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Hospital stays after surgery, or for things like births or illness, tend to be much shorter than they were in the past. A person with pneumonia in the 1950s might have stayed in the hospital for several weeks to a month, and person who had heart surgery could have been in the hospital for an equally long time. Now it’s not uncommon to see people undergo extensive surgery, such as a bypass operation or a hysterectomy, and leave the hospital within a few days.
There are several reasons why hospital stays after surgery have shortened. First, in general, it can be stated that various surgeries are far improved. Some surgeries of the past, like a hernia operation, required extensive cutting. Today, hernia repair may be done laparoscopically, avoiding huge surgical wounds. Even surgeries that involve open-heart procedures are significantly improved than in previous decades, resulting in many patients being able to go home within a few days. Anesthesiology and drugs used to create sedation are also improved, and many surgeries are now done under partial instead of full sedation, which dramatically speeds recovery time.
Certainly, costs associated with staying in a hospital are in part responsible for shorter hospital stays after surgery. Staying in a hospital for an extra day or two can mean astronomical increases in price to insurance companies. In fact, some insurance companies do expect or will only cover a stay of a certain time after a given surgical procedure, provided the patient is not having complications. Doctors can usually ignore such recommendations if they feel a patient is not recovered enough to go home.
Many studies also show that patients tend to recover better at home than they do in the hospital. They tend to get ambulatory (walking or moving) more quickly, and they also enjoy a much more restful environment. Hospitals, as any former hospital patient can attest, are not restful places. Strange noises occur throughout the night and day, you’re interrupted in the middle of the night to have your vitals taken, and you may share a room with an inconsiderate patient or with a patient who has visitors coming and going throughout the night. Most home environments tend to promote greater rest, and they also reduce chances of complications due to infections.
Unfortunately, patients who have hospital stays after surgery, particularly if they’re lengthy, may be at increased risk for developing other infections, due to the presence in many hospitals of antibiotic resistant strains of staph bacteria. Hospital workers make every effort to reduce this risk, yet it is still much more common to develop wound infections or pneumonia from bacteria like MRSA in a hospital, than it is to develop it outside of a hospital. Most doctors discourage patients from staying longer than they need because of this risk.
There are numerous studies that support shorter hospital stays after surgery for most people, and that suggest that many procedures performed in surgery outpatient clinics are just as safe as those performed in a hospital. Shorter hospital stays do place more burden of care on friends or family, which may mean that more people must miss work (both the recovering patient and the caretaker). Another issue of shorter hospital stays after surgery arises for patients who may not have access to help or aid at home.
It can be more than burdensome for a person who doesn’t have help to go home when they still feel awful, and may not be able to perform basic self-care. This may not be taken into account when a patient is being discharged, though many times a doctor will recommend a longer stay for someone who does not have friend or family support at home. Another alternative is to provide nursing care at home after a hospital stay, though this may not be covered by all insurance companies.
Well I think they should at least call you a cab. Every time I have been to the hospital for recurrent c-diff they have released me without a family member to pick me up and I have had to rely upon public transportation to get home. This can be a real issue if you are still suffering from diarrhea, and it has been for me.
Overall though, once I feel able enough to walk out of the hospital I want to leave. The longer you are in a hospital the more likely some intern or resident is to get a wild hair up his butt and subject you to some unpleasant diagnostic procedure. They're like, "here. drink these two gallons
of go-lightly and sleep on the toilet all night so we can perform a colonoscopy in the morning".
So hospitals to me do not represent places to rest. If you want to rest, go home, seriously go home as soon as you can. Even skilled nursing facilities don't allow you to properly rest. You usually share a room with someone who is dying, noisy, noisy and dying in cramped conditions, sharing a bathroom, etc. Taking a shower is problematic in a nursing facility even though you may require one desperately, if you know what I mean. Moreover, have you really ever tried to get any quality sleep in a hospital? Usually, when I arrive home the first thing I do is sleep, for like 12 hours. Private bathroom? Right there. Comfy bed with thick blankets? I'm lying in them. Consider also the issue of being ambulatory. When you are in the hospital you are required to get ambulatory to what, maybe use the bathroom? This leads to pneumonia.
Walking is good, a trip outdoors to the corner market is good. However a good point is raised about the lack of care for patient welfare and well being when hospital staff, prior to discharge, failure to ask how a medicaid patient on disability with an extremely low income is going to get home or what they are going to eat and drink when they get there.
If we lived in a decent socialized society we'd understand that the cost of a cab ride home is much less than five minutes (on average) spent in a hospital.
Also, what about a follow up call asking how the patient is doing? Are they all right? Do they have enough to eat? The idea that someone actually cares whether you recover or not is extremely reassuring and can only help the patient recover.
I always have to call back with some stupid question I have and when I do I always remind myself "there are no stupid questions, only stupid people". "Caring" is the operative word. So short stays that reduce the risk of infection to the patient and allows them to rest more is a good thing.
Discharging them and forgetting they exist is not. Making sure they have a safe and stress free way home is simple and easy and ought to be done. Making sure the patient has groceries or medical supplies is important or well, especially where poverty or lack of family support is an issue.
Even if the patient has food at home, it may be a diet they cannot tolerate because of their illness and they might not be able to afford the food they can eat.
Also, I should say I was discharged from a hospital after having lower back surgery, and the day I arrived home I suffered the most excruciating pain I have ever felt. An ambulance had to be called, I was given a huge dose of morphine and taken back to the hospital's ER where I lay in a morphine induced coma of sorts for like 10 hours while they found a skilled nursing facility that would take me.
The real problem is that in the USA no one really cares about anyone else the way we should. The bottom line is checking to see that someone is okay, whether they are lying in a hospital bed or on a street corner. If you want "care" you have to live in a caring society, bottom line.
I think this is appalling! I just watched a video about prostate surgery care, and the whole effort was to dump onto the patient and his poor, inexperienced wife all of the nursing care, medical training in bandage replacement, surgical catheter care, management of infection and emergencies, and all other technical medical care that should completely and appropriately be the business of the hospital, its medically oriented accommodations and equipment, and its nursing staff to provide for the patient for the longer, appropriate recovery time that used to be, and should be, the province of the hospital to provide.
Current practice is inexusably poor medical care. Nonsense that there are more germs and risk of infection in the hospital. What
environment should be more scrubbed thoroughly and antiseptically clean than a hospital - that is its job! That is what it should be prepared to do, as its essential business. Home environments aren't in the business of being prepared for being antiseptic or prepared for medical care.
Hospitals have the nursing staff, the specialized medical equipment and facilities, and the professional knowledge to provide recovery care following surgery, or for sickness, and they are not doing it.
No lay family member or surgically wounded or sick patient can possibly match this care, or learn in a 15 minute video, or even a few hours or day of onsite instruction, how to manage all the apparatus, infection, potential emergencies, or even simple acts such as showering (homes do not have special hand showers etc. or other facilities that hospitals have inherently by design) in the same way trained medical professionals and para-professionals do.
Patients should be in the hospital for the traditionally longer and appropriate recuperation periods that they used to be and need to be (days and weeks, not hours or barely a day) to be properly nursed and cared for until they are truly sufficiently recovered to return home.
They should not be dumped out the door full of tubes and barely bandaged wounds, traumatized and confused, with a bag of band aids and a cursory instruction on how to nurse themselves, and sent home as a burden on their equally unprepared and overwhelmed family, with instructions to call the emergency room if something goes wrong.
This is do-it-yourself medicine - barely a step away from the doctor and hospital just handing them a scalpel and a do-it-yourself video and telling them to take their own prostate out, their own appendix out, do their own heart bypass, etc. This is utterly ridiculous, appalling and atrocious and seems to be just medicine as a business -- maximizing the amount of patient turnover through a hospital room, and thus income, rather than providing true medical care.
The massive selling (which is what it is) of gastric bypass surgery, when sound and disciplined dietary practices and training are perfectly sufficient 95 percent of the time; the selling of orthopedic procedures (hip replacements, knee replacements), other dubiously necessary surgeries and drug prescriptions, the marketing of hospitals and expansion of branches of them out into the suburbs, etc. suggest that medicine has become a business all about money, with the practitioners' self interest first, and not a profession of providing medical care, with the patients' interest first.
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