Post-hospital syndrome (PHS) is described as the temporary, vulnerable condition of patients after discharge that puts them at greater risk for
generalized, adverse events that can cause readmission or death for reasons that have nothing to do with the condition for which they were being treated in the hospital.
While many patients may be readmitted due to poor discharge planning, mismanagement of medications, or lack of follow-up, inpatient stress may contribute to readmission more than organizations realize.
Below we’ll share a few ways hospitals can reduce the impact of stress and, therefore,
readmissions that could be caused by PHS.
Enhance discharge post-acute care plans to address the effects of PHS
Make sure you explain PHS to patients and their families so they can watch for warning signs, which may include difficulty sleeping or anxiety. Providing written or electronic guidelines can also prove useful so that patients and their families can reference them and call their physicians, if needed.
Reduce
unnecessary inpatient patient stressors
There are steps that providers can easily take to avoid stressors for patients. For example, work to eliminate some medical equipment noises and other unnecessary disturbances. It’s also important to ensure that you have enough staff to help patients when they need assistance. Don’t get caught up in following a process just because it has been in place for a while; modify process so that you are most effectively meeting patients’
needs.
Serve healthier, tastier food
If patients don’t want the food served in your hospital, this may disrupt their healing process as nutrition is an important element on the road to recovery. One great example is the Good Food, Healthy Hospitals Initiative in Philadelphia. Sixteen hospitals
signed a pledge to offer healthier and more sustainable food and beverage options to patients, staff, and visitors.
Improve patients' surroundings
There are several steps hospitals can take to improve their patients’ surroundings. From providing rooms with cheerful colors and natural light to allowing patients to bring their own clothes rather than wear hospital gowns, even a seemingly minor detail can affect patients’ stress
levels.
Be vigilant about follow-up
Finally, follow-up communication is a crucial step in helping patients avoid PHS. For example, patients may miss signs of a fever or mental health issue, which may be identified by a clinician communicating with them through a care management app, telehealth, or phone visit, or a visit by a home health provider. Follow-up calls should also inquire about patients’ well-being rather than just the condition for
which they were in the hospital.
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Patient education allows patients to play a bigger role in their own care. It also aligns with patient- and family-centered care.
To be effective, patient education needs to be more than instructions and information. Teachers and health care providers need to be able to assess patient needs and communicate clearly.
The success of patient education depends largely on how well you assess your patient's:
Needs
Concerns
Readiness
to learn
Preferences
Support
Barriers and limitations (such as physical and mental capacity, and low health literacy or numeracy)
Often, the first step is to find out what the patient already knows. Use these guidelines to do a thorough assessment before starting patient education:
Gather clues. Talk to the health care team members and observe the patient. Be careful not to make assumptions. Patient teaching based on incorrect
assumptions may not be very effective and may take more time. Find out what the patient wants to know or take away from your meeting.
Get to know your patient. Introduce yourself and explain your role in your patient's care. Review their medical record and ask basic get-to-know-you questions.
Establish a rapport. Make eye contact when appropriate and help your patient feel comfortable with you. Pay attention to the patient's concerns. Sit down
near the patient.
Gain trust. Show respect and treat each patient with compassion and without judgment.
Determine your patient's readiness to learn. Ask your patients about their outlooks, attitudes, and motivations.
Learn the patient's perspective. Talk to the patient about worries, fears, and possible misconceptions. The information you receive can help guide your patient teaching.
Ask the right
questions. Ask if the patient has concerns, not just questions. Use open-ended questions that require the patient to reveal more details. Listen carefully. The patient's answers will help you learn the person's core beliefs. This will help you understand the patient's motivation and let you plan the best ways to teach.
Learn about the patient's skills. Find out what your patient already knows. You may want to use the teach-back method (also called the show-me
method or closing the loop) to figure out what the patient may have learned from other providers. The teach-back method is a way to confirm that you have explained the information in a way that the patient they understand by asking them to act as if teaching it to you. Also, find out what skills the patient may still need to develop.
Involve others. Ask if the patient wants other people involved with the care process. It is possible that the person who volunteers to be
involved in your patient's care may not be the person your patient prefers to be involved with. Learn about the support available to your patient.
Identify barriers and limitations. You may perceive barriers to education, and the patient may confirm them. Some factors, such as low health literacy or numeracy may be more subtle and harder to recognize.
Take time to establish rapport. Do a comprehensive assessment. It is worth it because your
patient education efforts will be more effective.
Bowman D, Cushing A. Ethical practice and clinical communication. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clarke's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 5.
Bukstein DA. Patient adherence and effective communication. Ann Allergy Asthma Immunol. 2016;117(6):613-619. PMID: 27979018
pubmed.ncbi.nlm.nih.gov/27979018/.
Gilligan T, Coyle N, Frankel RM, et al. Patient-clinician communication: American Society Of Clinical Oncology consensus guideline. J Clin Oncol. 2017;35(31):3618-3632. PMID: 28892432 pubmed.ncbi.nlm.nih.gov/28892432/.
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division
of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
When providing patient care it is most important that you maintain effective communication with?
Emt E. When providing patient care, it is MOST important that you maintain effective communication with: your partner.
When caring for a critically ill patient three or more sets of vital signs will allow you to?
When caring for a critically ill patient, three or more sets of vital signs will allow you to: assess trends and to reassess whether the patient's condition is stabilizing, getting better, or getting worse.
When inquiring about a patient's pain it is most appropriate to?
When inquiring about a patient's pain, it is MOST appropriate to: let the patient describe the pain in his or her own words. Normal capillary refill time is: 2 seconds or less.
When a patient presents with two seemingly unrelated complaints it is most important for the paramedic to determine?
When a patient presents with two seemingly unrelated complaints, it is MOST important for the paramedic to determine: which complaint has a higher priority. When caring for a patient who is mentally challenged: you may have to obtain the medical history from a family member.
