By JOAN YEA
Senior Staff Writer
People usually go to the hospital to treat an illness, but staying in a hospital for too long may cause its own health problems. Hospitalization-induced malnutrition and sleep deprivation can cause significant physiological stress in patients, according to a recent commentary published in the journal BMJ Quality & Safety on Sept. 8.
A patient suffering from pneumonia, for instance, is not typically given food and drink while the patient waits to be seen by a senior physician at the emergency department, in case the physician orders invasive procedures. If the physician indeed decides that the procedure is required, the patient continues to be kept on an NPO (no food or liquids by mouth) status, not receiving anything until the procedure has been performed.
Longer waitlists for procedures lead to longer waiting times and can involve last-minute rescheduling for the patient, who is deprived of nutrition and adequate sleep. As may be expected at the end of the process, the patient, having suffered considerable physiological stress, leaves the hospital in a frail state, and may be later readmitted due to post-hospitalization complications, which are commonly dubbed the “post-hospital syndrome” (POS).
In the commentary, Martin Makary, the chief of minimally-invasive pancreatic surgery at the Johns Hopkins School of Medicine, and his co-authors urge hospitals to recognize the importance of addressing preventable yet widespread patient safety concerns like malnutrition and sleep deprivation. The authors of the commentary also argue for the implementation of evidence-based protocols and simple interventions to combat both problems.
According to the authors, reducing the elongated POS period from which many hospitalized patients suffer may require a change in the patient safety culture, which often prioritizes technical achievement at the expense of the importance of the patient’s overall well-being.
Malnutrition, for instance, is estimated to affect as many as one-third to one-half of all hospitalized patients, although this is not well-recognized. Even if malnutrition is noted in some patients, they may still be subjected to outdated but widely used protocols for specialty services, such as surgery, which impose long fasts before and after the procedure.
In fact, prolonged fasting after a procedure such as gastrointestinal surgery may increase the risk of infection and fail to significantly reduce the occurrence of post-operative complications. To reduce the length of surgically imposed fasts, medical institutions may choose to adopt the Enhanced Recovery After Surgery (ERAS) protocol, which has led not only to increased patient satisfaction, but also to shorter hospital stays and fewer cases of post-operative complications at the Johns Hopkins Hospital.
Designed to speed recovery following surgical procedures, the ERAS protocol espouses the curtailment of fasting and pre-medication prior to the operation, the use of short-acting anesthetics during the procedure and early oral nutrition and mobilization in the post-operative period.
In addition to the implementation of novel nutritional programs, which are urged by the ERAS protocol, the review’s authors note that promoting rest and sleep among patients may also help to greatly improve patients’ outcomes and satisfaction. In a noisy hospital environment, patients can often find it difficult to sleep soundly.
According to a 2012 study cited by the writers of the commentary, noise levels at an ICU unit in one hospital were found to exceed 55 decibels 70 to 90 percent of the time and surge to 85 decibels, which is equivalent to the decibel-level of busy city traffic. To mitigate sleep disruptions caused by high noise levels, hospitals may renovate patient rooms with sound-absorbing surfaces to produce a quieter environment.
A 2006 study that enforced this remodeling effort observed that the patients that stayed in the renovated rooms were not only more satisfied with their experience at the hospital but also much less likely to be readmitted in the 90 days after their discharge. Noise levels may be reduced with the help of such interventions and with the conscious efforts of the patient care team.
Smaller interventions, such as noise-reduction headphones and eye masks, could also be used to promote sleep if larger-scale interventions are not feasible. Furthermore, as mentioned by the writers of this commentary, interruptions due to vital signs check-ups may be unnecessarily repetitive with low-risk patients, and disruptions for medications and lab draws should be limited to daytime if possible.
To address preventable malnutrition and sleep deprivation among hospitalized patients, the authors of the commentary proposed that both should become part of standard safety checklists. Though hospitalization-induced harm may be easily overlooked, they do not doubt that patients would benefit from a more humanized approach, which would seek to diminish illness caused by factors besides disease. Many argue that ministering to the basic needs of the patient would greatly enhance the quality of care.