Tag Archives: Mental Health

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Trauma training is imperative for K-12 students, employees

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A report released by the Lastinger Center for Learning at the University of Florida shows glaring disparities in trauma training for K-12 students and school employees across various districts in Florida.

One can imagine that the story is the same elsewhere in the country as well. In-depth analysis and mapping patterns of adolescent trauma show how the lack of trauma support can be detrimental for students, families, and districts as a whole.

In the 29 districts surveyed, the researchers found that there was no uniform curriculum or training method for district personnel to help children who have experienced trauma.

One could say that the training differed, but mostly they found that there is no clarity in what kind of training should be offered in the first place. This lack of consistency is disturbing in light of recent shootings and makes the need for a statewide framework all the more imperative.

The map includes trauma intervention and prevention programs per county, and the results are telling. It contained a Risk Factor Rating Score (RFRS) for different counties, which showed how counties and districts with more risk have the fewest programs to tackle trauma. Meanwhile, counties like Broward, which has one of the lowest risk factor scores in Florida, has over two dozen programs in place.

The study on current trauma-informed care training was assigned by the Florida Legislature. It is an attempt to reflect on current practices and to identify opportunities for improvement in the area of trauma-informed care training available in the state of Florida.

The research is highly pertinent in light of recent crises on school campuses around the country. With improved systems in place, trained teachers and counselors can play a critical and better role in supporting social and emotional well-being in their students. Students in high-risk counties who have been exposed to trauma have higher rates of anxiety and depression, behavioral problems, and aggression

In another study, a nationwide analysis was done on how current public-school policies address student needs. It shows that, despite the spike in mass school shootings and an increasingly adverse climate of an opioid epidemic on campuses, only 11 states encourage their school districts to train their personnel and have a solid system in place to tackle the effects of trauma or have policies on suicide prevention.

In such a scenario, the role of the guidance counselor has become even more critical. They should be given more focused training on this subject, and they can then share the same with teachers and other school administrators.

Proponents of the cause have stated that schools need to adopt the same rigor for standardization in evaluating mental health resources as they have for additional security. This would go a long way to mitigate potential tragedies related to emotional and social safety.

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Why it might not pay to be a night owl

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Love staying up late to catch up on extra work? You may think you’re a natural night owl — but you could be hurting your overall physical and emotional health.

Intriguing research suggests you might want to flip the switch on your schedule to improve both your work and personal lives. Here’s why:

A study by the University of Surrey in the U.K. found that night owls have a 10 percent higher risk of dying sooner than people who go to bed early in the evening. How come?

Pushing your body clock back has both a psychological and physiological effect on your behavior — you feel more stressed, you eat later (and therefore store more calories), and you tend not to exercise the later it is.

To right your system and cut your risk of related cardiovascular and neurological disorders, start going to bed one hour earlier for several days until your body is used to falling asleep at a normal time. Then, the next morning, the researchers say it’s very important to spend a few minutes in natural light as soon as you wake up — this exposure will cement the change you’ve regulated for your body clock, plus help you feel more alert during the day and sleep better at night.

The earlier you eat breakfast, the lower your diabetes risk. A study by the University of Illinois Chicago found that people who rose in time to eat a healthy meal between 7:00 and 8:30 a.m. had a lower BMI, improved their diabetes symptoms and/or cut their risk for the disease over time.

On the other hand, people who slept later and ate breakfast between 7:30 and 9 a.m. saw no improvement in their BMI or existing diabetes symptoms and did not cut their risk for developing the disease if they didn’t yet have it.

Losing sleep can potentially cause a 5 percent increase in your chance of developing Alzheimer’s, according to the NIH. The reason is an increase in the protein beta-amyloid, which can clump to form plaque in the thalmus and hippocampus regions of the brain (the parts that are vulnerable to Alzheimer’s). The more sleep you get, the less risk you face.

Less sleep may make you feel isolated from your co-workers. If you snooze less than seven-and-a-half hours a night, U.K. researchers found that you’re 24 percent more likely to feel lonely, isolated and left out of social activities.

This is because sleep disturbance causes a biological response that cements negative thoughts in your head, so you convince yourself you’re completely alone. Rest stops this process and corrects your thinking so you’re more willing to bond with team members on a project and feel good about your work relationships.

Sleep cements concentration. If you don’t get enough shut-eye, you’re not likely to do well on detail-oriented tasks — it’s an established fact of working life. Your best bet — go to bed early, get eight hours of sleep, then get up, refreshed, and tackle your work.

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Palliative care: A slippery slope for hospice providers?

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Hospice and palliative care have traditionally been two distinct services, with the former being focused on the last six months of life. More recently, perhaps due to the aging population and shifting beliefs about end-of-life care, hospice is finally becoming more accepted.

The growing number of baby boomers with chronic conditions and the desire to improve quality of life are also contributing to increased demand for palliative care. The response by some providers has been to expand the operation of their hospice programs to accommodate palliative care services.

Medicare and Medicaid requirements have been loosening, and this is leading to patients being enrolled in “hospice” programs even when a physician has not deemed them to only have six months to live.

It is often anticipated and explained to patients and their family caregivers that the patient can be re-enrolled at the end of each six-month period. This should cause healthcare leaders to give pause and consider the unintended consequences and slippery slope of blending “palliative” with “hospice” care.

Should we expect there will be hand-offs from palliative to hospice? Yes, there certainly will need to be smooth transitions. However, these are really two different types of care — just as subacute and skilled nursing; optometry and ophthalmology; psychology and psychiatry; or even podiatry and orthopedics are different.

For each, there is a different scope of care and competencies required by caregivers. They also have different philosophies and approaches to care.

A Health Affairs article clearly defines both types of care and highlights the risks to medical plans/payers who are increasingly reimbursing for home and community based palliative care services. This includes risks to cost, quality and safety.

One potential for risk comes from existing hospice providers who expand services to accommodate this new population. Another is associated with scope creep, when new programs are designed without a clear understanding of the differences between the two populations, their needs, goals and fears.

Consider the mid-stage dementia or cancer patient who is told they are being enrolled in “hospice” care and the confusion or fears they may experience. Perhaps one might even object to seeking or accepting those services. Consider also the nurse or other provider who goes from one patient to another and the risk that they lose sight of whether the older person in front of them is in hospice (preparing for the inevitable) or palliative (working toward recovery) care.

The key comes down to support being provided along with curative treatment versus being provided to those at the end of their life. This becomes a quality of care and safety issue for very sick patients and healthcare leaders.

The question becomes: how do we ensure that each different type of patient gets the care they need? In addition, it also presents risks to the goal of reducing the total cost of care and moving patients out of the hospital more quickly.

The article includes recommendations for medical plans and payers to avoid unintended consequences.

By extension, it is important that hospice providers assess the distinctions between their palliative and hospice services. Home health agencies and other community providers should also begin to recognize the opportunity for new revenue streams that may complement their existing programs or services.

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Teamwork: A crucial healthcare engine

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Healthcare delivery revolves around the cooperation, coordination, and seamless teamwork of multiple individuals, many of whom are highly skilled and educated. Patients are not cared for in a vacuum, and every member of a robust team must play their part in order for outcomes to be as positive as possible.

In this regard, teamwork is indeed a crucial healthcare engine.

Dedicated Individuals and Successful Teams

In order to be optimally functional and successful, healthcare teams must be cohesive and cooperative, with excellent communication skills being one of the core principles of such an endeavor.

Teams are vital and essential to patient care in almost every milieu where healthcare is delivered. When each member is dedicated to the team’s collective goals, the potential for achievement of positive outcomes is much more likely.

Intrapreneurs — individuals who go above and beyond in terms of “owning” their position and autonomously seeking ways to innovate and improve — are often essential as drivers of accomplishment and success. Not everyone has the intrapreneurial spirit, but a few team members who function in this manner can elevate everyone else with their keen interests and insights that elucidate ways for the group to truly shine.

When Problems Arise

In human groups, stratification almost always manifests in terms of certain individuals doing more and “showing up” in ways that other members may not — this is natural, normal, and an aspect of basic human nature that generally cannot be avoided.

In groups where such differences cause rancor or resentment, it’s important for a strong leader to step forward and mitigate these differences as much as possible through the communication of expectations and inspiration. With the goal of a tightly knit and highly functional group, some difficult conversations may need to take place when certain individuals are apparently not as committed as the rest of the team.

Emotional and relational intelligence are key factors when it comes to resolving conflict and advancing individual and collective goals, and a solid leader will use these skills to resolve conflicts and move the team in the right direction.

Learning to Cooperate

Just as some members may be more interested in the team’s success than others, some will also be more cooperative than others. Learning to cooperate, listen, communicate clearly, and move towards the group’s goals are all essential; thus, creating a spirit of cooperation is key.

As mentioned above, the development of emotional and relational intelligence can be a life-saver. These skills can increase cooperation by teaching members how to actively listen, and empathize with and understand the emotions being felt by both themselves and others. Some may think that one’s level of emotional intelligence is set at birth; to the contrary, research shows that these skills can actually be learned and improved over time.

Cooperation is essential to teamwork and group success, and it again falls to leaders to assure that cooperation and excellent communication skills are at the center of group culture.

Healthcare, Cooperation, and Teams

Teams are certainly the driving force of any healthcare facility, group, or institution. From food service and maintenance to the OR and the ICU, teams must come together in order to advance the goals of each team, all in service to the overarching goals of the larger organization.

In all likelihood, each reader of this article has experienced highly functional teams and terribly dysfunctional ones. As in any human endeavor, this is par for the course; however, no team must remain stagnant and unchanging — evolution over time is possible and essential.

For optimal healthcare delivery, teams are at the center of the universe and each member is an essential star contributing their own light. Making those stars shine as one is the ultimate goal of any successful team.

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Are your doctors asking patients the right questions?

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In healthcare, you know how crucially important good doctor-patient communication is. Are the doctors in your organization shedding enough light on the key information needed to make an accurate diagnosis every time?

It’s vital for doctors to utilize the best verbal and nonverbal forms of communication in order to determine what each patient needs. The good news: research has focused on how doctors can perfect their Q&A skills so they get the patient the accurate info they need.

Suggest that your organization’s physicians put this advice into practice:

Be nonjudgmental.

A study from University of Utah Healthfound that up to 80 percent of patients have lied to their doctors, especially about how much they eat and how little they exercise. Top reasons for fibbing: patients said they didn’t want a lecture, or to have their doctors look down on them.

Stress the importance of user-friendly language to your doctors in this regard. Instead of saying, “I asked you to walk three times a week — you aren’t walking at all, are you?” a doctor could reframe things to ask a patient, “Is that three times a week walking schedule working for you, or should we look at another exercise plan?” Showing respect and speaking inclusively will help with patient compliance.

Don’t interrupt out of the gate.

Researchers from the University of Florida, Gainesville and the Mayo Clinic report that patients get an average of 11 seconds to make an opening statement about the symptoms that brought them to the doctor’s office before being interrupted by their physician.

Specialists in particular are notorious for cutting off patient descriptions too soon — only one-in-three doctors make a point of allowing patients to fully outline their situation. Encourage your doctors to refrain from asking any questions until a patient pauses naturally during conversation — that’s the time it’s OK to draw out the rest of the information necessary, without making a patient feel rushed or not properly listened to.

Make sure all potential outcomes are discussed.

Research from the UNC Lineberger Comprehensive Cancer Center found that doctors on average spent less than a minute explaining the specifics of lung cancer screenings to patients. This can lead patients not to understand the impact of false positives, or the potential risks of invasive follow-up — more than 95 percent of lung nodules are actually not cancer.

Stress the importance of laying out all the risks and benefits of any testing to your doctors, so patients can avoid unnecessary worry, pain or risk from screening procedures.

Use point-by-point checklists.

A study from Michigan Medicine found that what patients describe in terms of their symptoms and what doctors actually record in the medical record is often at odds. This may be because doctors misinterpret vague symptoms or rely too much on their gut instincts when it comes to interpreting what their patients say.

A mandatory, point-by-point diagnostic checklist that can be used by your doctors for each patient eliminates the guesswork.

Welcome your input.

Drop in to your doctors’ appointments, with patient permission, for a regular check of how well they communicate and engage. You can then objectively coach your physicians on how to improve their patient interactions. The result: better patient safety and satisfaction.

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Tips on how school counselors can use technology to up their game

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In a time when school counselor caseloads can vary from the desired ASCA model number of 250 students per counselor to a caseload of over 900 students, counseling offices are constantly searching for avenues to produce large results with limited time and resources.

Utilizing new technology is a great way to reach the masses and leave a lasting impression. New apps and websites are constantly hitting the market and can help counselors work smarter and not harder. Here are a few of my favorites:

Communication Tools

School counselors have great resources and opportunities for students and families, yet, we need an avenue to share this information. Many counseling offices use social media such as Twitter, Facebook, and Instagram.

A few years ago, the Remind website was created and changed the student/teacher communication scene tremendously. It has been a highly popular program that allows teachers to text information to students and parents without any personal contact information being revealed.

Teachers as well as counselors have found the resource to be a great way to get information to classes/grade levels in a succinct manner. Students are attached to their phones and will typically check a text message before they look at their email or return a voicemail.

Counseling offices often use the Remind technology to remind families of information nights, deadline dates, new opportunities for scholarships, etc. Prioritizing the announcements that will be used on Remind is important. If overused, students begin to ignore the announcements.

Setting Your Calendar

Meetings, meetings, meetings. School counselors are constantly scheduling meetings or being invited to meetings. Acuity, an online appointment scheduling software, has created a calendar in which students and parents can book an appointment online. There are several similar programs on the market with a similar goal, including Youcanbookme.

By having an online calendar, counselors can avoid the back and forth emails of availability. Online calendars can also provide an increased number of college visits to your high school campus. In the world of college admissions, admission representatives can play a major role in how your school and students are viewed by a college.

Repvisitsv is a software program that was created to increase the relationship between high school counselors and college admission representatives. The website is free and is designed to create an online calendar for college representatives to see the availability of your school for college rep visits and aids in the college representatives travel plans for the year. It is a win/win for both parties.

The program takes out the continuous emails back and forth as to when a rep can stop by for a visit to see your students. By having your school on the website, it could increase the visibility of your school by college representatives that will be in the area for a college fair or campus visit.

Keeping Up

The role of a school counselor in a building varies and can change rapidly. To keep up with the latest trends in the school counseling profession, technology can be an excellent tool. By utilizing counselor groups, following lead counseling organizations (ASCA, NACAC, etc.), and watching the trends of dynamic individual counselors, a school counselor can begin to navigate how they want to shape their program and school.

Blogs, posts, tweets, etc., can help a counselor feel more educated about the changes that are happening in their state, profession, and world. Following a wide range of individuals will keep a counselor in the loop.

Here are some great starting points:

School counseling news: ASCA and state school counselor organizations.

College admission tips: @NACAC and @CollegeEssayGuy, @CommonApp, and colleges and universities that your students want to attend. Several colleges have phenomenal blogs that provide great insight to their admission practices and trends. An example is Georgia Tech’s admission blog.

Industry and workforce trends: Find the industry that best reflects your students, i.e., @USDOL (U.S. Department of Labor), @NCWIT (National Center for Women & Information Technology), etc.

Individual accounts to follow: @LRossSchCnslr, @AngCleveland, @CollegeisYours.

By using electronic devices to deliver information in a trendy manner, counselors are able to connect with their students in a mode that is convenient and efficient.

Talk with your students and families to see which format for social media or application of technology is the best fit for your school and utilize that format as your sole source of information. Once it is established, followers are bound to come and trending is inevitable.

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CVS Health to give $100 million to take on the social determinants of health

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Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. According to the Office of Disease Prevention and Health Promotion (ODPHP), conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.”

In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live. “Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins,” per the ODPHP.

Following on this impact, and CVS Health’s $69 billion acquisition of Aetna, the company announced that it will give $100 million over the next five years to improve community health. Its “Building Healthier Communities” initiative will be funded by the newly combined company and associated foundations. The project’s investments in the social determinants of health include providing screenings and pushing the company’s employees to volunteer locally, CVS Health announced.

CVS CEO Larry Merlo said that the company has long focused on leveraging its diverse set of tools to improve community health, and this program is a natural extension of that work. “Our company’s purpose is helping people on their path to better health,” Merlo said. “At CVS Health, we have a sense of urgency about the need to bring real change to healthcare — because the current system isn’t working, and worse, it’s not sustainable.”

Per the announcement, some of the anticipated funding will be earmarked for expanding CVS’ existing Project Health campaign, which aims to provide people in underserved and underinsured regions with free health screenings, including blood pressure, cholesterol and glucose. CVS will also invest in several local programs, including Meals on Wheels and community health clinics, to reach these patients.

CVS’ statement also said that it will partner with groups like the American Cancer Society and American Diabetes Association to take on some social determinants, in addition of its association with the American Heart Association to invest more than $4 million in adding blood pressure kiosks in a number of regions. Other focus areas will include the opioid epidemic and continued work on smoking cessation, CVS said.

The Aetna Foundation will also spearhead the joint company’s participation in the U.S. News & World Report’s Healthiest Communities rankings, which can identify an individual community’s needs. In addition, CVS employees have pledged 10 million hours’ worth of community service annually, Merlo said.

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Ways to protect your healthcare workers from workplace violence

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Patient-driven abuse: it’s a sad but true reality for nurses, doctors and medical assistants today. As a hospital administrator, keeping your staff safe is obviously an essential priority, and your organization no doubt has policies in place to make this happen. Are those policies as effective as they can be, though?

Reassess your strategies by reviewing and implementing the following research-driven findings:

Mandate reporting.

Healthcare workers underreport violent encounters with patients. A study from Australia’s Curtain University of Technology found that only 1 in 6 incidents of verbal abuse, physical threats, or actual physical assault from patients that nurses experience is reported on average.

This statistic is even more shocking when you consider that this study found three-quarters of nurses have directly experienced such abuse. Don’t allow your nurses to simply adapt to abuse as part of their jobs — correct that mindset by emphasizing that you want them to report every incident, and that you care about their well-being.

Make sure employee debriefing is immediately available.

Patient-driven abuse causes lasting damage. Research from the University of Montreal found that healthcare workers who directly experience or witness any form of abuse by patients are 16 times more likely to develop feelings of anger, fear, disgust, and sadness related to their jobs as well as serious conditions like PTSD.

Employee debriefing should be swiftly deployed for any employee who needs it, and follow-up should be done if employees need further counseling or treatment for any emotional issues they subsequently develop.

Have clear policies in place for your home healthcare-affiliated workers.

A study from Johns Hopkins School of Nursing found that home healthcare workers often face harassment and abuse from patients during home visits and frequently haven’t been given guidelines on how to handle it. Implement clear procedures for documentation of incidents, how to leave leaving a home if need be, understanding the warning signs of violence, and communication/de-escalation strategies so your workers feel safe and in control.

Review your risk assessment strategies.

Meet with your organization’s executives after every incident of reported abuse to make sure everything is being done most effectively when it comes to patient screening and evaluation so future incidents may be more easily predicted and avoided. Consult with security professionals to make sure the measures you have in place are as up-to-date in terms of your organization’s needs as they possibly can be.

Keep on top of your wards.

Immediately meet with the staff on any ward where an incident has occurred to get a fast, accurate overview of what occurred. Reassure your healthcare workers that you are on top of the situation and then back up that promise by reporting back to them on how each case of abuse was fully evaluated and investigated. The trust you build in doing this is invaluable to your organization’s safety goals — and your workers’ peace of mind.

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Study: Female brains may age more slowly

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Anything you can do, I can do better! I can do anything better than you…”

It’s an oldie for sure, but it turns out, the catchy tune by Irving Berlin from “Annie Get Your Gun” might just have been on to something.

It turns out that female brains tend to age more slowly than those of men, researchers report.

Not to Brag, But…

Women’s brains appear to be about three years younger than those of men at the same chronological age on average. This finding could provide one clue to why women tend to stay mentally sharp longer than men, the authors noted.

“Women tend to score better on cognitive tests than men as they age,” said lead researcher Dr. Manu Goyal, an assistant professor at the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis. “It’s possible the finding we’re seeing helps to explain some of that.”

The Science Behind Aging Brains

Scientists have long known that people’s brains change both in function and in structure as they age. “The brain really relies on glucose and oxygen to meet its metabolic needs, and it’s a very large consumer of those resources,” Dr. Goyal explained. “How it uses glucose and oxygen, and in what parts of the brain it uses the most, changes as people…age.”

The study authors recruited 205 people aged 20 to 82 to undergo brain imaging scans that were designed to measure the flow of oxygen and sugar in the brains. That data was then integrated into the computer program.

“When we started looking at [men versus women], we were pleasantly surprised that when the machine was trying to age a woman compared to a man, it consistently aged the woman to be a little bit younger than the man,” Goyal said. “On average, it found that women appeared to be younger than men in terms of their metabolic brain age, in terms of what their brain metabolism pattern looked like.”

This trend held true and was detectable even when comparing men and women in their 20s, the researchers said. They suspect that women initially gain this advantage during puberty.

Important to note, researchers are reluctant to speculate about how (or even if) brain metabolism is related to conditions like Alzheimer’s and dementia.

The full study appears in the Feb. 4 edition of Proceedings of the National Academy of Sciences.

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Study: Patients experiencing high trauma from hospitalizations had more readmissions, ED visits

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Hospitalization can be traumatizing for patients. Previous research shows that one in three patients who survived an ICU stay for an acute lung injury suffer from post-traumatic stress disorder (PTSD). Disturbances in patients’ sleep, nutrition, mobility, and mood are common in medical inpatients, and these disturbances can be traumatic for patients. Traumatic hospitalization can also increase the risk of readmissions and emergency department (ED) visits.

The results of a new study, published in JAMA, show that patients who experience high trauma of hospitalization may have a greater risk of an ED visit or readmission within 30 days compared with patients with low trauma exposure.

Study Shows Association of Trauma of Hospitalization with Increased ED Visits, Readmissions

Researchers enrolled 207 participants into the study. The participants were adult patients admitted to the internal medicine wards of two academic hospitals in Toronto, Canada, between Sept. 1, 2016, and Sept. 1, 2017. All participants remained in the hospital for more than 48 hours. Thirty-nine percent of the participants were female; 60.4 percent were male.

Prior to discharge from the hospital, participants filled out a standardized questionnaire regarding disturbance of sleep, mobility, nutrition and mood while in the hospitalization. The scientists then categorized the responses as disturbance or no disturbance. They classified patients experiencing disturbances in zero to two domains as having low trauma of hospitalization, and those with disturbances in three or four domains as having high trauma of hospitalization.

Nearly all the participants — 92.8 percent — reported disturbances in at least one domain. Sixty-one of the participants, 29.5 percent, had high trauma of hospitalization.

Mobility disturbance and nutrition disturbance were the most common. Among the 207 participants, 78.3 percent reported mobility disturbance, 55.1 percent said they experienced nutrition disturbance, 36.2 percent reported sleep disturbance, and 23.2 percent reported mood disturbance. There was a dose-response relationship between the patients’ length of stay and high trauma.

Within 30 days of discharge from the hospital, 30 of the 2017 participants were readmitted and another 25 visited the emergency department but were not admitted. Compared with their low-trauma counterparts, the high-trauma patients had a 15.8 percent higher risk of readmission or ED visit within 30 days, at 21.9 percent versus 37.7 percent. Even after adjustment for baseline characteristics and propensity score matching, the differences between the high-trauma and low-trauma patients remained significant.

The study was limited in that it included only those patients discharged to home, who were younger and who had fewer co-morbidities, shorter lengths of stay and less severe illness than did the broader population of the internal medicine population. Furthermore, the trauma survey has not been validated, the researchers had not included ED visits and readmissions to other hospitals. Lastly, the study included a small sample size.

“Changing the culture of the hospital will require support from all stakeholders, formation of a shared vision, and removal of organizational barriers. This culture change is key to developing hospitals into places to heal, not to get worse,” the editorialist wrote in an accompanying commentary. Despite successful interventions, such as Hospital at Home and Acute Care for Elders, current hospital care models appear to be detrimental to patients.

The researchers published their results on Dec. 3, 2018.

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