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MEDICAL YEAR AL YEAR MEDICAL YEAR
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• Shorter Hospital Stays: Due to managed care and advancements in References:
technology and treatment approaches, hospital stays are generally 1. Goodwin J.S., Li S., Zhou J., Kuo Y.F., Nattinger A. Variation
becoming shorter. This shift emphasizes the importance of effective among hospitals in the continuity of care for older hospitalized
patients: a cross-sectional cohort study. BMC Health Serv Res.
discharge planning and transitional care to ensure patients receive 2021 Jun 5;21(1):552. doi: 10.1186/s12913-021-06584-0.
appropriate support and follow-up after leaving the hospital. It is PMID: 34090431; PMCID: PMC8180074
critical to have family and patient input in this decision-making 2. Goodwin J.S., Li S., Kuo Y.F. Association of the Work Schedules
process.2 of Hospitalists with Patient Outcomes of Hospitalization. JAMA
• Rise of Telemedicine and Remote Monitoring: The COVID-19 Intern Med. 2020 Feb 1;180(2):215-222. doi: 10.1001/jamaint-
ernmed.2019.5193. PMID: 31764937; PMCID: PMC6902197
pandemic accelerated the adoption of telemedicine and remote 3. Farid M., Tsugawa Y., Jena A.B. Assessment of Care Handoffs
patient monitoring technologies, which are now being integrated Among Hospitalist Physicians and 30-Day Mortality in Hospi-
into routine hospital care. These tools enable virtual consultations, talized Medicare Beneficiaries. JAMA Netw Open. 2021 Mar
remote monitoring of vital signs, and improved communication 1;4(3):e213040. doi: 10.1001/jamanetworkopen.2021.3040.
PMID: 33760093; PMCID: PMC7991971
between patients and healthcare providers. Many seniors miss out 4. Stommel M., Olomu A., Holmes-Rovner M., Corser W., Gar-
on this change due to being less tech savvy and lacking internet diner J.C. Changes in practice patterns affecting in-hospital and
resources, particularly in rural areas.9 post-discharge survival among ACS patients. BMC Health Serv
• Emphasis on Value-Based Care: The healthcare industry is moving Res. 2006 Oct 24;6:140. doi: 10.1186/1472-6963-6-140. PMID:
towards a value-based care model, where reimbursement is tied to 17062154; PMCID: PMC1630429
patient outcomes and the quality of care. This shift incentivizes 5. König S., Hohenstein S., Pellissier V., Leiner J., Hindricks G.,
Nachtigall I., Kuhlen R., Bollmann A. Changing trends of patient
hospitals to focus on reducing readmissions, preventing complica- characteristics and treatment pathways during the COVID-19
Changing Patterns of Hospital • Growing Role of Hospitalists: Hospitalists, physicians who spe- pandemic: A cross-sectional analysis of 72,459 inpatient cases
tions, and improving patient satisfaction. The data is unclear cur-
from the German Helios database. Front Public Health. 2022
10
rently as to the achievement of these aspirational goals.
Nov 7;10:1028062. doi: 10.3389/fpubh.2022.1028062. PMID:
36420010; PMCID: PMC9678052
Patient Care in 2024 cialize in inpatient care, are becoming more prevalent in hospitals. 6. Rennke S., Yuan P., Monash B., Blankenburg R., Chua I., Harman
They provide dedicated care to hospitalized patients, thus allowing
S., Sakai D.S., Khan A., Hilton J.F., Shieh L., Satterfield J. The
primary care physicians to focus on outpatient care and continuity SDM 3 Circle Model: A Literature Synthesis and Adaptation
By John J. Seidenfeld, MD, MSHA, FACP of care. Is the patient best served by this model where patients may for Shared Decision Making in the Hospital. J Hosp Med. 2017
see several hospitalists during their stay due to shift handoffs and Dec;12(12):1001-1008. doi: 10.12788/jhm.2865. Epub 2017
Oct 18. PMID: 29073314; PMCID: PMC5709161
he metaphor of “Frog warming in an increasingly hot bath” out) adage whereby flawed, biased or poor-quality information or rotations? We must ensure that doctors who choose this work are 7. O’Connor A.M., Bennett C.L., Stacey D., Barry M., Col
is applicable to the change in hospital care we have seen over input produces a result or output of similar quality. 8 deeply devoted to patient care and work with specialists to tailor N.F., Eden K.B., Entwistle V.A., Fiset V., Holmes-Rovner
Tthe past twenty years. You do not realize the dramatic changes Often the patient is left out of the initial care discussion, and care to the patient’s needs. They cannot cede the care to the spe- M., Khangura S., Llewellyn-Thomas H., Rovner D. Decision
in hospital care in 2024 until you need to access it. Now, human-like consultants and diagnostic procedures begin in the ER and proceed cialists and must constantly advocate for their patients as captain aids for people facing health treatment or screening decisions.
robotic voices through either algorithmic or artificial intelligence (AI) throughout the hospitalization. A critical difference in these processes of the care team despite the pull of other allegiances. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD001431. doi:
phone instructions direct us to the emergency room for daytime, after is that the choice of medical consultants and nurse practitioner • Focus on Patient-Centered Care: The concept of patient-centered 10.1002/14651858.CD001431.pub2. Update in: Cochrane
Database Syst Rev. 2011 Oct 05;(10):CD001431. doi:
hours and weekend care. Twenty years ago, we would contact our fam- specialists, diagnostic tests and treatment are no longer done by the care is gaining momentum, emphasizing patients’ preferences, 10.1002/14651858.CD001431.pub3. PMID: 19588325
ily doctor to be examined at the office, in the patient’s home, or at the patient and their primary care doctor. Often in this era of managed values and needs in the decision-making process. This approach 8. Kulikowski C.A. Beginnings of Artificial Intelligence in Medi-
emergency room. In the previous model, the patient and primary care care, the caregivers may be out of network and procedures may not be includes involving patients in their care plans, providing them cine (AIM): Computational Artifice Assisting Scientific Inquiry
physician, after a careful history and examination, would craft a strat- authorized by the insurer. In this case, the patient ends up with out of with information and resources, and ensuring clear communica- and Clinical Art - with Reflections on Present AIM Challenges.
egy for diagnosis, consultation with specialists, and treatment once network bills, which increase the cost of the hospitalization and add tion throughout the hospitalization. This approach is largely aspi- Yearb Med Inform. 2019 Aug;28(1):249-256. doi: 10.1055/s-
0039-1677895. Epub 2019 Apr 25. PMID: 31022744; PMCID:
hospitalized. We now have a significantly different approach to care. 1-5 confusion to the already complicated process. rational at this time in the San Antonio community. (personal PMC6697545
Currently the ER physician, contracted often through a group, Overall, the pattern of medical care for hospitalized patients communication) 9. Haleem A., Javaid M., Singh R.P., Suman R. Telemedicine for
decides on initial care and admission, and then contacts a hospitalist is constantly evolving, driven by factors such as technological healthcare: Capabilities, features, barriers, and applications. Sens
contracted with the hospital. Allegiances are unclear; the patient, advancements, changing demographics and healthcare policy shifts. Whatever our concerns are, we will not be going back anytime Int. 2021;2:100117. doi: 10.1016/j.sintl.2021.100117. Epub
2021 Jul 24. PMID: 34806053; PMCID: PMC8590973
the group, the hospital, the contract and the corporation all have Staying informed about these changes is crucial for healthcare providers soon. We must do our best as physicians to make sure that hospitalized 10. van Staalduinen D.J., van den Bekerom P., Groeneveld S.,
influence on the physician. The hospitalist plans (with or without to deliver high-quality, patient-centered care in the hospital setting. patients or their designated caregivers become partners in care and Kidanemariam M., Stiggelbout A.M., van den Akker-van Marle
the patient’s input) diagnosis, and consultation and treatment. Patients are often unaware of the many changes that comprise their care. planning, and we must make sure that their improvement and return M.E. The implementation of value-based healthcare: a scoping
6,7
Training of hospitalists varies, and they are mostly residency What are the changing patterns of medical care for hospitalized to wellness is topmost in our minds. To do this, we must put the review. BMC Health Serv Res. 2022 Mar 1;22(1):270. doi:
trained internists, family practitioners or pediatricians. Physician patients? Below are key trends and observations: interests of the patient above corporations that employ us, hospitals 10.1186/s12913-022-07489-2. PMID: 35227279; PMCID:
PMC8886826
societies give certification or designation for these doctors, but • Increased Complexity of Patient Cases: As baby boomers, an that give us privileges to practice in their institutions, managed care 11. The Essential Deming: Leadership Principles from the Father of
these certificates are not available at the time of care and usually not unusually large population group, require hospitalization, there is companies that we credential and contract with to care for their Quality W. Edwards Deming, 2013 McGraw-Hill
communicated so the patient is unaware of a physician’s credentials. a rise in patients with multiple chronic conditions and comorbid- enrollees and pharmaceutical companies that reach into practice by
Critical medical histories often become the work of aides and AI ities, leading to more complex medical needs and treatment plans. employment (CVS model) and education. The complexity and power
instead of careful work by trained physicians, and histories derived This trend necessitates a greater focus on careful history taking, care and priority differentials of this environment should be focused on John J. Seidenfeld, MD, MSHA, FACP, is an Associate
from interview and exam are often abbreviated by specialists and coordination and multidisciplinary teams. Are the changes noted the excellent care of our patients, and further research is needed in Professor, CASE, at the University of the Incarnate Word School
focused in most cases. The result might be characterized by a critical above up to this challenge? Did COVID hospitalizations increase this area to complete the quality circle of Edward Deming. As Deming of Osteopathic Medicine. He is a member of the Bexar County
practitioner or patient reviewer by the GIGO (garbage in garbage avoidable out-of-hospital deaths for those without COVID? said, “In God we trust: all others bring data.” 11 Medical Society and serves on the Publications Committee.

12 SAN ANTONIO MEDICINE • December 2024 Visit us at www.bcms.org 13