For the last 20 years, it has been a given in the NHS that
patients need to be sent home as soon as possible after an operation or treatment;
‘it’s in the patient’s best interests’.
Ask any patient and they will tell you they were sent home
too early – I certainly was. In my case one extra day would have made all the
difference.
In fact it’s all aimed at reducing the number of occupied
beds and thereby reducing costs.
The assumption that the ‘community’ or ‘family’ will help out
just leaves a lot of vulnerable people at risk.
The problem is that there aren’t the medical facilities and
knowledge available at home. Often there isn’t a family or a community to help
out.
The importance of this study is that it uses survival rates
after hip injuries which are one of a number of international standard for
hospital outcomes. The results for one country are relevant to another; in this
case our results would be worse than Sweden as our community facilities are
worse than theirs.
The fact is that sending patients home too early may save
money but it costs lives.
The answer may well be to have wards with reduced medical cover for those who are recuperating rather than being actively treated;
Short
hospital stays after hip fracture 'may increase risk of death'
Medical
News Today
Wednesday
25 February 2015
A new study
published in The BMJ finds that adults aged 50 and older who are subject to
short-term hospital stays after admission for hip fractures may be at higher
risk of death than those who have longer hospital stays.
Researchers
found that hospital stays lasting less than 10 days after hip fracture was
associated with increased risk of death.
Hip
fractures are an increasingly common problem among older adults, with more than
95% of cases being caused by falls.
In 2010,
there were around 258,000 hospital admissions in the US for hip fractures among
adults aged 65 and older. And according to the Centers for Disease Control and
Prevention (CDC), the number of hip fracture-related hospital admissions is
expected to rise in coming years along with the aging population.
These
admissions put an enormous strain on health care services and costs.
One-way
health care systems have attempted to reduce this burden is by reducing the
length of hospital stays for patients, referring them to home- or community-based
care instead.
However,
the researchers of this latest study - from Umeå University in Sweden - note
that there are fewer sufficiently educated staff outside of hospital settings,
and shorter hospital stays may mean the patient has less time for satisfactory
rehabilitation.
These
points raise the question: does early hospital discharge increase patients'
risk of complications and death?
Patients at
twice the risk of death with short-term hospital stays;
To find
out, the team assessed 116,111 Swedish patients aged 50 and older who had been
admitted to the hospital for hip fractures between 2006 and 2012.
The
researchers analyzed how long the patients stayed in hospital and calculated their
risk of dying within 30 days after being discharged.
Between
2006 and 2012, the team found that the average length of stay in the hospital
for hip fracture patients fell by around 20%, from 14.2 days to 11.6 days.
Compared
with patients who stayed in the hospital for at least 15 days, those who stayed
in the hospital for 5 days or less were twice as likely to die within 30 days of
being discharged, according to the researchers.
In
addition, the researchers found that for patients whose hospital stay lasted less
than 10 days, each 1-day reduction in length of stay was associated with an 8%
increased risk of death in the 30 days following discharge.
Male
patients and those with pre-existing heart, lung or kidney disease were found
to be at highest risk of death in the 30 days after discharge following short-term
hospital stays. Commenting on their findings, the researchers say:
"Our
results suggest that the continuous efforts to decrease length of stay after
major surgery in many countries is associated with higher mortality after hospital
discharge.
In addition
to evaluation of other diagnoses than hip fractures, further research should
seek to gain a better understanding of the underlying cause of the increased
risk of death after discharge in surgical patients, and evaluate whether early
discharge to rehabilitation centers or nursing homes is associated with a worse
outcome."
The
researchers admit their findings are subject to some limitations. For example,
following a hip fracture, risk of death is highest early on. This means that if
a patient's length of hospital stay is reduced, they will automatically be at
increased risk of death. "In the present study, this could bias the association
between length of stay and death during follow-up as length of stay decreased,"
the authors note.
In
addition, the researchers say they were unable to assess whether subjects received
home- or community-based care following discharge, noting that it would be
interesting to see whether one or the other may lead to a more positive outcome.
In an
editorial linked to the study, Peter Cram and Raphael Philip Rush - both of the
University of Toronto in Canada - say these study results may "serve as further
warning to those who seek to discharge patients as quickly as possible."
"As
clinicians we should be aware that, although hospitals are scarce resources, rapid
discharge of patients should be considered carefully," they add. "For
some patients, early discharge is likely beneficial and for others perhaps not.
As policy makers, we should be aware that, while we have the tools to reduce
length of stay, the potential for unintended consequences should not be
forgotten."
In February
2014, Medical News Today reported on a study published in JAMA suggesting that
home-based exercise programs may improve recovery for patients following hip
fracture.
Written by
Honor Whiteman
References;
Length of
hospital stay after hip fracture and short term risk of death after discharge:
a total cohort study in Sweden, Peter Nordström, et al., BMJ, doi: 10.1136/bmj.h696, published online
24 February 2015.
Length of hospital stay after hip fracture:
how low can we go before patients are at risk?, Peter Cram, Raphael Philip Rush,
BMJ, doi: 10.1136/bmj.h823, editorial.
Additional source: CDC, Hip fractures among
older adults, accessed 23 February 2015.
Please use one of the following formats to cite
this article in your essay, paper or report:
Whiteman, Honor. "Short hospital stays
after hip fracture 'may increase risk of death'." Medical News Today.
MediLexicon, Intl., 25 Feb. 2015.
Medical News Today is concerned about it's copyrite; in this case this article is really an abstract of a British medical Journal article and therefore (with the correct attributions) I am reproducing it.
Neil Harris
(a don’t stop till you drop production)
Contact me: neilwithpromisestokeep@gmail.com
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