Facility-level and system-level reform is necessary to balance the health needs of hospital-dependent patients with those of the larger hospital community, according to a recent article published in BMC Medical Ethics.
Researchers from Quinnipiac University in Hamden, Connecticut, remark that acute-care hospitals struggle to provide cost-effective care for hospital-dependent patients who often fail to return to their lives following hospitalization because of a condition such as myocardial infarction or pulmonary edema and who may have multiple chronic conditions.
Hospital-dependent patients are often best served by acute-care hospitals, as they may require extensive laboratory capabilities, imaging modalities, and skilled nursing services. In contrast, long-term care hospitals specialize in care for patients who have persistent organ failure and ongoing need for life-sustaining equipment, which hospital-dependent patients do not have. This patient population may cycle back and forth between the acute-care hospital and rehabilitation center or nursing home.
Although hospital-dependent patients may experience sudden and unexpected health problems, in many, their conditions are stable enough to maintain an adequate quality of life in the hospital. The hospital setting may also provide more social stimulation than does their daily life at home, which may outweigh the loss of control they experience as an inpatient.
However, acute-care hospitals risk financial penalties under the Affordable Care Act for the readmission of these patients within 30 days of discharge. Furthermore, with the current increased attention on reducing patient length of stay and readmissions, hospitalists and intensivists may be disproportionately and adversely affected by hospital-dependent patients, as most of their practice involves treating patients in medical units and intensive care units.
The authors argue that physicians are often caught between the best interests of individual patients and the just distribution of healthcare resources. Given the limited resources of the healthcare system, care provided to hospital-dependent patients may be considered unjust and unsustainable when others are denied the care they require. Yet, allocation or rationing of healthcare resources cannot happen at the level of the individual patient, as this may lead to bias and mistrust. Change must come from reform at the facility or system level.
Sung C, Herbst JL. The ethics of caring for hospital-dependent patients. BMC Med Ethics. 2017;18:75.