The Dangers of Hospital Admission 2

The first possible step to avoid the harms of hospital admission is to question how necessary the admission is.

How necessary is your admission?

Always

We are talking about “emergency” admissions – does your current medical condition really justify all the perils inherent in being hospitalised? In some instances their should be little doubt – chief among these are those conditions which need to be treated by immediate surgery – suspected appendicitis, bowel obstruction, some broken bones etc. Amongst the medical conditions, suspected heart attacks and strokes demand urgent admission. In both these, salvaging threatened tissue (heart muscle or brain tissue) depends on  urgent action to restore blood flow to the threatened organ. Delay means loss of this opportunity with worsening of the outcome.

Sometimes

Clinicians and patients should think carefully about whether admission is genuinely necessary. Many conditions can be safely managed through ambulatory care, virtual wards, community services or hospital-at-home models. Avoiding unnecessary admission may sometimes represent the safest option, particularly for frail patients. If you, as the patient or relative, have any doubt, this needs discussion before admission is arranged.

In hospital

What is recommended below is the ideal – but shortage of staff and ill-placed concern for “patient safety” may interfere. You as patient and/or your relatives can make a fuss if necessary to ensure that mobility is maintained.

The first concern will be the prevention of deconditioning which should be addressed as soon as possible after admission. The first hours in hospital are crucial. The pyjama period should be kept as short as possible. A recent survey found that newly admitted patients spend 83% of their time in bed and 12% in a chair which only leaves 5% being mobile!

The patient, and that could include you, dear reader, should be encouraged to get dressed, mobilise early and maintain normal routines where possible. Simple interventions such as sitting out of bed, walking to the toilet rather than using bedpans, and taking short walks along the ward — may substantially reduce decline.

Comprehensive geriatric assessment (CGA) is a particularly valuable framework. CGA involves multidimensional assessment of medical, functional, psychological and social factors followed by coordinated management planning. If things are going badly on the mobility front this can be requested.

Another important preventive strategy is medication review – and again this can be requested.  Don’t be afraid to ask about drug treatment – both those being taken on admission and those added after admission. Sedatives, anticholinergics and unnecessary psychoactive medications increase risks of falls and delirium. Rationalising drug regimens, minimising catheter use and avoiding unnecessary restraints are important components of safer hospital care.

Finally, discharge planning should start as soon as possible after admission and should involve families, community teams and rehabilitation services. Functional decline acquired in hospital often becomes apparent only after discharge, when patients struggle to cope at home. Poor transitions of care contribute to medication errors, readmission and caregiver stress.  Recovery from deconditioning may take weeks or months, and some patients never regain baseline function.

Hospital admission is a potentially hazardous intervention rather than a neutral setting for treatment. Just as clinicians weigh the risks and benefits of surgery or medication, they should also weigh the risks and benefits of hospitalisation itself. Admission may save life and treat acute illness, but it can simultaneously expose patients to physical, cognitive and emotional harm –  and long-trm increase in debility.

Conclusion

The dangers of hospital admission are real, common and frequently preventable. Frailty and deconditioning can develop rapidly, often within hours of arrival. Immobility, delirium, infection, poor nutrition, sleep disruption and overmedicalisation combine to produce significant harm, particularly in older adults. Preventing these outcomes requires a cultural shift in acute care: prioritising mobility, independence, nutrition, orientation and patient-centred care from the moment of admission. Both patient and concerned relatives can play a part in the process.