Background: The Atlanta Medical Center (AMC) closure in fall 2022 resulted in diversion of its patients to Grady Memorial Hospital, Emory University Hospital-Midtown (EUHM), Emory Decatur Hospital, and Emory Hillandale Hospital. The impact on Emory has not been examined; this reflects a gap in the literature. There are many studies of negative impacts of rural hospital closures, but few on urban hospital closures. We seek to describe qualitatively how hospitalists perceive the impact of AMC’s closure on hospital work culture, patient care, and work-life balance and wellness, and to develop recommendations for burnout mitigation. Our intermediate-term objective is to build the evidence base for impact on providers of nearby hospital closures, expanding research to include ED providers and intensivists. Long term, we hope to use mixed methodology with clinical data on patient outcomes to produce and disseminate data to inform decisions regarding hospital closure and response by neighboring facilities to protect staff.
Methods: We are conducting structured in-depth interviews of 5-20 physicians and Advanced Practice Providers (day and night shifts) at each site (total sample goal = 40) to rapidly expand our understanding of the impact of AMC’s closure on hospitalists’ work-life balance, hospital medicine service culture, and overall wellness, as well as perceptions of impacts on patient care and whether use of health information exchanges (HIEs) mitigated information discontinuity. We are using inductive and deductive coding approaches to analyze textual data.
Results: Interviews are ongoing; we hope to conclude interviews by the end of January 2025.In preliminary analysis, themes that have emerged are the universal perception at community and teaching hospitals alike of a large bolus of new, medically complex patients during a time when staffing levels had not yet recovered from the COVID-19 pandemic; negative impacts of a sudden high volume of high-acuity patients on work-life balance and hospitalist morale; and frustration when helping patients who were receiving specialized care (e.g., psychiatric, mother/baby) when similar care is not available at the referral facility. Several hospitalists noted that colleagues resigned due to the challenges and frustrations of this wave of high-need patients without corresponding resources for their care. They found HIEs useful but often poorly organized, requiring searching to find pertinent information.Hospitalists frequently expressed concern for vulnerable patients. In general, participants felt that patient care was negatively impacted initially—not from challenges of high census, which providers perceived as burdensome but manageable by providers themselves—but from disconnection to regular sources of care, particularly for those with limited transportation access. Positive findings were the effectiveness of rapid leadership response to increase staffing and the impact of these efforts on hospitalist morale, gratitude and appreciation for ancillary staff (social workers, case managers) and provider perceptions that colleagues and ancillary staff “stepped up” to manage the higher patient volume.
Conclusions: Urban hospital closures have wide-ranging impacts on the work-life balance of providers at surrounding facilities, which may include domino-effect burnout and resignations in addition to negative impacts on patients.