Why do hospitals discharge people so early?

Picture of St Helier Hospital in south LondonThese days, if you go into hospital for virtually any procedure or any surgery, chances are high that you will be out in much shorter time than you would have been in the past. I recall reading a book by Judy Blume, titled Deenie, about a girl who had to wear a back brace for scoliosis, and the doctor told her that the options were the brace or an operation. However, the operation would mean months on her back and possible complications. These days, people are up in days and out in weeks following that operation, and nobody wears a Milwaukee brace anymore. However, it seems that more and more procedures are being done on a day or overnight basis, and there is an obvious reduction in after-care and the potential for things to go wrong once the patient is back home.

I know of two women this happened to in the last year and a half. One went in to have a baby last June. The baby had been threatening to arrive for the previous month, but when she did, it was a comparatively quick delivery. They were discharged the next day, but had to return because the baby lost weight because breastfeeding was too difficult, and also developed jaundice. This was a first baby, and when my mother had me (her first) she was in hospital for ten days afterwards. While this may be too long for most mothers, it does allow the nurses and midwives to make sure the baby is healthy and stays healthy, and that breastfeeding is established (not just that the mother knows how to do it), and also makes sure that any early difficulties are handled by people who have seen them before and know what is going on, not an inexperienced young mother on her own.

The second happened more recently; the lady underwent a gynaecological procedure on a day surgery basis and went home late that evening. The surgeon explained what had been found while she was still drugged and so she did not remember much of what she had been told. After she was discharged, she developed an infection and, a few days later, she had to be readmitted. While keeping her in for three or four days afterwards might not have prevented her readmission in this instance, it does seem like quite a big procedure to do in an afternoon and expect the patient to be home the same day (surely they should take some rest before undertaking any journey).

Minimising hospital admissions and stay times has obvious advantages for the patient in terms of convenience, and makes it easier for them to keep in contact with their families; it has advantages also from an infection control point of view. However, one suspects that money is the main motive for this change; it is just cheaper to do day surgeries and let them go than keep someone in hospital and feed them for several days. It does not take into account the fact that things can go wrong and operations can take longer than expected, so they may have come unprepared for a night’s stay or a late-night discharge (fine if people can drive you home, not so if you need to take public transport). Surely, any procedure that involves being opened up under general anaesthetic should not be conducted on this basis, and the reduced risk of complications more than justifies the cost of the after-care.

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