Perceived Safety and Value of Inpatient “Very Important Person” Services

Abstract

Providing care to "very important person" (VIP) patients can pose unique moral and value-based challenges for providers. No studies have examined VIP services in the inpatient setting. Through a multi-institutional survey of hospitalists, we assessed physician viewpoints and behavior surrounding the care of VIP patients. A significant proportion of respondents reported feeling pressured by patients, family members, and hospital representatives to provide unnecessary care to VIP patients. Based on self-reported perceptions, as well as case-based questions, we also found that the VIP status of a patient may impact physician clinical decision-making related to unnecessary medical care. Additional studies to quantify the use of VIP services and its effect on cost, resource availability, and patient-specific outcomes are needed. Recent publications in the medical literature and lay press have stirred controversy regarding the use of inpatient 'very important person' (VIP) services.1-3 The term "VIP services" often refers to select conveniences offered in addition to the assumed basic level of care and services provided by a hospital. Examples include additional space, enhanced facilities, specific comforts, or personal support. In some instances, these amenities may only be provided to patients who have close financial, social, or professional relationships with the hospital.How VIP patients interact with their health system to obtain VIP services has raised unique concerns. Some have speculated that the presence of a VIP patient may be disruptive to the care of non-VIP patients, while others have cautioned physicians about potential dangers to the VIP patients themselves.4-6 Despite much being written on the topics of VIP patients and services in both the lay and academic press, our literature review identified only 1 study on the topic, which cataloged the preferential treatment of VIP patients in the emergency department. 6 We are unaware of any investigations of VIP-service use in the inpatient setting. Through a multisite survey of hospital medicine physicians, we assessed physician viewpoints and behavior regarding VIP services. METHODSThe Hospital Medicine Reengineering Network (HOMERuN) is a nation-wide learning organization focused on measuring and improving the outcomes of hospitalized patients. 7 We surveyed hospitalists from 8 HOMERuN hospitals (Appendix 1). The survey instrument contained 4 sections: nonidentifying respondent demographics, local use of VIP services, reported physician perceptions of VIP services, and case-based assessments (Appendix 2). Survey questions and individual cases were developed by study authors and based on real scenarios and concerns provided by front-line clinical providers. Content, length, and reliability of physician understanding were assessed by a 5-person focus group consisting of physicians not included in the survey population.Subjects were identified via administrative rosters from each HOMERuN site. Surveys were administered via SurveyMonkey, and results were analy...

V.I.P. care: Ethical dilemmas and recommendations for nurses

“…patients include the excess ordering of laboratory tests, imaging, and consultations that may not be clinically indicated. 9,3,17,24 V.I.P. care can also result in extended lengths of stay.…”

“…services were offered at their hospitals, including special menus, private or luxury-style rooms, and personal care attendants. 17 While these V.I.P. options are common, they are different from the V.I.P.…”

“…patients, healthcare professionals have reported feeling pressure to expedite their care, and eliminate any wait time for services. 17 While little is known about the nursing response, more than one-third of the 160 hospitalists surveyed reported feeling pressure from the hospital staff to provide special treatment to V.I.P. patients.…”

“…patients. 17 A survey of medical directors in Connecticut posited that there was a common and justifiable "widespread agreement" to expedite the care for V.I.P. patients in the emergency department; it was believed that if V.I.P.s had a positive experience, it would benefit the hospital.…”

The VIP patient syndrome in Latin America is known as “The recommended patient syndrome” a tale of unfortunate decisions and complications.

“…To continue Illen Dicker describes there is a pressure associated with the care of these patients, close to 67% of the doctors exposed to the treatment and management of a VIP patient, said to feel an external pressure about the possible outcomes of their patient, and does not act according to the medical logic, In addition to this feeling, the study reported that 56% of the physicians agreed to the demands of the patients regardless of whether they were relevant to their treatment (8). This is where the ethical dilemma of the physicians begins, a struggle between their autonomy and what is justly correct, a struggle between what should be done and what the patient wants to be done.…”