Too often a hospital is more like a battleground than a place to heal. Insurance companies want to hold the line on expenses, hospitals want to maximize use of their services and providers of care want their piece of the action. An interesting new study showed that one factor in how happy patients were with the whole experience was how ready they felt to go when they were discharged.
A recent story on Reuters.com reviewed a study in the Journal of the American College of Surgeons that found that hospitalized patients who felt ready to go home when they were discharged were more satisfied with both the hospital and their caregivers than those who felt rushed out the door.
It was a small study, but it might be useful for medical community members who depend on patient satisfaction for at least some of their remuneration (per Medicare’s patient survey initiative), not to mention anybody who really cares about the quality of the patient experience.
But a key point not to be overlooked is that being ready for discharge was not tied to how often patients were readmitted to the hospital. And readmission rates are a much more significant measure of the quality of patient care, and often patient safety, than subjective metrics.
“In general, the length of hospitalization is determined by the amount of time it takes for patients to return to a state of health that will allow the remainder of their recovery to be done safely outside the hospital,” said the study’s senior author, Dr. Emily R. Winslow of the University of Wisconsin School of Medicine and Public Health in Madison.
The study involved patients hospitalized mostly for small bowel obstruction. Typically, that brings abdominal pain, nausea or constipation and can result from a variety of problems, including hernia or Crohn’s disease. Some patients with the problem need surgery, some don’t. Obviously, how long someone needs to stay in the hospital depends on the treatment need.
The researchers analyzed data from surveys completed by 220 adults admitted to the hospital with small bowel obstruction and 98 patients with other conditions who stayed in the hospital for at least 21 days. One survey question was “did you feel ready for discharge?”
Slightly more than half of the respondents felt “very good” about being discharged. They were deemed to be ready for discharge.
Of this group, nearly 9 in 10 were satisfied with the hospital experience overall; of people who felt less ready to be discharged, only about 6 in 10 were satisfied overall. Patients ready for discharge also were happier with the communication they had with their clinical caregivers.
Slightly more than 1 in 10 people “ready” for discharge were readmitted to the hospital within 30 days; almost twice as many in the less ready group were readmitted.
Hospitals are incentivized to prevent readmissions, as some that occur within 30 days are not subsidized by insurance. So it’s in a hospital’s best interest to make sure a patient is ready to go home.
People might not feel ready to leave the hospital if they don’t believe they’ll get the care necessary at home to continue recovery; they might not have an adequate support system to help with ongoing medical procedures, pain or other symptoms. Elderly people who live alone are more likely not to feel ready to leave hospital care. Insurance coverage and financial issues generally can lead to a shorter hospital stay than what a patient might feel comfortable with.
The best hospitals plan discharge on the day someone is admitted. They ask patients and their families what resources they will need at home, and who will provide them. They demonstrate an interest in the management and continuity of care beyond their own doors.
If you or a loved one is hospitalized, make sure post-discharge plans are made well before they’re needed. For additional information, see Patrick’s newsletter, “You Can Go Home Again (from the Hospital), but There’s a Lot You Need to Know First.”