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Cited by 55Hospital Admissions and OutcomesEmergency and Acute Care StudiesIntensive Care Unit Cognitive Disorders

Association of the Trauma of Hospitalization With 30-Day Readmission or Emergency Department Visit

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Rawal, Shail, Kwan, Janice L., Razak, Fahad, Detsky, Allan S., Guo, Yishan, Lapointe-Shaw, Lauren, Tang, Terence, Weinerman, Adina +3 more·2019·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2018.5100PMC PMC6583419
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Abstract

Importance: Trauma of hospitalization refers to the depersonalizing and stressful experience of a hospital admission and is hypothesized to increase the risk of readmission after discharge. Objectives: To characterize the trauma of hospitalization by measuring patient-reported disturbances in sleep, mobility, nutrition, and mood among medical inpatients, and to examine the association between these disturbances and the risk of unplanned return to hospital after discharge. Design, Setting, and Participants: This prospective cohort study enrolled participants between September 1, 2016, and September 1, 2017, at 2 academic hospitals in Toronto, Canada. Participants were adults admitted to the internal medicine ward for more than 48 hours. Participants were interviewed before discharge using a standardized questionnaire to assess sleep, mobility, nutrition, and mood. Responses for each domain were dichotomized as disturbance or no disturbance. Disturbance in 3 or 4 domains (the upper tertile) was considered high trauma of hospitalization, and disturbance in 0 to 2 domains (the lower 2 tertiles) was considered low trauma. Main Outcome and Measures: The primary outcome was readmission or emergency department visit within 30 days of discharge. The association between trauma of hospitalization and the primary outcome was examined using logistic regression, adjusted for age; sex; length of stay; Charlson Comorbidity Index Score; Laboratory-Based Acute Physiology Score; and baseline disturbances in sleep, mobility, nutrition, and mood. Results: A total of 207 patients participated, of whom 82 (39.6%) were women and 125 (60.4%) were men, with a mean (SD) age of 60.3 (16.8) years. Among the 207 participants, 75 (36.2%) reported sleep disturbance, 162 (78.3%) reported mobility disturbance, 114 (55.1%) reported nutrition disturbance, and 48 (23.2%) reported mood disturbance. Nearly all participants (192 [92.8%]) described a disturbance in at least 1 domain, and 61 participants (29.5%) had high trauma exposure. A statistically significant 15.8% greater absolute risk of readmission or emergency department visit was found in participants with high trauma (37.7%; 95% CI, 25.9%-51.1%) compared with those with low trauma (21.9%; 95% CI, 15.7%-29.7%), which remained statistically significant after adjusting for baseline characteristics (adjusted odds ratio, 2.52; 95% CI, 1.24-5.17; P = .01) and propensity score matching (odds ratio, 2.47; 95% CI, 1.11-5.73; P = .03). Conclusions and Relevance: Disturbances in sleep, mobility, nutrition, and mood were common in medical inpatients; such trauma of hospitalization may be associated with a greater risk of 30-day readmission or emergency department visit after hospital discharge.

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  • Prolonged hospitalization increases risk for adverse outcomes including accelerated functional decline, delirium, pressure ulcers, nosocomial infections and falls.

    “First, prolonged hospitalization increases risk for adverse outcomes including accelerated functional decline, delirium, pressure ulcers, nosocomial infections and falls [8–12].”

    From Risk factors, costs and complications of delayed hospital discharge from internal medicine wards at a Canadian academic medical centre: retrospective cohort study (2019) · cites this paper as [12]

    The Introduction (page not provided) says mobility declines during hospitalization and is associated with persistent functional decline. The Discussion (page not provided) links longer stays to more disturbances in sleep, mobility, nutrition, and mood. Our copy does not identify delirium, pressure ulcers, nosocomial infections, or falls as outcomes of prolonged hospitalization, and its length-of-stay finding is an association rather than proof of increased risk. (LLM, conf=0.84)

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Authors
Rawal, S., Kwan, J. L., Razak, F., Detsky, A. S., Guo, Y., Lapointe-Shaw, L., Tang, T., Weinerman, A., Laupacis, A., Subramanian, S. V., & Verma, A. A.
Affiliations
  • University Health Network (CA)
  • Mount Sinai Hospital (CA)
  • St. Michael's Hospital (CA)
  • Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • University of Toronto (CA)
  • Sunnybrook Health Science Centre (CA)
  • Harvard University (US)
Corresponding author
Verma, Amol A.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2019-01-01
Volume
179
Issue
1
Pages
38
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2018.5100
PMC
PMC6583419
OpenAlex
W2902572397
Cited by
55
References
50
Citations by year
2026: 6 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 12 · 2020: 5 · 2019: 6 · 2018: 1
FWCI
7.33
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Keywords
hospital readmission, emergency department visits, sleep disorders, mood disturbance, medical inpatients, patient-reported outcomes, hospital discharge, 30-day readmission risk, length of hospital stay, comorbidities, APACHE II score, patient safety
MeSH terms
Emergency Service, Hospital, Female, Hospitalization, Humans, Inpatients, Male, Middle Aged, Nutrition Disorders, Ontario, Patient Readmission, Prospective Studies, Surveys and Questionnaires, Risk Factors, Sleep Wake Disorders, Mood Disorders, Mobility Limitation

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