Hospital-dependent patients drive up readmissions, costs

Medical advances are saving the lives of older, sicker patients, but at the cost of a surge of hospital-dependent patients that drive hospital readmissions, according to a blog post for the New York Times.  

"Hospital-dependent patients are those who, a generation ago, were doomed to die. Now they are being saved," Pauline W. Chen, M.D., wrote in the post. "Medical advances can snatch them from the clutches of death, but not necessarily free them from dependence on near-constant high-tech monitoring and treatments."

For example, Chen wrote, a hospital saved one patient in his late 60s a year earlier with a defibrillator, heart surgery and a state-of-the-art intensive care unit. However, complications arose from the procedures and the breathing machine he eventually required, leaving him hospitalized for two months before the hospital released him to a skilled nursing facility. In his weakened state, he suffered even more setbacks and was in and out of the hospital for almost a year, Chen wrote.

One-fifth of patients deemed well enough to go home after being treated with newer technologies like CAT scans, MRIs and critical care teams end up being re-admitted within 30 days of their discharge, Chen wrote. Each readmission drives up hospital costs and spending.

Chen referenced a recent opinion piece published in the New England Journal of Medicine in which authors David Reuben, M.D., and Mary Tinetti, M.D., said the first step to ensure doctor communication with patients is to understand their specific desires and goals. For example, doctors should ask if patients want to continue with acute care or start talking about hospice options, according to Reuben and Tinetti. Hospitals and healthcare systems need to recognize that many post-care facilities aren't equipped to deal with these patients and plan accordingly to provide the most efficient and high-quality care possible, they argue.

"Until we begin making different decisions regarding how we allocate our resources, [hospital-dependent patients'] presence will be a constant reminder of which medical research and healthcare we consider worthy and which we do not," Chen wrote.

To learn more:
- read the blog post