Most common mistakes patients do that get them hospitalized, sometimes repeatedly.

Do you notice that some patients need recurrent hospitalizations?

I have been a medical doctor for more than 15 years. I work primarily in the hospital. In the last decade I saw multiple readmissions with the same problems. Some of the most common conditions with which the patients get admitted repeatedly or congestive heart failure, chronic obstructive pulmonary disease/COPD, falls with fractures, altered mental status due to repeated infections, acute kidney injury, electrolyte disturbances like hyponatremia, hypokalemia causing symptoms, bleeding through the gastrointestinal or urinary tract, intractable pain, intractable nausea and vomiting etc. I wanted to list some of the most common conditions or issues that make the patient’s get hospitalized.

• Not taking medications as prescribed: Lot of people stop taking medications once they start feeling better. Some medications like, for example, heart medications or blood pressure medications cannot be stopped just because you are feeling good, without telling your doctor. Let doctors decide if they need to be stopped. A patient, who had a heart attack and had a stent placed, is given medications which must be taken as recommended by the cardiologist. If those meds are stopped prematurely, stent can close and cause heart attack again.
• Not following up with primary care physicians or specialists: After a hospitalization, all patients should ideally follow up with either family doctor or a specialist within a week or two to make sure everything is going well. Some patients don’t due to several reasons and they could get hospitalized again.
• Not making or keeping follow-up appointments: Everyone should see a family doctor once or twice or even multiple times a year depending on your medical history. Some patients come to hospitals because they did not see any doctor for years and now suddenly, they have multiple medical problems all together at one time. Patients with uncontrolled blood sugars should follow-up with family doctor or endocrinologist to make sure the blood sugars are well controlled otherwise they will develop conditions like gastroparesis which can cause recurrent vomiting and abdominal pain leading to hospitalizations.
• Not adhering to a recommended treatment plan: Some patients stop taking antibiotics after a couple of days instead of the full course or sometimes, they don’t fill their prescriptions for important medications. This can cause problems.
• Not making necessary lifestyle changes, such as quitting smoking or losing weight: Lifestyle changes are very important in preventing disease. There are thousands of patients who come with exacerbation of emphysema/COPD with shortness of breath and cough every year. All that this patient should do is quit smoking early in life to prevent the problem to begin. Once a person has COPD, even if they have quit, they might still get exacerbation but the frequency and worsening of their condition will be far less. Good dietary habits and lifestyle changes like quitting smoking and minimizing alcohol intake are very important to prevent disease and hospitalization.
• Not understanding the warning signs of a condition and seeking care too late: We see a lot of patients with infections at different different sites. For example if patient has had a recent surgery and they should be able to recognize early signs of postoperative infection otherwise infection after surgery can be very difficult situation to be in. Sometimes we see patients coming a little bit late after infection started after a dog bite and the infection can go into the bone requiring several weeks of IV antibiotics at home. It is very important to seek medical attention as early as possible once you recognize the early signs of disease.
• Not being able to afford medications or follow-up care: We see a lot of patients come to the hospital because they are unable to afford the medications. If they are on insulin, they may be taking lower dose than required trying to stretch their supply of medication and that can cause problems.
• Not having access to transportation to get to appointments: A lot of patients have issues with ambulation or transportation. We see them canceling their appointments with doctors and finally a surgery coming when they are feeling sick and ended up calling the emergency medical services to bring them to the emergency room and get hospitalized. These are related to social economic issues, but family and friends help in this regard is very useful.
• Not having a support system to help with recovery and management of chronic conditions: Patients with certain kind of diseases need a lot of support from the family and friends. This is more important if the patient has issues with ambulation or unable to drive.
• Not understanding or being able to communicate with healthcare providers: Sometimes the problem agrees with the unclear discharge instructions or inability for the patient to understand the discharge instructions. Due to multiple medical issues the patient has, discharge instructions sometimes are also complex. It may be difficult for the patient to understand the sequence of follow-up plan that they need to adhere to after discharge and then the all the confusion they get admitted to the hospital.
• Drinking too much water: Sometimes the patient ends up in the hospital because they are drinking too much water more than they should. Patients with heart failure, kidney failure, liver failure, low albumin states, etc. can get in trouble if they drink too much water more than needed. From childhood, everywhere he is told that they should drink a lot of water to keep themselves well-hydrated. This fact is not true once the patient starts having swelling in the legs, and shortness of breath due to fluid overload.
• Drug/Tobacco/Alcohol abuse: We see a lot of patients getting hospitalized due to drug abuse. Bloodstream infections can occur in IV drug abusers. Infections in the heart requiring heart surgery can be a complication of bloodstream infections in these patients. Hepatitis is a very common infection in these patients. Tobacco causes all kinds of health problems. One should never smoke in life if they are health conscious. Alcohol abuse can cause alcohol withdrawal and liver damage in the long term. We see increased admissions in the hospitals after holidays with alcohol withdrawal and some of them require Intensive Care Unit treatment for a few days before they get better. Alcohol also causes recurrent pancreatitis in a lot of patients.
• Dog/cat bites: We see infections from bites by pet animals requiring surgeries and IV antibiotics for weeks occasionally. If a pet animal bites and you notice redness, swelling, fever, pain, seek medical attention immediately.
• Falls after a snow day: This is extremely common and patients come to the hospital with hip fracture or vertebral fractures a day or 2 days after he has no fall. Take every precaution to avoid falls especially during winter months.
• Dehydration: This is a very frequent reason for hospitalizations. Patient’s go out to sporting events or other activities and do not drink enough water. The outside weather may be warm and combination of these leads to dehydration, hypotension and syncopal episodes. Make sure you are well-hydrated during these events especially with the weather is warm. Falls can lead to fractures or other injuries like concussion if they hit the head during the fall.
• Not knowing potential medical issues that could arise: Every person or caretaker should be aware of certain medical conditions that could arise after being ill recently. For example, COVID-patient should keep an eye on development of post COVID symptoms like shortness of breath, leg swelling, dizziness as blood clots can occur after COVID infection. Early recognition and early medical attention can save the patient from having fatal outcome. A small cut wound in the foot can cause severe infection in patients with diabetes. Since there may have peripheral neuropathy, that wound are currently not giving much pain even though it is getting worse with infection and the patient’s mild delay going to the doctor.
• Taking too much of over-the-counter medications: We see a lot of patients with kidney failure, ulcers in the stomach, uncontrolled high blood pressure in patients taking over-the-counter NSAIDs like Motrin, Advil, Aleve etc.
• Stress and altered food habits: The visiting parents from India can go through a lot of stress staying in USA as their lifestyle, food habits may change and traveling can add to this problem. Disturbed sleep, stressful discussions etc. can increase a blood pressure and cause strokes. It is very important that they are visiting elderly parents be kept calm and comfortable while they are here for visiting.
• Bedbound status: Some patients are bedbound due to dementia, some after traumatic brain injury etc. They need a lot of care including frequent turning or changing positions to prevent pressure injuries/decubitus ulcers. They also need care to prevent aspiration. Head of the bed should be elevated to prevent aspiration. If there is no enough help at home to take care of them, they might better be taken care of from facilities with good staffing support. Some patients who are on ventilator chronically, may develop repeated aspiration, infections, ulcers. It is very challenging to take care of these patients at home or even in specialized centers. Unfortunately, we see them getting hospitalized repeatedly. Make sure everything is being done to prevent pressure injuries, aspiration, and prompt medical attention when needed.

These are only if you have the reasons that caused multiple hospitalizations every year. Every patient and caretaker should know some medical facts as to how to avoid hospitalization.