Should hospitals run more like hotels?

“She thinks that this is a hotel.” That phrase gets spoken a lot in hospitals, about a certain type of patient who seems disinclined to leave, even after their medical problems are resolved. It frequently but not always seems to be a woman, maybe middle-aged, with kids and lots of responsibilities at home or work, who is unable or unwilling to set limits on what they can reasonably do there, and is thus very reluctant to go home again. And so when you tell them they’re ready for discharge, they mentions some new ache or pain, which sometimes must be evaluated, prolonging her stay…and then the process repeats itself the next day. Even though it’s not (necessarily) on purpose, it’s still frustrating for the medical team, who see the culprit as taking time and resources away from those who are actually sick.

And so patients are stereotyped: people who bring their own pajamas or pillows are suspect, because it looks as if they’re settling in. Don’t let them get too comfortable, is the feeling, because then they won’t want to leave again. I think this is part of the reason there hasn’t been more of a movement to reorient hospital routines so that they’re centered around patients, instead of the needs of the hospital staff: on many services, it’s impossible to sleep after 5am, because of repeated interruptions for vital signs, phlebotomy, medication administration, and 1-4 visits from people on the medical team. Not to mention that no one seems to understand the global picture of what’s going on with the patient; you would think the doctors would, but one of the surprises of medical school for me was how much stuff happens that the medical team isn’t involved in (or is involved in only nominally): immunizations and fall risk by nursing, placement by case management and physical therapy, random visits by the chaplain or social worker because someone thinks it’s indicated. (It’s not that the nurse necessarily has a better handle on what’s going on, either – information gets lost when they change shifts, and also their focus is less on the medical issues.) Some units do a really good job of having interdisciplinary rounds where everyone communicates, but on most it’s pretty haphazard. And this general state of disorganization makes life uncomfortable for patients, which encourages them to want to “go home so I can get some rest”. I know that part of this is inertia/resistance to change and not active hostility to patients overstaying their welcome, but the general attitude in most hospitals I’ve been in is not one that prioritizes patient comfort.

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