Program Director & Clinical Ethicist Northwestern Memorial Hospital Chicago, Illinois
Abstract: This paper presents insights from a collaborative research project between hospital medicine and clinical ethics that explores how care of complex high needs patients (CHNPs) impacts the interprofessional care team. The study defined CHNPs as “a small group of patients who require more hospital resources than most other patients. They may be admitted frequently for short periods of time, or less frequently for long periods of time. The underlying cause of CHNPs medical problems and reason for seeking care in the hospital are largely societal in origin.” Subsets of this population include: Persons without stable housing; persons with chronic pain; frail, non-decisional patients who are unsafe to reside at home; and patients whose behavior impedes placement.
Results demonstrate alarmingly high levels of moral distress, compassion fatigue, and loss of meaning of work among the care team. Throughput pressure, lack of community resources, and blaming some patients for their condition led to perceptions that these patients take care away from those who could benefit from care or who, to resurrect on old welfare trope, are “truly deserving.”
Focus groups allowed physicians, advance practice providers, nurses, social workers, rehabilitation specialists, and patient care technicians to share their role-specific sources of distress, to admit how they hold other disciplines accountable for delays in discharge, and to reconsider their perception of who is and is not worthy of acute hospital care. The research findings were leveraged to implement strategies for mitigating the negative impact on the clinical teams and for improving outcomes for CHNPs.
Keywords: Complex High Needs Patients, Interprofessional Care Team, Deserving Poor
Learning Objectives:
After participating in this conference, attendees should be able to:
Understand how care for CHNPs negatively impacts clinicians’ compassion, moral integrity, and meaning of work.
Appreciate how the rise in CHNPs in the context of the scarce resource of acute care beds may strengthen the divide between the “deserving” and “undeserving” needy, poor, and sick.
Recognize how participation in research and quality improvement initiatives by all members of the interdisciplinary team can promote trust and collaboration.
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