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Informing Policy. Advancing Health.

The Patient’s Not Always at Fault

Last month, I had major surgery. Six hours later, I was home. Eight hours after that, I was on my way to the emergency room with internal  bleeding  – “not uncommon” after this operation, the surgeons said.  Why then, I asked the physicians, did they send me straight home after an extensive operation? Why didn’t they keep me overnight in the hospital to make sure everything was as it should be?

“Most” patients, a surgical resident told me, do fine at home. And, she added, sending them home is cheaper than keeping them in the hospital overnight. Yes, but not cheaper than a visit to the ER and a subsequent second surgery followed by two days in the hospital. And it’s certainly not beneficial to the patient’s health.

Efforts are under way in Colorado and across the country to reduce the number of hospital readmissions. Of the more than 39 million hospital discharges a year in the nation, 19 percent of patients experience what research calls “a post-discharge adverse event.” One in five Medicare patients is readmitted within 30 days. The problem affects millions of patients and costs Medicare an estimated $17 billion a year. Why does this occur?

Patients apparently aren’t listening. At least that seems to be the key message emanating from hospitals: Patients and their caregivers don’t follow their discharge instructions. Patients don’t take their prescribed medicines properly. Patients go to the ER rather than to their doctor if there’s a problem after discharge….

My experience, though not a true “readmission,” tells me it’s not always the patient who’s at fault. The surgery I had used to require an overnight hospital stay but is now done on an outpatient basis. Outpatient surgery has been a terrific advance in health care, generally saving money and helping patients heal more quickly. But maybe it’s gone a little too far and is being used a little too often. Patients who’ve had joint reconstructions, mastectomies and other major surgeries are commonly released within a few hours of waking up from anesthesia.

It’s a dilemma: get people out of the hospital or outpatient center fast to save money or risk their return when something goes wrong. No matter how urgent our need to cut health care costs, the health care system shouldn’t gamble with people’s lives. And they shouldn’t always blame the patient when something goes awry. All health policy decisions are difficult to make, but it’s important to remember that each decision affects real live human beings.