COMMENTARY

No Return Trips: Hospitals Under Pressure to Lower Readmissions

Shmuel Shoham, MD

April 23, 2015

Infections and the Posthospital Syndrome

This phenomenon now has a name. The term "posthospital syndrome" has been coined to describe an acquired, transient period of vulnerability to a range of adverse health events.^[4] The perturbations associated with acute illness can substantially alter host/pathogen interactions, and often the time and circumstances required for an infection to develop are reached only after discharge. Table 2 lists factors that may contribute to infections after discharge from hospital.

Table 2. Factors That Increase Risk for Infection or Medication Side Effects

Factor	Resulting Impairment	Possible Outcome
Surgical procedure	Surgical wounds	Surgical site infection
Indwelling catheters	Breaks in anatomic barriers	Catheter-associated infections
Encephalopathy and frailty	Aspiration of oropharyngeal contents; skin breakdown	Pneumonia; soft-tissue infections
Anesthetics/sedatives	Decreased airway clearance	Pneumonia
Corticosteroids and immunosuppressants	Multiple host immune defects	Increased rate and severity of infection
Antibiotics	Change in microbiome	CDAD
Gastric acid suppression	Change in microbiome	Pneumonia; CDAD^[5,6]
Malnourishment	Multiple immune defects and impaired wound healing	Increased rate and severity of infection
Imprecise medical plan hand-off to caregiver	Underuse or overuse of key medications; failure to monitor for medication side effects	Recrudescent or new infection; drug toxicity^[7,8]
CDAD = Clostridium difficile-associated disease

1 2 3 4 5 6

Next Section

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Shmuel Shoham. No Return Trips: Hospitals Under Pressure to Lower Readmissions - Medscape - Apr 23, 2015.

The Well-Traveled Patient
Unplanned Hospital Readmissions
Infection and Readmission
Infections and the Posthospital Syndrome
Avoiding Readmissions Related to Infections
Targeting Surgical-Site Infection
References

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.