Archive for February, 2012

Specialty nursing certification linked to lower healthcare acquired infection rates

The challenges to infection control are great. Whether a patient develops a hospital acquired infection depends on a number of variables, not least of all adherence to safety protocols and checklists.

But did you know that new research shows that certain nursing certifications are associated with lower rates of HAI?

The research, presented last month at the American Nurses Association's Nursing Quality Conference, used data from ANA's National Database for Nursing Quality Indicators (NDNQI) to determine the relationships between HAI and nurse workforce characteristics on adult critical care units, according to a February 21 HealthLeaders Media article. More than one-third of the nation's hospitals participate in NDNQI, an ANA program that's administered by the University of Kansas School of Nursing.

Researchers investigated three HAIs: central line-associated blood stream infections (CLABSI); catheter-associated urinary tract infections (CAUTI); and ventilator-associated pneumonia (VAP).

Two of the study's main findings don't seem all that surprising. First, it found that higher levels of RN hours per patient day (staffing ratios) were associated with lower CAUTI and CLABSI rates. It also found that VAP rates were high in units that had higher percentages of agency RNs—that is, temporary, non-hospital employees.

Read more on the HealthLeaders Media website.

Sneak Peek: Planning for homecare can reduce avoidable readmissions

Case managers want their patients to leave the hospital with a successful transition to home or aftercare and not have to return to the hospital unnecessarily.

But the reality is that many patients are coming back too soon.

Nearly 20% of Medicare patients boomerang back to the hospital within 30 days of being discharged, according to Deborah Perian, RN, MHA, who works in the visit clinical leadership office, a support office for the skilled visit service offices, at Bayada Nurses, a home health agency in Moorestown, NJ. As many as three-quarters of those return visits may be preventable, Perian says.

A substantial number of rehospitalizations occur when patients are discharged home without aftercare, she says. Targeting the main causes of readmissions and forming strong partnerships with homecare agencies can help reduce readmissions substantially, says Perian.

This item is adapted from an article which originally appeared in the February, 2012 issue of the eight-page, HCPro, Inc. newsletter, Case Management Monthly.
 

Creating accountability for patient experience

This article appears in the February 2012 issue of HealthLeaders magazine.

Any story that attempts to discuss ways to improve the patient experience should attempt to define it, because there is ample confusion in healthcare, even among otherwise highly competent leaders, about what patient experience actually is.

It isn’t providing excellent quality healthcare—at least not totally. A basic assumption by patients is that when they receive a medical intervention, the actual medical care will be excellent. Rather, patient experience is much more comprehensive, even encompassing patients’ feelings about the hospital brand and their “stickiness,” that is, their loyalty.

Our own HealthLeaders Media survey on patient experience in 2009 showed how difficult it was for hospital and health system senior leaders to define the term: 34% chose “patient-centered care,” 29% selected “an orchestrated set of activities that is meaningfully customized for each patient,” and 23% said it involved “providing excellent customer service.”

The rest agreed that the patient experience meant “creating a healing environment,” was “consistent with what’s measured by HCAHPS,” or was something “other” than the aforementioned options.

Sounds like patient experience encompasses just about everything except, possibly, the clinical care itself.

That’s just about right, says James Merlino, MD, Cleveland Clinic’s chief experience officer. The wide-ranging view of what constitutes patient experience used to be perplexing, he says, but the correct answer for him and for many others who are looking to improve is that it’s “all of the above.”

Read more on HealthLeaders Media.

Sneak Peek: Respect patient choice; ensure education on appropriate discharge options

By Wei Deborah Lee, RN, MSN, case manager

Ms. W is admitted to a Kindred long-term acute care hospital with diagnoses of thrombosis of the superior vena cava and osteomyelitis of the spine. She is a bariatric patient (360 pounds) and is receiving hemodialysis. She needs maximum assistance to get up from her bed. She also has severe back pain requiring management with intravenous Dilaudid® every four hours.

Ms. W has a boyfriend and a 12-year-old daughter at home. She is depressed due to her three-month hospitalization and insists she will be going home upon discharge.

Despite the case manager spending copious amounts of time educating Ms. W on Medicare acute days, her risk of going home, compliance, and the need for safe continuing care at a SNF, the patient insists on either staying in the hospital for more physical therapy or going home. Ms. W’s physician and physical therapists agree she should not go home, even if she receives home health services.

This item is adapted from an article which originally appeared in the February, 2012 issue of the eight-page, HCPro, Inc. newsletter, Case Management Monthly.

Facing the care coordination challenge

Editor’s note: This article appears in the February 2012 issue of HealthLeaders magazine.

When it comes to clinical quality improvement, CEOs see care coordination as their greatest strategic challenge. In fact, with 10 possible answers, it was the choice of 30% of the CEOs who took the annual HealthLeaders Media Industry Survey. For perspective, improving patient experience, including patient flow, was the top strategic challenge for only 17%, the next most popular choice. How to overcome the care coordination challenge?

According to William Jacobsen, CEO of 37-bed Carilion Franklin Memorial Hospital in Rocky Mount, VA, and a vice president in the Carilion Clinic system based in Roanoke, VA, what’s needed is “an army of care coordinators.”

“Carilion has taken a stance to work toward coordination of care in a system that has the primary care physician as captain of the ship,” he says. “But you just can’t take your typical primary care physician and ask them to coordinate these people.”

Jacobsen sees care coordinators as the glue that binds physicians, nurses, hospitals, rehabilitation centers, skilled nursing centers, and nursing homes, among others, around the needs of single patients. Currently, most care is still episodic, and information gained or treatments given at one location may not be known by others who treat the patient. Patients with multiple diagnoses are unquestionably some of the most expensive, so it stands to reason that someone who can tie the disparate sources of care together can improve quality and reduce waste, the two top goals of health reform.

Read more on HealthLeaders Media website.

News: Keeping readmission rates low with treatment guidelines

Low readmission rates are reaching a new level of importance, according to a February 8 HealthLeaders Media article. Beginning in 2013, hospitals with "excess" readmissions will face financial penalties. Those ranking in the highest quartile in the country could lose 1% of their Medicare DRG in the first year, 2% in the second, and 3% in the third. That amounts to about $850 million in the first year.

UPMC Hamot, Lancaster (PA) General Hospital, and Muncie, IN–based Indiana University Health Ball Memorial Hospital, have readmission rates that beat Medicare's HospitalCompare dataset national average in three key areas: 30-day readmission rates for heart attacks, 30-day readmission rates for heart failure, and 30-day readmission rates for pneumonia.

There is a common thread tied to each organization's success: detailed treatment guidelines.

Read more on the HealthLeaders Media website.
 

Emergency departments in 2012—the fastest changing places in healthcare!

By Karen Zander RN, MS, CMAC, FAAN, principal and co-owner, The Center for Case Management

This March 30-31, the first national conference about successful care and case management programs in the most dynamic and very expensive patient rooms in acute care will be given by The Center for Case Management at Texas Health Harris Methodist Hospital: “Becoming a Top Shot ED: Managing Care and Cases Into, Out of, Through, and Beyond the Walls.”

It is offered for ED professionals, and taught by ED professionals, with data, honest lessons learned, and itemized returns on investment (ROI). Jay Kaplan, MD, FACEP, ACEP Board of Directors, will be the keynote speaker.

Over the past several years, emergency departments have heeded the call for fast-track care and are always prepared for both natural and human-made disasters. Now it looks as though EDs will continue to evolve — with or without healthcare reform mandates. Emergency departments have taken it upon themselves to address the changing needs of their surrounding community while tackling increasingly complicated issues such as:

• Access
• Improved throughput
• Avoiding RAC denials from Medicare through implementing RN case managers to determine accurate level of care
• Use of observation (clinical decision) units
• Rapid patient placement with physician orders into acute care beds
• Safe, smooth, and sustained transitions (decreasing readmissions and ED visits) for patients that do not require any acute care bed at all
• Emphasis on both acute and chronic care interventions
• Building Accountable Care Organizations (ACOs)

For example, some facilities have developed specialized exam rooms to better suit the health and safety needs of senior citizens. Others are implementing new methods, including case management and new software, to increase flow and capacity as well as the patient/family experience of care through the ED and beyond.

In addition, some EDs have coordinated with neighboring facilities and hospitals to address those shared, complex patients that require frequent ambulance and ED services. With increased attention on the efficient care of patients requiring mental health services, EDs will need to be equally as creative in coordinating care for this population.

Truly, the ED has morphed from the hospital’s back door to the community’s “front porch,” positioning itself front and center for operationalizing ACOs and other innovations.

Blanketed approach to seeking continued care for our patients

Our case manager (UR) wants to send out a copy of the patient’s medical record to 10 or 20 SNF’s within a 100-200 mile range our facility to see if they are willing to accept a patient. These are inpatients, hard to place and we are in an extremely rural area with only a few SNF’s within driving distance for families in this area.

What kind of consent form would be needed to cover this blanketed approach to seeking continued care for our patients? Would this even be legal? Do any of you have such practices within your systems and if so, would you be willing to share your consent forms? Need some help please. I’ve never heard of such a proposition.

– Health Information Management director