Emergency room protocols that call for food to be withheld and don't make significant considerations for sleep are sickening up to half of the already seriously ill patients who seek medical attention, according to a commentary published in BMJ Quality & Safety.
"Surgery takes a huge physiologic toll on the body, and forcing sick people, especially the elderly, who are already in a frail state, to fast for eight to 12 hours, or even days, before surgery, only amplifies that stress on the body," Martin Makary, MD., co-author of the commentary, said in a statement. "Subject sick or elderly individuals to those same conditions and each next medical intervention becomes more dangerous as their illness takes a turn for the worse."
The authors use the example of a 65-year-old female patient who develops pneumonia and is too sick to eat or drink for several days before arriving at the emergency room. Upon arrival, medical personnel may withhold food in case she requires certain invasive tests or actual surgery, in which case she may spend more time without food and little sleep due to continuous monitoring.
The combined lack of nutrition and sleep can cause healthy people to develop weakened immune systems and dangerous fatigue within 24 hours. It is common for many pre-op patients to be instructed to not eat or drink anything past midnight on the day before a scheduled surgery, but surgeries are often late the next day or delayed, resulting in extensive malnourished periods.
These recommendations are woefully outdated, the authors wrote, and they cite a protocol called Enhanced Recovery After Surgery that, combined with amended pre-op recommendations, can reduce the average length of stay by two days among colorectal patients and those with other complications.
At Johns Hopkins Hospital in Baltimore where a study was conducted using the ERAS method, costs also decreased from nearly $11,000 to $9,000 per patient.
"Avoidable starvation and induced sleep deprivation are ubiquitous in healthcare. It's no surprise that these factors influence patient outcomes," Dr. Makary said in a statement. "We should view hospitals as healing environments rather than isolated clinical spaces and design patient care accordingly."