SHM Converge Scientific Abstract ePoster Gallery-When the Hospital Becomes a Home: The Challenge of Caring for Patients With Complex Health and Social Needs

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This study examined how caring for complex high-needs patients (CHNPs) affects hospital-based interprofessional care teams. CHNPs represent a small patient group that uses a disproportionate share of hospital resources, often through frequent readmissions or prolonged stays despite being medically ready for discharge.<br /><br />Using a mixed-methods design, researchers surveyed and held focus groups with physicians, advanced practice providers, nurses, patient care technicians, social workers, and physical/occupational therapists at a 900-bed hospital. They assessed perceptions of why CHNPs are increasing, the impact on staff, and possible solutions. Quantitative and qualitative analyses were used to measure distress, compassion fatigue, and themes in clinician responses.<br /><br />Participants largely attributed the rise in CHNPs to system-level issues such as limited community resources, lack of safe housing, poor access to primary care, inadequate post-acute facilities, and insurance barriers. Many also cited patient-related factors like refusal of care or non-adherence. More than half of respondents believed CHNPs had increased, and 75% felt pressure to shorten length of stay or prevent readmissions. However, this pressure was not significantly linked to compassion fatigue or distress.<br /><br />The main source of clinician distress was a feeling of not being able to practice high-quality medicine in line with professional values. Many described loss of meaning in their work, frustration, and feeling that they were “babysitting” patients rather than providing meaningful care. Overall, 91.77% reported moderate to high distress related to CHNP care, and 63.6% reported moderate to high compassion fatigue. Higher CHNP-related distress was associated with greater overall compassion fatigue.<br /><br />The study concludes that CHNP care creates substantial burden for staff and suggests solutions at multiple levels: improving community resources and housing, increasing Medicaid and post-acute support, standardizing discharge processes, expanding specialty services, providing formal debriefs and mentorship, and showing greater institutional appreciation for staff work.

Asset Subtitle

Niti Patel

Meta Tag

Author List Anna Eike, Jeanne Wirpsa, Manasi Singh, Niti Patel, Sarah Russe

Category Research

Concept Complex High-Needs Patient

Concept Hospital Utilization

Concept Healthcare Cost

Concept Compassion Fatigue

Concept Moral Distress

Distinguished Non-Finalist

Presenter Organization Northwestern Memorial Hospital

Presenting Author Niti Patel

Track Value in Hospital Medicine

Keywords

complex high-needs patients

interprofessional care teams

hospital readmissions

compassion fatigue

clinician distress

length of stay

discharge planning

community resources

mixed-methods study

healthcare burden

Complex High-Needs Patient

Hospital Utilization

Healthcare Cost

Compassion Fatigue

Moral Distress