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Hospitalism — Clinical Guidelines

Overview

Hospitalism refers to adverse health outcomes, particularly in vulnerable populations such as the elderly, often linked to prolonged hospital stays, polypharmacy, and medication-related issues leading to increased readmissions and adverse drug reactions. 1 4 5 10 15

Diagnosis

Key Diagnostic Criteria: Increased number of medications, polypharmacy, medication discrepancies at discharge, and medication-related adverse events. 4 10 20 21

Recommended Tests: Medication reconciliation, comprehensive medication review, and assessment of medication adherence and side effects post-discharge. 1 16 20

Management

First-Line Treatments: Medication review and deprescribing to reduce polypharmacy, implementation of structured discharge planning involving pharmacists. 2 4 1 19

Adjunctive Treatments: Use of electronic transfer of care tools (e.g., "Connect with Pharmacy") to enhance continuity of care post-discharge. 9

Special Populations

Elderly: High risk of polypharmacy and medication-related adverse events; benefit significantly from medication review and deprescribing strategies. 4 5 10 15 19

Pediatrics: Risk factors for adverse drug reactions include specific clinical conditions and medication interactions; predictive models can aid in identifying high-risk patients. 3 11

Key Recommendations

Implement structured medication reviews and deprescribing interventions during hospital stays to reduce polypharmacy and prevent medication-related readmissions in older adults. (Evidence: Strong 2 4)

Utilize electronic transfer of care systems to improve medication management continuity from hospital to community settings, particularly beneficial for elderly patients. (Evidence: Moderate 9)

Focus on discharge planning that includes pharmacists to minimize medication discrepancies and enhance patient safety post-discharge. (Evidence: Moderate 1 16)

Monitor and manage the number of discharge medications to predict and reduce 30-day hospital readmission rates in older adults. (Evidence: Moderate 10 15)

Develop and apply predictive models for identifying pediatric patients at high risk of adverse drug reactions to tailor interventions effectively. (Evidence: Moderate 3)

References

1 Marinović I, Baćićrca V, Marušić S, Grgurević I, Brkić M, Jambrek N et al.. Effect of care transfer model led by the hospital clinical pharmacist on reduction of hospital readmissions in the elderly. Die Pharmazie 2024. link 2 Carollo M, Crisafulli S, Vitturi G, Besco M, Hinek D, Sartorio A et al.. Clinical impact of medication review and deprescribing in older inpatients: A systematic review and meta-analysis. Journal of the American Geriatrics Society 2024. link 3 Niehaus IM, Kansy N, Stock S, Dötsch J, Müller D. Applicability of predictive models for 30-day unplanned hospital readmission risk in paediatrics: a systematic review. BMJ open 2022. link 4 DiConti-Gibbs A, Chen KY, Coffey CE. Polypharmacy in the Hospitalized Older Adult: Considerations for Safe and Effective Treatment. Clinics in geriatric medicine 2022. link 5 Glans M, Kragh Ekstam A, Jakobsson U, Bondesson Å, Midlöv P. Medication-related hospital readmissions within 30 days of discharge-A retrospective study of risk factors in older adults. PloS one 2021. link 6 Jones RP. Were the hospital bed reductions proposed by English Clinical Commissioning Groups (CCGs) in the sustainability and transformation plans (STPs) achievable? Insights from a new model to compare international bed numbers. The International journal of health planning and management 2021. link 7 Goniewicz K, Misztal-Okońska P, Pawłowski W, Burkle FM, Czerski R, Hertelendy AJ et al.. Evacuation from Healthcare Facilities in Poland: Legal Preparedness and Preparation. International journal of environmental research and public health 2020. link 8 Bergmans RS, Mezuk B, Zivin K. Food Insecurity and Geriatric Hospitalization. International journal of environmental research and public health 2019. link 9 Sabir FRN, Tomlinson J, Strickland-Hodge B, Smith H. Evaluating the Connect with Pharmacy web-based intervention to reduce hospital readmission for older people. International journal of clinical pharmacy 2019. link 10 Basnet S, Zhang M, Lesser M, Wolf-Klein G, Qiu G, Williams M et al.. Thirty-day hospital readmission rate amongst older adults correlates with an increased number of medications, but not with Beers medications. Geriatrics & gerontology international 2018. link 11 Andrade PHS, Lobo IMF, da Silva WB. Risk factors for adverse drug reactions in pediatric inpatients: A cohort study. PloS one 2017. link 12 Eassey D, Smith L, Krass I, McLAchlan A, Brien JA. Consumer perspectives of medication-related problems following discharge from hospital in Australia: a quantitative study. International journal for quality in health care : journal of the International Society for Quality in Health Care 2016. link 13 Messler J, Whitcomb WF. A History of the Hospitalist Movement. Obstetrics and gynecology clinics of North America 2015. link 14 Kisuule F, Howell EE. Hospitalists and Their Impact on Quality, Patient Safety, and Satisfaction. Obstetrics and gynecology clinics of North America 2015. link 15 Picker D, Heard K, Bailey TC, Martin NR, LaRossa GN, Kollef MH. The number of discharge medications predicts thirty-day hospital readmission: a cohort study. BMC health services research 2015. link 16 Harris CM, Sridharan A, Landis R, Howell E, Wright S. What happens to the medication regimens of older adults during and after an acute hospitalization?. Journal of patient safety 2013. link 17 Gallego B, Perez-Concha O, Lin F, Coiera E. Exploring the role of pathology test results in the prediction of remaining days of hospitalisation. Studies in health technology and informatics 2012. link 18 Miguel A, Azevedo LF, Araújo M, Pereira AC. Frequency of adverse drug reactions in hospitalized patients: a systematic review and meta-analysis. Pharmacoepidemiology and drug safety 2012. link 19 Sikdar KC, Dowden J, Alaghehbandan R, MacDonald D, Peter P, Gadag V. Adverse drug reactions in elderly hospitalized patients: a 12-year population-based retrospective cohort study. The Annals of pharmacotherapy 2012. link 20 Stitt DM, Elliott DP, Thompson SN. Medication discrepancies identified at time of hospital discharge in a geriatric population. The American journal of geriatric pharmacotherapy 2011. link 21 Classen DC, Jaser L, Budnitz DS. Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance. Joint Commission journal on quality and patient safety 2010. link36003-x) 22 Hug BL, Witkowski DJ, Sox CM, Keohane CA, Seger DL, Yoon C et al.. Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention. Journal of general internal medicine 2010. link 23 Hoonhout LH, de Bruijne MC, Wagner C, Asscheman H, van der Wal G, van Tulder MW. Nature, occurrence and consequences of medication-related adverse events during hospitalization: a retrospective chart review in the Netherlands. Drug safety 2010. link 24 Picone DM, Titler MG, Dochterman J, Shever L, Kim T, Abramowitz P et al.. Predictors of medication errors among elderly hospitalized patients. American journal of medical quality : the official journal of the American College of Medical Quality 2008. link 25 Panis LJ, Verheggen FW, Pop P, Prins MH. The impact of hospital discharge on inappropriate hospital stay. International journal of health care quality assurance incorporating Leadership in health services 2004. link 26 Letrilliart L, Hanslik T, Biour M, Fagot JP, Guiguet M, Flahault A. Postdischarge adverse drug reactions in primary care originating from hospital care in France: a nationwide prospective study. Drug safety 2001. link 27 Allen A. A view from the other side of the bed. Journal of post anesthesia nursing 1995. link 28 Jarman B. Is London overbedded?. BMJ (Clinical research ed.) 1993. link

Hospitalism