University Hospitals, the Cleveland Clinic and the Parkinson's Foundation were among the hospital systems who published an article this month laying out standards of care to minimize preventable harm for patients with Parkinson's disease.
Hospitalization is a concern for the 1 million people living with Parkinson's in the U.S., including approximately 30,000 in Ohio, said Annie Brooks, senior director of strategic initiatives at the Parkinson's Foundation. Parkinson's is the second most common neurological disease in the country after Alzheimer's, she said.
"Folks with Parkinson's are at an increased risk of hospitalization when we compare them to peers," Brooks said.
The problem is that hospitals treat patients based on the symptoms that brought them to the hospital, often not accounting for the specific treatment requirements of Parkinson's, she said. One out of every three people with Parkinson's are hospitalized each year, Brooks said.
One of the main risks to patients during their hospital stays is medication mismanagement — including not receiving enough medication, receiving medication that clashes with what they are already taking or not getting their medication in a timely manner, said Dr. Peter Pronovost, University Hospitals' chief Quality and Clinical Transformation Officer.
Parkinson's patients also lack mobility in hospitals, Pronovost said, and are susceptible to dysphagia or difficulty swallowing — which can lead to aspiration pneumonia from food or fluids that are supposed to be limited to the digestive tract but instead make it into the lungs.
Aspiration pneumonia accounts for 25% of deaths in patients with Parkinson's disease, he said.
"Too many patients will go to an intensive care unit, they may be put on a breathing tube on average up to two weeks or longer," Pronovost said.
Patients who stay that long are unlikely to go home afterwards, increasing the incidence of aspiration events.
"And again, many of these things are preventable or at least largely preventable with the protocols and the tools that we've published in our article," Pronovost said.
The article, Protecting Parkinson's Patients: Hospital Care Standards to Avoid Preventable Harm, published in the December edition of The Joint Commission Journal on Quality and Patient Safety, focuses on five best practices to prevent such problems.
The first recommendation is to administer the patient's medication in the same time frame and in the same manner as done at home and ensure that none of the other medications they are given have potentially harmful reactions with their current prescriptions. Secondly, hospitals are encouraged to provide patients with Parkinson's disease with three opportunities to move and be otherwise mobile per day if clinically appropriate. Third, hospitals are recommended to screen patients with Parkinson's for dysphagia, or difficulty swallowing, within 24 hours of being admitted and take measures to avoid aspiration pneumonia.
Pronovost and other experts originally issued the recommendations in an April 2023 report by the foundation, but getting the recommendations approved and published in peer-reviewed journal was necessary to ensure their broader adoption, Pronovost said.
Brooks agreed.
"Getting this level to this level and having peer review helps us to make the case for inpatient administrators," Brooks said.
Pronovost and Brooks say there are currently cohorts of hospitals applying the recommendations and assessing their effectiveness.
The first cohort of 20 hospitals included the Cleveland Clinic, University Hospitals, Hackensack Meridian Health, MidHudson Regional Hospital, Northwestern Medicine, University of Florida Health Shands Hospital, and Vanderbilt University Medical Center.
Their review concluded earlier this year, Brooks said. The next cohort of hospital reviews will begin in January.
"We are building up quite a lot of momentum and really starting to improve care," she said. "It's a long journey. We have a lot more to do. But we have built up some steam."
