A stay in the hospital isn’t always good for your health.
Bright lights, loud noises, sleep deprivation, frequent blood draws and other painful procedures are among the stressors that can take a toll on patients—and might even make them more vulnerable to other health threats once they are discharged, researchers theorize.
But a recent article published in Annals of Internal Medicine suggests a possible remedy for the anxiety associated with hospitalization: Make adult hospitals more like children’s hospitals.
At children’s hospitals, procedures are grouped together, wakeups are kept to a minimum, the décor is bright and cheerful, and patients are encouraged to engage with music and art, among other things.
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The Wall Street Journal spoke with one of the study’s authors, Dr. Kumar Dharmarajan, an assistant professor at Yale School of Medicine, about using pediatric techniques to reduce stress for adults during inpatient stays and perhaps even aid their recovery once they are discharged.
What follows are edited excerpts:
WSJ: Why was it important to study the ways in which hospital procedures can cause stress?
Dharmarajan: Right now almost one in six older adults is readmitted to the hospital within a month of discharge. It’s possible the hospital environment itself contributes to this problem. Bright lights, loud noises and sleep disruptions are techniques used by animal researchers looking to induce stress in labs and are known to contribute to an increased risk of infection, cognitive problems, including depression, and even heart attacks.
How are children’s hospitals different?
Dharmarajan: In pediatrics there is a sensibility that certain medical practices can cause stress, so it’s minimized as much as possible. Pediatricians also actively try to lift children’s spirits. The walls are colorful and cheerful. There are playrooms. Children are engaged in music and art. There are even professionals, called child life specialists, dedicated to addressing psychosocial and developmental concerns of children and their families during hospitalization.
Can you explain more about child-life specialists?
Dharmarajan: They help children prepare for medical procedures in an age-appropriate way, provide pain management, coping strategies and encourage self-expression. They are considered so essential that the American Academy of Pediatrics says child-life services should be included in a hospital’s operating budget.
In the U.S., about 200 institutions are participating in the Hospital Elder Life Program, which uses elder-life specialists, among other interventions, to help prevent older adults from developing delirium [a condition that some estimate affects about one in four elderly patients in the hospital]. There is currently no pervasive equivalent in adult medicine, though in theory, professionals could be trained to help adult patients manage stress, anticipate procedures, and even use music and art to foster self-expression.
Involving the family
What other pediatric practices reduce the stress of hospitalizations?
Dharmarajan: Families are invited on rounds, where the physician and nursing team discuss the patient’s case, so parents are real collaborators in their child’s care.
For adults this is a real, and often missed, opportunity. Family members, who are actually helping to manage a hospital stay or chronic condition, are often left in the dark or left to chase down providers. But they could be a real resource when clinicians come up with a care plan.
In the neonatal intensive-care unit, interventions are often grouped together and done at the same time, so preemies are allowed to rest. We are starting to see some of that in the adult-care setting, too, so rather than wake a patient up at 12 a.m. to check their vital signs, at 2 a.m. to draw blood, at 4 a.m. to give medicine and at 6 a.m. to again check their vital signs, clinicians are doing it all at once.
Dharmarajan: Children also go to a specific room to draw blood or undergo other procedures. The idea is children won’t associate the stress of a procedure with the room where they are sleeping. Their room is a safe space.
But on the adult side, patients are routinely awakened in the middle of the night for blood draws, sometimes by an orderly they don’t recognize. This is particularly challenging for older adults with memory problems. Imagine a stranger in your room in the middle of the night with a sharp needle.
What about cost?
Dharmarajan: This is a potential win-win for hospitals and insurance companies, which are interested in lowering readmission rates and avoiding costly nursing-home stays. Post-acute care sometimes costs as much as an entire hospital stay.
Lisa Ward is a writer in Mendham, N.J. Email her at firstname.lastname@example.org.