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The woman was rolled into the emergency department by paramedics. Struggling to breathe, she bent forward, hands on her knees, using gravity to help expand her chest.

“This all started when she was admitted, and now she’s worse,” her husband told me. A few weeks earlier, pneumonia had put her in the hospital for five days. When her oxygen levels improved she was discharged, but at home she struggled to get out of bed, and couldn’t shake a deep fatigue. The day I saw her in the E.R., her breathing was becoming increasingly labored.

Her lungs sounded quiet and clear, but her heartbeat was rapid. Her forearms were covered with red and purple bruises, the aftermath of daily blood tests. Her face was gaunt; her lips were dry. According to her husband she rarely slept, and ate poorly, while in the hospital. She was losing weight.

Her husband’s description led me to a diagnosis that my colleagues and I are increasingly recognizing: post-hospital syndrome.

It’s long been known that hospitals can be the source of illness — 1.7 million Americans develop hospital-acquired infections each year. But post-hospital syndrome is something different and more ominous.

In a 2013 paper, Dr. Harlan Krumholz, a professor of medicine and public health at Yale School of Medicine, described a syndrome that emerges in the days and weeks after a hospital stay: “Physiologic systems are impaired, reserves are depleted, and the body cannot effectively avoid or mitigate health threats.” He called this period of vulnerability “post-hospital syndrome.”

The syndrome was identified as a result of new Medicare rules that hold hospitals responsible for re-admissions within 30 days after discharge. When health systems began studying patients who returned to the hospital soon after discharge, two critical facts emerged. First, the problem is common and widespread, occurring after nearly one in five hospitalizations of patients on Medicare. Second, and even more surprising, the majority of cases represent an illness distinct from the initial hospitalization.

Post-hospital syndrome is therefore not a relapse, it is a state of susceptibility that most often leads to a new affliction. Infections, for instance, which are known complications of a hospital stay, were just one small category of post-hospital illnesses tracked in a large study of Medicare admissions. Others included heart failure, gastrointestinal conditions, mental illness, nutrition-related problems, electrolyte imbalances and trauma (probably from falls and weakness).

My patient was an example of this. After the hospital stay, her body’s defenses were crippled and dehydration, nutritional depletion and overall weakness took a toll. But her pneumonia — the reason for her initial hospitalization — had resolved.

Last month in JAMA, Dr. Krumholz and Dr. Allan Detsky, a professor of health policy at the University of Toronto, for the first time described precisely how to fix post-hospital syndrome: fix the hospital

“In many ways the hospital environment can be the opposite of healing,” Dr. Krumholz said.

Beeping machines, frequent needle sticks, unpredictable waits to see the doctor, unappetizing food and sleep deprivation are among the barrage of stressors he cites.

“The result is that hospitalized patients are often deconditioned, in pain, malnourished, stressed, with circadian disruptions,” he said. “And we ask why patients return to the hospital? Maybe it’s what we’ve done to them.”

To help solve the problem, Drs. Detsky and Krumholz have proposed sweeping changes in hospital care. Their recommendations range from more cheerful décor and preserving dignity by having patients wear their own clothing, to reducing needles and procedures. In the kind of self-searching language rarely seen in scientific journals, they call out most hospitals for serving a “draconian unsavory diet” at a time when eating well is critical for healing. They also cite sleep deprivation caused by machine alarms, unnecessary wake-ups, and preventable room traffic.

Ironically, the intensity with which medical providers work to cure the problems that bring a patient into the hospital may be creating the very problems that bring them back. “Our mentality is that the hospital is a battlefield, and everyone will have to deal with the fallout,” Dr. Krumholz told me. Post-hospital syndrome, however, suggests that patients can be the victims of friendly fire.

My patient began to look and feel better with intravenous fluids, and her breathing eased. When her primary care doctor arrived, we devised a plan for her second hospital stay. Her husband brought in her favorite foods each day, and jealously guarded her sleep. Physical therapists worked with her to quickly increase mobility. And her doctor ordered that needles and procedures be avoided whenever possible. Within three days she was home, functional and slowly recovering.

Many of the changes proposed in the paper have already been put in place in some institutions. In pediatric hospitals, certainly, décor is often bubbly and bright; painful procedures are minimized. Most hospitals now have wards that offer, at a cost, amenities including better food, and service that is centered around a patient’s needs — proof that care can be structured with the patient in mind.

Of course, hospital care represents a vast industry with many stakeholders, and whether fundamental change can happen, or how quickly, remains to be seen. Modern medicine is famous for being slow to adjust to new evidence.

But Dr. Krumholz is focusing on the basics. “There doesn’t have to be all this collateral damage,” he said. “We can create a healing environment.”



Dr. David Newman is an emergency room physician in New York City and author of “Hippocrates’ Shadow: Secrets From the House of Medicine.”