Patients who are hospitalized have become more complex over time, according to new research.
In an observational cohort study that included some 3.4 million nonelective hospital admissions and about 1.3 million patients between 2002 and 2017, patients admitted to the hospital toward the end of the study period were more than twice as likely to have been admitted through the emergency department than patients admitted at the beginning of the study period. They were also more likely to receive treatment for five or more acute medical issues and to experience an adverse event while hospitalized.
“For nurses, doctors, and other health professionals, taking care of a patient today is, on average, more complicated than taking care of a patient was 10 or 15 years ago,” study author Hiten Naik, MD, a research fellow at the University of British Columbia, Vancouver, Canada, told Medscape Medical News. “More complicated patients require more time and resources to take care of, and this does create more work. Also, patients with complicated medical issues often need other types of care that may require the involvement of multiple members of the healthcare team as well, such as pharmacists, physiotherapists, dieticians, and occupational therapists.”
The findings were published on January 8 in JAMA Internal Medicine.
Burden on Clinicians
“There is a general sense among clinicians who work in the hospital that patients have become more complicated than they were in the past,” said Naik. “But that notion hasn’t been comprehensively studied in the literature, so we decided to investigate.”
The researchers examined population-based administrative health data to discover trends in the complexity of patients admitted to hospitals in British Columbia from April 1, 2002, to January 31, 2017.
During that period, there were 3,367,463 nonelective acute care hospital admissions among 1,272,444 adults. The median age of the study population was 66 years (range, 48-79 years).
Compared with patients admitted at the beginning of the study period, patients who were hospitalized toward the end of the study period were more likely to have been admitted through the emergency department (odds ratio [OR], 2.74), have multiple comorbidities (OR, 1.50), and require multiple medications (OR, 1.82) at presentation.
These patients were also more likely to receive treatment for five or more acute medical issues (OR, 2.06) and to experience an in-hospital adverse event (OR, 1.20).
The study also found that the likelihood of an intensive care unit stay (OR, 0.96) and of in-hospital death (OR, 0.81) declined over the study period. However, the risks for unplanned readmission (OR, 1.14) and death in the 30 days after discharge from hospital (OR, 1.28) increased.
The increased complexity places an added burden on healthcare professionals working in hospitals, said Naik. “This is an observational study, but looking at the trend is helpful because it gives us a sense of where things may be going, and then we can be proactive. Our results reinforce the notion that healthcare systems should continue to invest in the healthcare workforce to support these patients inside and outside the hospital.”
Workforce Challenges
In an accompanying editorial, Daniel M. Blumenthal, MD, a cardiologist at Massachusetts General Hospital, Boston, endorsed this view.
“As the authors astutely point out, to effectively care for an increasingly complex patient population, we must also prepare our clinician workforce with the requisite skills to manage this complexity — skills that span not just medicine and science but also multidisciplinary team management, leadership, remote care delivery, care transitions, and complex care management,” wrote Blumenthal.
Since the COVID-19 pandemic began, healthcare delivery systems have faced tremendous workforce challenges, including “unprecedented rates” of clinician burnout and attrition, he added.
“In this moment, policymakers and health system leaders — all of us — must stop asking frontline clinicians to do more with less. Instead, we must continue to invest in our workforce and in the systems and care models necessary to effectively manage an aging, and ever more medically complex, populace. If we do so, we, along with patients, will be rewarded,” Blumenthal concluded.
Commenting on the findings for Medscape Medical News, Sanam Ahmed, MD, a critical care physician and associate director of surgery at Mount Sinai Hospital, New York City, said that she is seeing an increase in patient complexity at her center.
“I’ve been an intensivist for 12 years now, and I know that even in that 12-year time span, I find myself asking why everybody is so sick, compared to 12 years ago. COVID delayed care for many patients, and they are now coming into hospital sicker. But we are also getting older as a population. As science progresses, people survive diseases that they would have succumbed to in earlier days, but this survival is at the expense of good health that is generally associated with youth,” said Ahmed.
The study was funded by grants from the Specialist Services Committee (a collaboration between Doctors of BC and the BC Ministry of Health) and the Vancouver Coastal Health Research Institute. Naik reported personal fees from the University of British Columbia Clinician Investigator Program Fellowship during the conduct of the study. Ahmed reported having no relevant financial relationships. Blumenthal reported owning equity in Devoted Health, which is a Medicare Advantage Health Plan, and in Cardiovascular Associates of America outside the submitted work.
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Publish date : 2024-01-18 10:40:18
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