing home residents are elderly, frail, and
chronically ill which puts them at high risk for complications and
readmission after a hospital stay," said Dr. Jennifer Goldstein, a
hospitalist with Christiana Care Hospitalist Partners who wasn't
involved in the study.
"Because these patients often cannot communicate the full details of
their hospital stay or discharge plans, care providers in the
nursing homes rely on discharge paperwork and instructions from the
hospital staff, which may be of variable quality," Goldstein said by
email. "When communication fails, patients don't get the care they
need."
Families may need to step in to make sure communication happens,
said Dr. Deepak Bhatt, a researcher at Brigham and Women's Hospital
Heart & Vascular Center and Harvard Medical School in Boston who
wasn't involved in the study.
"It is important to realize that a nursing home patient who was
recently hospitalized is at very high risk for problems over the
next several weeks," Bhatt said by email. "So don't think they are
out of the woods yet."
SOURCE: http://bit.ly/30OUV1c JAMA Internal Medicine, online July
22, 2019.
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