The pain of repeat admissions

It was past midnight, and my brain was still fogged from pain medication and muscle relaxers. Yet I listened like a devout acolyte as the ER nurse gave instructions on my care at home. I would do anything to prevent those horrible back spasms – and a return trip to the hospital.

Pick up this medication now at a 24-hour pharmacy, and take it right away, the nurse said. Take that one as needed. Do a regular routine of 20 minutes of a heating pad, then stretch for 20 minutes, followed by 20 minutes with a cold pack.

She gave me a sheet of instructions. I asked her questions, as did my wife. I wanted no misunderstandings.

Six hours earlier, I had been on my bedroom floor, lying flat and trying to stay immobile. My lower back, balky for a few days, had just suffered a complete blowout. Whenever I moved, a fist of pain drove into my back, starting spontaneous spasms, making me holler. My lower back had caused trouble before, but now it was in full-scale riot. One of my stepchildren asked whether I was dying. Good question, I thought.

Later, I lay on an ER gurney for hours, in a frozen position, until medication numbed the worst of the pain. There was no structural damage, the X-rays found.

The midnight discharge planning turned out well. The medication did its job, and the nurse’s heat/stretch/cold routine made my back loosen up. A trusted chiropractor helped as well. I followed all the instructions, treating my back like a fragile infant. I stretched more often than a yoga instructor.

The kind of exchange of information I had with the ER nurse – the handoff between hospital and patient – is crucial for any recovery. And that education is a vital step in preventing readmissions of patients within 30 days of hospital discharge, an issue that’s getting increased scrutiny by government insurance programs.

A large number of Medicare beneficiaries – one in five – are readmitted to a hospital within 30 days of discharge, a 2009 study found. Many readmissions are unavoidable, but up to 40 percent are preventable, experts say. The estimated cost of unplanned re-hospitalizations: $17 billion annually.

In an article I wrote for AARP Bulletin – before my summer cataclysm – experts emphasized that readmission often involves a communications breakdown between hospitals and patients or their caregivers. So the instructions and help from a discharge planner, a social worker or (as in my case) a nurse have huge consequences. The readmission rate for Georgia Medicare patients is 17.7 percent, which is middle of the pack among the states, according to 2009 Commonwealth Fund figures.

Nationally, the new health care reform law will require financial penalties on hospitals for excessive readmissions for certain medical conditions.

On our Consumer Corner page, patients and their families can get information on home care after a hospital discharge, in a New York Times article. Insurance often doesn’t cover some of the things patients need, and if possible, families need to get involved. Asking questions is a good thing to do.

And no, I haven’t returned to the hospital since my episode. I am now a stretching machine.