Background: Post-hospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on aspects of hospitalization that contribute to this decline, but until an in-depth analysis is completed we cannot be certain. Therefore the aims of this project were to identify aspects of hospitalization that are particularly stressful for patients and factors that may mitigate these stressors.
Methods: This was a qualitative study using grounded theory methodology. Over a three-month period, we interviewed general medicine inpatients using a semi-structured interview guide to understand the entirety of their hospital stay. Subjects were recruited from both house staff and hospitalist-APP teams. We first used random and then purposive sampling to ensure diversity. Audio recordings were transcribed verbatim for analysis. One investigator analyzed all transcripts using open coding in NVivo. Data collection and analysis were iterative so that new themes were explored in subsequent interviews. Interviews were completed until thematic saturation occurred. Emerging themes were discussed with the larger study team. Once the coding scheme was verified, we organized themes into bigger categories which resulted in an explanatory model.
Results: We recruited 20 patients from an academic medical center. Of the participants, 12 were women and the mean age was 55. Our model included 3 major themes that led to a variety of emotions that we hypothesize impact the overall experience of hospitalization. Each of the three major themes had multiple subthemes: 1) hospital environment with 5 subthemes (e.g. food quality and cleanliness), 2) patient factors with 6 subthemes (e.g. self-care and patients’ expectations about hospitalization), and 3) hospital personnel with 6 subthemes (e.g. care team size and level of helpfulness of individual workers). There were also subthemes that overlapped between two major themes (e.g. sleep quality and level of comfort). We also discovered a number of emotions ranging from positive (e.g. appreciative) to negative (e.g. feeling like an object) arising from hospital experiences that, together with the three major themes, led to the patients’ perception of their hospital experience overall. An unexpected finding was the tolerance or indifference patients expressed towards things they were unhappy with but felt were simply part of the hospital experience.
Conclusions: This conceptual model clarifies how environment, patient, and personnel factors affect patient emotions and therefore their experience of hospitalization. It provides insight into possible modifiable contributors to post-hospital syndrome, such as sleep quality and care team size, and offers a blueprint for specific quality improvement initiatives. Lastly, patients’ expression of tolerance may suggest we are not getting the full picture with our current surveys and quality metrics.
To cite this abstract:Snyder, HJ; Fletcher, KE . THE HOSPITAL EXPERIENCE THROUGH THE PATIENTS’ EYES. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 217. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/the-hospital-experience-through-the-patients-eyes/. Accessed July 22, 2019.