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Gridlock in hospital medicine
Jennifer K. Readlynn, Jennifer Zagursky, Robert E. Burke, Jin Sol Lee, Andrew P. J. Olson. Journal of Hospital Medicine, 2023-12-12
Topic: Risk, prevention and care in population studies
Before the COVID-19 pandemic, supply and demand forcast models predicted significant nursing shortages across the United States through 2030 due to both an aging patient population and nursing workforce.1, 2 However, during the pandemic, we saw an exodus of younger nurses in addition to early retirements. Disruptions in the workforce, especially in post-acute care facilities, contribute significantly to the gridlock keeping patients in the hospital, especially in a time of unstable staffing and variable resources.3 The American Nurse's Foundation COVID-19 Two-Year Impact Assessment Survey found that 52% of nurses are considering leaving their current position, most commonly due to insufficient staffing, lack of resources to provide quality care, and impacts on personal health and wellness.4 We focus on post-acute placement in a facility but recognize that resources for care in the home are also limited and likely contribute to the need for higher use of post-acute care facilities and long-term care than if in-home options were more readily available. In a survey of SNF administrators and staff, respondents indicated that patients with mental and behavioral health issues and obesity were most difficult to care for due to staffing resources availability in the facility and physical limitations in the facility. The "system," at present, is not working well for any of its stakeholders, and the most vulnerable patients experience harm as a result. This gridlock results from many factors with myriad consequences, and requires complex, interrelated, and innovative solutions.
Key findings
- Before the COVID-19 pandemic, supply and demand forcast models predicted significant nursing shortages across the United States through 2030 due to both an aging patient population and nursing workforce.1, 2 However, during the pandemic, we saw an exodus of younger nurses in addition to early retirements.
- Disruptions in the workforce, especially in post-acute care facilities, contribute significantly to the gridlock keeping patients in the hospital, especially in a time of unstable staffing and variable resources.3 The American Nurse's Foundation COVID-19 Two-Year Impact Assessment Survey found that 52% of nurses are considering leaving their current position, most commonly due to insufficient staffing, lack of resources to provide quality care, and impacts on personal health and wellness.4 We focus on post-acute placement in a facility but recognize that resources for care in the home are also limited and likely contribute to the need for higher use of post-acute care facilities and long-term care than if in-home options were more readily available.
- In a survey of SNF administrators and staff, respondents indicated that patients with mental and behavioral health issues and obesity were most difficult to care for due to staffing resources availability in the facility and physical limitations in the facility.
- The "system," at present, is not working well for any of its stakeholders, and the most vulnerable patients experience harm as a result.
- This gridlock results from many factors with myriad consequences, and requires complex, interrelated, and innovative solutions.
Why it matters
This article discusses nursing shortages and workforce disruptions contributing to patients remaining in hospitals, especially related to post-acute care placement. It does not address treating, curing, or preventing Alzheimer's disease.
Study details
- Participants100
- Evidence strengthLow
How this study scored 43/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Hospital Medicine) |
| Journal's citation record | 1 / 4 | Journal of Hospital Medicine: journal h-index 103 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 2 / 4 | 100 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 5 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.0 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 2 / 6 | Cited 1.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 5 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Andrew P. J. Olson: h-index 27 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Pennsylvania: institution h-index 1,859 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 38085675) |
| Free to read | 2 / 2 | Free to read |
| Total | 43 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1002/jhm.13259
- PubMed: 38085675
- Original source →
- Free full text: Journal of Hospital Medicine →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Readlynn, J. K., Zagursky, J., Burke, R. E., Lee, J. S., & Olson, A. P. J. (2023). Gridlock in hospital medicine. Journal of Hospital Medicine. https://doi.org/10.1002/jhm.13259
Vancouver
Readlynn JK, Zagursky J, Burke RE, Lee JS, Olson APJ. Gridlock in hospital medicine. Journal of Hospital Medicine. 2023. doi:10.1002/jhm.13259. PMID: 38085675.
BibTeX
@article{readlynn2023-38085675,
author = {Readlynn, Jennifer K. and Zagursky, Jennifer and Burke, Robert E. and Lee, Jin Sol and Olson, Andrew P. J.},
title = {{Gridlock in hospital medicine}},
journal = {Journal of Hospital Medicine},
year = {2023},
doi = {10.1002/jhm.13259},
pmid = {38085675},
url = {https://doi.org/10.1002/jhm.13259}
}
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