The hospital’s role in healthcare is shifting as we begin to emerge from the pandemic.
Existing hospitals are designed to operate near capacity. And over time, we’ve built our finances, floor plans, staffing models, and workflows around a high patient census.
However, the role of hospitals is changing before our eyes. Although it’s hard to believe while we are in the middle of the COVID-19 pandemic, acute care will shift toward community-based virtual delivery, and only the sickest patients will require face-to-face inpatient care. As a result, hospitals will serve a smaller but “super-acute” population. This raises the question: How can health systems adapt to this new paradigm?
As the patient population trends sicker, hospitals that rely on staffing benchmarks from a bygone era could quickly find their teams overwhelmed. These highly acute cases will require more intensive nursing care. Clinicians will require additional time at the bedside and afterward to document more complex encounters. This population will also demand more patient education and assistance with social support like food, shelter, and transportation.
Clinging to outdated staffing models could also stoke the fires of burnout. In the past, acute care clinicians could rely on having a few “easy” patients on every shift. Spending just half an hour on a simple case freed them to spend two hours on a more complex one. But as our inpatient census grows more acute, these opportunities will disappear. It’s therefore imperative that hospitals start planning for the future before it’s thrust upon them.
From competition to coordination
The burden of caring for a highly acute patient population could incentivize hospitals to work together. To some degree, COVID-19 has already kick-started this trend. To better weather the pandemic, hospitals created pathways to report test results, positivity rates, hospital capacity, and other key metrics. A standout example is the state of Arizona, which established a centralized network to allocate beds, which likely saved lives during their summer surge.
This spirit of solidarity was apparent even among competitors. In the Seattle area where I practice, leaders from Swedish Health Services, UW Medicine, and EvergreenHealth coordinated information and agreed to share ventilators, protective equipment, and other resources. I sincerely believe this goodwill helped us to successfully weather the nation’s first COVID-19 surge and could serve as a blueprint for future hospital partnerships.
The possibilities of such networks are endless. To concentrate resources and expertise, tomorrow’s hospitals might organize into high-volume “centers of excellence” specializing in certain acute conditions. What’s more, community hospitals could improve their finances by pooling staffing, back-office, and infrastructure costs.
Taking hospital care to the community
For as long as most of us have been working in acute care, we’ve defined ourselves by practice location. Even the names of our specialties (ED physician, hospitalist) reflect this narrow geographic focus. In other words, we limit our impact to a piece of earth a little bigger than a football field.
However, even before the pandemic, small-scale programs demonstrated that hospitals could safely manage many “inpatients” at home with telehealth providers and mobile care teams. And throughout 2020, ER teams have used virtual care to screen, treat, and follow up with patients in mobile medical trailers, cars, fever clinics, homes, prisons, and skilled nursing facilities.
This shift toward virtual care could solve some of acute care’s toughest challenges—from access and costs to ED crowding. To succeed in a post-pandemic world, we must therefore shoulder the responsibility of stepping out into our communities, meeting patients where they are, and bringing them the care they need. Successful acute care teams will follow our primary care colleagues embracing telehealth.
What will we achieve in 2021?
2021 could be a watershed year for acute care. While I don’t have a crystal ball, experience suggests we’re moving toward implementation for virtual front door and ED triage models. These could help greatly increase hospitals’ ability to absorb COVID-19 and flu surges one winter from now. At the same time, programs like hospital at home and telefollow-up could greatly expand inpatient capacity.
I also expect acute care to accelerate its shift outside physical locations like hospitals, emergency departments, and medical pavilions. The sooner health systems begin adapting to this new reality, the more resilient they will be in a rapidly shifting healthcare landscape. It’s important to realize that there will be no return to normality and that our post-COVID-19 world will be a different ballgame. And as any good coach knows, it’s never too early to start preparing the players (and the fans) for change.
Gregg Miller, MD, is chief medical officer at Vituity, a physician-owned and -led multispecialty partnership of 5,000 doctors and clinicians across 450 practice locations and nine acute care specialties. He provides leadership in risk management, quality, continuing medical education, CMS performance, patient experience, operations flow, and data management. He is also a practicing emergency physician at Swedish Edmonds Hospital near Seattle, WA.