It’s not just keeping patients in bed that could use a rethink—it’s keeping them all closed off. In 2017, both community and hospital-acquired infections are still a clinical concern, but the dominant threats to human health—heart disease and cancer, for instance—no longer require isolation. In fact, with the exception of a few acute instances in our lives, most of us benefit from the opposite. Former Surgeon General Vivek Murthy has recently characterized loneliness as the most common “pathology” he encountered in medical practice—insidious but present on an epidemic scale. Future hospitals may find opportunity to intentionally forge connections. A community hospital in Massachusetts recently created an early labor lounge for patients who did not yet need a labor and delivery room, but could not return home. Rather than curtaining her off, the lounge was set up to let mothers socialize with their families and with one another in a relaxing and comfortable setting. Anecdotally, the lounge seemed to be most effective at preventing premature hospital admission when it was full.
Redesigning hospitals isn’t an easy job: they’re big, expensive, highly regulated environments. And it will require culture shifts as well, since a great deal of medical practice, from surgical rounds to nurse assignment, is built around the “beds” model of health care. But some people are already thinking about this. Back at Mount Sinai, an industrial engineer with an appointment in the Department of Internal Medicine has created an Ambulatory Care Transformation Network to begin crowdsourcing better ways of providing care from clinicians working in the trenches of their health system. In many cases, this involves coordinating with neighborhood services surrounding the patient’s home, rather than clinical services surrounding his or her hospital bed.