Journey to Refine Acute Care Hospital Process Improvement Projects for Ethically Complex Patients: Applying Complexity Tools to the Problem of Identifying Which Patients Need a Little More Attention than Most

  • Evan G. DeRenzo


Clinical medicine and clinical medicine ethics differs from clinical research and clinical research ethics, primarily, in that clinical medicine is much messier. That is, clinical research seeks to avoid confounders in the study by stripping the study population of as many extraneous variables as is safe for the research participants. In clinical medicine, there is no such correlate. The messiness of clinical medicine is simply a fact of patient care that contributes majorly to the medical, psychosocial, and ethical complexities of the care of clinical patients.

Over the past several decades, my colleagues from various institutions and professional backgrounds and I have come together at various times to identify patient populations that represent groups of patients who predict medical, psychosocial, and ethical complexity. Our ultimate intention for this work is to develop methodology that can identify the patient groups who will need just a bit more support to avoid problems brought about by these patients’ medical and/or psychosocial complexity. This work is being performed to help hospitals know where to put their quality assurance/quality improvement (QA/QI) dollars.

Progress to date brings this work to validation of the specific patient populations identified as predictors of medical, psychosocial, and ethically complex care. Further, in the process of this variable validation research, we are examining the prospect of using big data analytics applied to hospital electronic medical records to identify these special populations.



Study 1: This protocol was approved by the MWHC hospital’s IRB on October 25, 2009. No personally identifying information was collected.

Study 2: This protocol was approved by the MLHS hospital’s IRB on September 19, 2014. No personally identifying information was collected.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.John J. Lynch MD Center for EthicsMedStar Washington Hospital CenterWashington, DCUSA

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