Hospital patients who experience poor sleep, missed meals or stress may be more likely to be readmitted within 30 days of being discharged, according to a new study co-authored by doctors at University Health Network (UHN) and St. Michael’s Hospital.
The study was published in JAMA Internal Medicine, a journal from the American Medical Association.
Of the 207 patients who participated in the study, 65 per cent reported disturbances in one of four categories – sleep, mobility, nutrition or mood -- while admitted. About 30 per cent of patients reported disturbances in three or more of the categories.
Patients who reported disturbances in three or more categories were classified as “patients with a high trauma of hospitalization” and had a 16 per cent higher risk of readmission.
"Everyone who works at a hospital knows intuitively that the disruptive hospital environment has a profound impact on patients, but with this research, we have a clearer picture of the scale of the problem and we now know that it could affect patient outcomes," Dr. Amol Verma, a physician at St. Michael's who co-led the study, said in a statement.
About 36.2 per cent of participants reported sleep disturbances, 78.3 per cent reported mobility disturbances, 55.1 per cent reported nutrition disturbance and 23.2 per cent reported mood disturbances.
All the patients were admitted to the internal medicine ward at St. Michael’s Hospital and Toronto Western Hospital for more than 48 hours. They were interviewed using a questionnaire to gauge their disturbances while in hospital.
A patient’s sleep patterns were measured by a series of questions related to falling asleep and feeling restful. Mobility was evaluated based on how active patients perceived themselves to be and nutrition was measured based on whether patients’ meals were interrupted, disturbed or missed.
Mood was self-evaluated and based on feelings of anxiety or depression at the time of a patient’s discharge.
Verma said that the study helped point out three major things they didn’t know previously.
"First, we didn't know how common and connected these disturbances were,” Verma said. “Second, we learned that patient experience is linked to patient outcomes and the cumulative effect for disturbances has more impact than disturbance in only one domain. Third, this study suggests that we might be able to improve patient experience and outcomes at the same time."
Dr. Shail Rawal, a physician at UHN’s Toronto Western Hospital and lead author of the study, said that the results of the study provided “a snapshot” into how certain factors can affect recovery.
"The results suggest that enhancing our patient-centred healing environment through initiatives that address these issues may go a long way in improving care,” Rawal said. “And there are gains that can be made without much pain.”
Rawal said that small initiatives such as minimizing alarms at night, offering ear plugs or eye masks, and making food more accessible could help improve the hospital experience and lower the risk of readmission.
Rawal and Verma are working with colleagues in other cities to confirm their findings.
"The next thing is to try to re-design hospital care to try to improve people's sleep, nutrition, mobility, and mood without losing efficiency," Verma said. "Our plan is to try and work with a group of patients, frontline health care providers and everyone else who participates in a patient's care, like hospital meal staff, to co-design an intervention to improve the experience of care in hospital."
