After returning home from a fabulous vacation or an enjoyable visit with family or friends, you might be keen to go back again. You may even begin making plans for a future trip. Not so when it comes to a hospital stay: whether it was a scheduled surgery or a sudden health scare that took you there, once you’ve been treated and are cleared to leave you’re not planning to come back anytime soon! Yet many do, and often (1).
Frequent use of emergency department and other hospital services has major implications for healthcare systems but also for the patients who tend to have ongoing health problems and a lower life expectancy (2). Since many repeat hospital visits are due to fear, compounded by uncertainty about what to do and expect after going home (3) it’s essential that patients receive clear instructions and have access to the appropriate follow-up care.
Want to avoid repeat trips to the hospital? The following evidence-based tips are a great starting point. Click on the links for details about the related studies.
1. Predict your risk
In Canada, nearly one in ten acute-care patients return to the emergency department after leaving the hospital (4). Some people – including older adults– are more likely to be among that 10% (5). Your age, medical condition, chronic diseases and other factors can put you at higher risk and in need of extra support and strategies for staying well while staying away from the hospital.
Research evidence shows that tools such as the Identification of Seniors At Risk (ISAR) and Probability of Repeated Admission (Pra) can help predict when you’re ready to go home from the hospital and if you’re at high risk of returning (6;7). While these tools are intended for health care professionals, you can advocate for your own care by asking about your risk and what it means for your discharge and care needs.
2. Make a care plan
A comprehensive, tailored care plan – based on your health history and unique circumstances – is an important step towards a successful recovery and reduces the risk of suffering complications that could send you back to hospital. Discharge care plans include clearly outlined steps to follow once you leave the hospital and are an effective way to avoid going back (8). In some cases the plan will involve “case management” in which members of multidisciplinary teams (doctors, nurses, psychologists, social workers etc.) play a role in developing and carrying out the care plan. Don’t leave the hospital without asking your healthcare providers about developing an appropriate discharge plan that will meet your unique needs.
3. Recruit your pharmacist
Older adults and others who take multiple medications are at risk of serious side effects due to drug interactions, which can result in a trip to the hospital. It’s a good idea to get a pharmacist involved even before leaving the hospital to conduct a medication review and give you instructions about your prescriptions, including the correct timing and dosage (9). Once at home, keep your pharmacist in the loop by keeping track of any medications you’re taking and how often, asking for advice and pamphlets about your prescriptions, and enlisting their help to dispose of any unused or expired medications.
4. Access post-treatment care
Sometimes recovery includes follow-up care delivered by medical professionals. But that doesn’t always have to be in a hospital setting. Home visiting programs and transitional care or nurse-led clinics are effective options for people recovering from heart failure and with other conditions (10-13). For people living in areas without specialty clinics or services, support by telephone can work well to check on your condition and you help manage symptoms and recovery.
5. Commit to making lifestyle changes
Often, an unplanned hospital visit is a “wake-up call” for people whose diagnosis was complicated by poor diet, lack of exercise, smoking, substance use or a combination of life-style factors. It’s never too late to make changes that will improve your health and your life – and keep you away from the emergency room. Read more in these blog posts:
– Living with heart failure: Effective self-care is key to coping well
– Diet or exercise: Which works best for weight loss?
– 5 diet changes supported by research evidence
– Exercise for people with heart disease: Can health education help change behaviours?
– 5 tips to help you quit smoking for good
– Sitting too much? Take steps to support healthy aging
Don’t go until you know
If you have to spend time in the hospital, ideally it’s a short stay involving a successful and effective treatment. You may be eager to get back home, but before you’re discharged, make sure you have the information you need and fully understand all the components of your care plan. By preventing a repeat visit to the hospital you’ll have the time and energy to plan more enjoyable trips for when you’re fully recovered!