Two of our recently posted blogs – “I Have a Dream: Acute Care
Hospitals May No Longer Be Necessary” and “Where Have All
the Volumes Gone?” strongly suggested that the acute care hospital,
as we presently know it, will look significantly different in the future.
Envisioning the attributes of this “future state” will assist
healthcare leaders in developing the roadmap creating the sustainable,
growing, high quality, safe, and affordable delivery systems essential
for future success.
First, and foremost, the majority of the inpatient beds will be filled
with extremely ill, high-risk patients coming from a relatively small
number of service lines. These will include:
- Trauma – new ‘routine trauma cases” will include total
limb and facial transplant programs added to the increasing number of
patients injured from gunshot wounds, terror attacks, auto accidents,
and natural disasters. Trauma most likely will surpass cancer and become
the leading cause of death in America.
- More and more of the Emergency Department bays will be converted to trauma
rooms as a greater portion of the non-traumatic care will move to alternative
delivery access points both on and off the main campuses. The rapidly
rising number of free-standing urgent care, emergency care, and walk-in
clinics will facilitate this critical transition.
- Neurosurgery – new procedures will be available for patients suffering
from Parkinson’s, Altzheimers, metastaic and primary brain tumors,
strokes, hearing, and vision disorders.
- Cardiac Surgery – mechanical pumping will be used much longer on
selected patients with heart failure, and used as a permanent option for
some slected older patients.
- Organ Replacements- new services will be developed as an increased number
of organs will be created in tissue cultures from stem cells.
- Neonatal Services - as the age of the mother having her first child rises,
complications seen in newborns will increase. Fortunately, this increase
is being offset by the measurable decline in teen-age pregnancies, where,
again, high-risk babies are often delivered.
Because of the increasing high risk of the overall inpatient population,
much money and effort will have to be put into innovative facility planning.
Future facilities will have to address enhanced infection control processes
for both patients and visitors. Instead of “infection control rooms
with negative air pressure”, the entire hospital may have to have
the same capabilities.
Practitioners will be more dependent on comprehensive clinical information
systems which will guide them in directing increasingly complex medical
protocols. Care givers will often be assisted by robots, and new monitoring
and treatment equipment which will carry out much of the “routine” care.
Simultaneously, the composition and competencies of clinical staffs will
change. Because of the complexity of the patients, it will be difficult
for recently graduated individuals to enter the workforce without additional
work experience. The practice of not hiring recent graduates is already
in place in some health systems. Traditional hospitalists will be joined
by surgically oriented trauma-care hospitalists, and we will see a growing
number of "in-house deliverists", obstetricians who decide to
do shift work just delivering babies. Again, this will lead to enhanced
safety since many of the babies will be high risk, often requiring a C-Section
with a 5 minute surgical intervention from skin to baby. Mid-level providers
will grow in numbers and with expanded roles, and nursing leadership will
assume increasing importance in the C-Suite team. Pharmacist roles will
change as they will be involved in creating more “individualized
medicines”, which, if given to the wrong patients, will result in
significantly more damage than the medications errors we are experiencing
today. Of course, all medication errors must be eliminated. More experienced
and single focused clinical staff, aided by clinical IM support, will
help achieve improved patient safety. And finally, the leadership teams
will require a higher level of accountability and new competencies, including
the CMOs, the CMIOs, IT, Supply Chain, and Revenue Cycle.
And, as is already occurring in foreign countries, including the low cost,
high quality cardiac surgery programs in India, the family of the patient
likely will be trained as part of the treatment team. This methodology
will be patterned after the total knee replacement programs in some hospitals
today where each patient has a “care partner” for all phases
of the treatment facilitating a 3 to 4 day length of stay,
Yes, the acute care hospital of the future will be different, certainly
smaller and looking more in its entirety like the intensive care units
we build and staff today. What does this mean for the present small and
rural hospitals? Many will close as we have stated in prior blogs, but
if they remain operational, they will effectively become triage centers
for the larger centers to which they are formally or informally connected
by increasingly sophisticated mobile intensive care units and life flight