Akshatha Raghuveer1, Erik Youngson2, Pamela Mathura1, Narmin Kassam1, Finlay A McAlister3,4. 1. Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 2. Alberta Strategy for Patient Oriented Research Support Unit Data Platform, University of Alberta, Edmonton, Canada. 3. Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Finlay.McAlister@ualberta.ca. 4. Alberta Strategy for Patient Oriented Research Support Unit Data Platform, University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca.
Abstract
BACKGROUND: Trauma of hospitalization is characterized by patient-reported disturbances in sleep, mobility, nutrition, and/or mood and one study suggested it was associated with more 30-day readmissions. OBJECTIVE: To define the trauma of hospitalization in medical inpatients and determine whether higher rates of disturbance correlate with adverse post-discharge outcomes. DESIGN: A prospective cohort study was conducted between June 2018 and August 2019 with patients reporting disturbances in sleep, mobility, nutrition, and/or mood. High trauma of hospitalization was defined as disturbance in 3 or 4 domains. PARTICIPANTS: General medicine inpatients at an academic hospital in Edmonton, Canada. MAIN MEASURES: 7-day, 30-day, and 90-day rates of death, unplanned hospital readmission, or emergency department (ED) visit. KEY RESULTS: Of 299 patients (mean age 65.9 years, 47.8% female, mean Charlson score 3.6, and mean length of stay 8.2 days), 260 (87.0%) reported disturbance in at least one domain (most commonly nutrition or mobility) during their hospitalization, 179 (59.9%) reported disturbances in multiple domains, and 87 (29.1%) met the criteria for high trauma of hospitalization. Patients who reported a high trauma of hospitalization did not differ from those reporting less hospitalization disturbances in terms of demographics, burden of comorbidities, or length of stay, but did report higher rates of pre-hospital disturbances in sleep (32.3% vs. 14.4%, p = 0.03), nutrition (77.4% vs. 54.4%, p = 0.02), and mood (41.9% vs. 13.3%, p = 0.0007). High trauma of hospitalization was not significantly associated with death, readmission, or ED visit at 7 days (12.6% vs. 11.3%, aOR 1.13 [95% CI 0.52-2.46]), 30 days (31.0% vs. 32.1%, aOR 1.03 [95% CI 0.59-1.79]), or 90 days (52.9% vs. 50.9%, aOR 1.16 [95% CI 0.69-1.94]) after discharge. CONCLUSIONS: In-hospital disturbances in sleep, mobility, nutrition, and mood are common in medical inpatients but were not associated with post-discharge outcomes.
BACKGROUND: Trauma of hospitalization is characterized by patient-reported disturbances in sleep, mobility, nutrition, and/or mood and one study suggested it was associated with more 30-day readmissions. OBJECTIVE: To define the trauma of hospitalization in medical inpatients and determine whether higher rates of disturbance correlate with adverse post-discharge outcomes. DESIGN: A prospective cohort study was conducted between June 2018 and August 2019 with patients reporting disturbances in sleep, mobility, nutrition, and/or mood. High trauma of hospitalization was defined as disturbance in 3 or 4 domains. PARTICIPANTS: General medicine inpatients at an academic hospital in Edmonton, Canada. MAIN MEASURES: 7-day, 30-day, and 90-day rates of death, unplanned hospital readmission, or emergency department (ED) visit. KEY RESULTS: Of 299 patients (mean age 65.9 years, 47.8% female, mean Charlson score 3.6, and mean length of stay 8.2 days), 260 (87.0%) reported disturbance in at least one domain (most commonly nutrition or mobility) during their hospitalization, 179 (59.9%) reported disturbances in multiple domains, and 87 (29.1%) met the criteria for high trauma of hospitalization. Patients who reported a high trauma of hospitalization did not differ from those reporting less hospitalization disturbances in terms of demographics, burden of comorbidities, or length of stay, but did report higher rates of pre-hospital disturbances in sleep (32.3% vs. 14.4%, p = 0.03), nutrition (77.4% vs. 54.4%, p = 0.02), and mood (41.9% vs. 13.3%, p = 0.0007). High trauma of hospitalization was not significantly associated with death, readmission, or ED visit at 7 days (12.6% vs. 11.3%, aOR 1.13 [95% CI 0.52-2.46]), 30 days (31.0% vs. 32.1%, aOR 1.03 [95% CI 0.59-1.79]), or 90 days (52.9% vs. 50.9%, aOR 1.16 [95% CI 0.69-1.94]) after discharge. CONCLUSIONS: In-hospital disturbances in sleep, mobility, nutrition, and mood are common in medical inpatients but were not associated with post-discharge outcomes.
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