Announcing Patient Safety Monitor!

HCPro is launching its newest product today: Patient Safety Monitor, an online resource for your patient safety needs. The product features the monthly newsletter Briefings on Patient Safety, a tools library, access to our popular “Patient Safety Talk” listserv, and weekly news alert. The main features is the Crosswalk, which organizes many patient safety-related regulations by what is required by The Joint Commission, CMS,  and all 50 states.

This blog is actually a part of the larger Patient Safety Monitor product, and you’ll now notice a link back to the home page in the “links” section in the righthand column of the blog. If you’re already a subscriber of Briefings on Patient Safety, you now have access to Patient Safety Monitor as part of your subscription.

If you’re interested in finding out more about Patient Safety Monitor, be sure to check out the demo. You can also sign up for a free 7-day trial.

I don’t often publicize lots of our HCPro products using this blog simply because I know that most readers aren’t coming here for that. But I do think that readers of this blog might be interested in what this product has to offer. I hope you check it out!

RI hospital commits fifth wrong-site surgery since January 2007

Staff members at Rhode Island Hospital in Providence, have committed the facility’s fifth wrong-site surgery since January 2007, resulting in a $150,000 fine levied by the state’s Department of Health (DOH), reports The Providence Journal. This is only the second time that the hospital has been fined, the first being after the hospital’s third incorrect neurosurgery occurred in 2007. The latest wrong-site surgery involved a procedure done on a patient’s incorrect finger. In addition, the DOH is requiring that the hospital

• install video and audio monitors in each operating room
• allow a licensed clinical professional who isn’t part of the surgical team to observe every surgery for a year
• adopt the statewide procedure for using safety checklists and marking the surgical site
• summarize each wrong-site surgery since 2005 to send to accrediting and government agencies
• conduct mandatory training sessions for all staff members who work in the operating room to review procedures

Readers, I’m wondering what you, as people who work in hospitals each day, make of this? This hospital, which should have been by all accounts been following the Universal Protocol as well as the state’s guidelines for preventing wrong-site surgery, did not. However, many readers of this blog may know and understand the culture necessary to ensure that the correct steps are taken to prevent a wrong-site surgery. Do you think the requirements made by the Health Department will prove to help this facility sort out its patient safety issues? Do you have any general thought about this instance?

In a related note, the president and CEO of Rhode Island Hospital, Timothy Babineau, MD, has offered to answer questions on the hospital’s Web site through November 9 (not specifically related to this event, but you could get any questions on this topic to him if you so desire).

Please see the Providence Journal article, it does a good job of explaining the story.

Quantifying healthcare’s waste

I thought readers of this blog might be interested to see some hard numbers that Thomson Reuters released earlier this week about the amount of waste present in the healthcare industry. According to a new white paper, the healthcare industry wastes between $600 billion and $850 billion each year. Here are the areas that were identified as the causes of waste:

• Unnecessary care (40%)
• Fraud (19%)
• Administrative Inefficiency (17%)
• Healthcare provider errors (12%)
• Preventable conditions (6%)
• Lack of care coordination(6%)

You can find the full descriptions of the bulleted list by clicking here. What struck me most about the list is the order–based on what I hear in the industry and even on mainstream media news reports, I would think that healthcare provider errors, preventable conditions, and lack of care coordination would account for a larger share of the waste. It’s not often that I hear of  fraud or administrative inefficiency as areas where lots of waste exists.

What about you, does this jive with your perceptions of where healthcare could tighten up? $650 billion to $850 billion annually is a lot to flush down the drain. What has your facility done to address this?

HHS awards $17 million to projects dedicated to preventing healthcare-associated infections

Last week the Department of Health and Human Services (HHS) announced it awarded $17 million to specific projects in the name of fighting healthcare-associated infections (HAI). Of the total award, $8 million will specifically fund the national expansion of the Keystone Project, a program that successfully reduced the rate of central line-associated bloodstream infections (CLABSI) in Michigan hospitals within 18 months, saving 1,500 lives. The coordination of the program in all 50 states is being run through the American Hospital Association’s Health Research & Educational Trust. Last year, the Agency for Healthcare Research and Quality expanded the Keystone Project to 10 states.

The remaining $9 million will be spent on strategies to reduce other HAIs. In collaboration with the Centers for Disease Control and Prevention, HHS will fund projects that will investigate methods for:

• Reducing Clostridium difficile infections through a regional hospital collaborative.
• Reducing the overuse of antibiotics by primary care clinicians treating patients in ambulatory and long-term care settings.
• Evaluating two ways to eliminate MRSA in ICUs.
• Improving the measurement of the risk of infections after surgery.
• Identifying national-, regional- and state-level rates of HAIs that are acquired in the acute care setting.
• Reducing infections caused by Klebsiella pneumoniae Carbapenemase-producing organisms by applying recently developed recommendations from CDC’s Healthcare Infection Control Practices Advisory Committee.
• Standardizing antibiotic use in long-term care settings (two projects).
• Implementing teamwork principles for frontline health care providers.

I see the Keystone Project as one of the major successes in recent years in the patient safety world. Not only does it reduce the chance for patient harm from an HAI, but it reduces the excessive amount of money that is spent on HAIs each year—a $6.5 billion expenditure. There are lots of patient safety standards out there, but this project has guided facilities in lowering CLABSI rates by using succinct steps with an emphasis on building a culture of safety and top-down leadership engagement.

Has your hospital become involved yet in this project?

To read more about this announcement, click here.

NCQA says quality of U.S. healthcare stagnant

After a decade of improvement, The National Committee for Quality Assurance has said that during last year the quality of healthcare was at a standstill in its annual State of Healthcare Quality Report. The study also  found that there no links between higher spending and better healthcare outcomes. The quality data that the report is based off of was submitted by 979 health plans across the country that collectively cover 116 million Americans, which is a 9 percent increase over 2008. The health plans use the HEDIS measures, which stands for Healthcare Effectiveness Data and Information Set.

Some of the trouble spots from this year’s report include the following statistics:

• Only 46.4% of people taking anti-depressant drugs are monitored by their physicians;
• 34.1% of children prescribed medications for attention deficit hyperactivity disorder (ADHD) are seeing a doctor for follow-up care
• Half of patients previously hospitalized for mental illness see a physician for a follow-up visit
• 45.3% of people are receiving colon cancer screening at the appropriate age
• Only 42.6% of patients with alcohol or drug dependency are entering into treatment

There was also an increase in the overuse of medical imaging for back pain and breast cancer.

I think the most striking point to come out of the report is the NCQA’s estimation that if all health plans were able to perform at the level of the top 10 percent of plans, the U.S. would avoid up to 115,000 thousand deaths and save at least $12 billion in medical costs and lost productivity every year.

In light of this report, the NCQA asked Congress to include language about quality improvement in its final bill.

Does any of this surprise you? I was mostly shocked to hear that this was the first year that the report showed little change in quality improvement.

Mistake-proofing and its relation to process management

One of my colleagues at HealthLeaders Media, Cheryl Clark, wrote this columnyesterday about making things fail-proof–anything really. She starts out by giving the example of how her fancy refrigerator beeps when the doors have been open for too long, reminding owners to shut the doors. She used that analogy to draw some comparisons to many of the mistake-proofing devices in healthcare, and how we are now really are coming into the age of really predicting how an error might occur and designing systems better to prevent those errors.

I’ve been reading up a lot lately on process management and even when speaking with people in the healthcare industry, there seems to be a lot of momentum behind the Lean and Six Sigma, the notion of ridding our systems of waste if we truly want them to succeed–and be the easiest and most logical way of doing things. Designing processes so that they are “mistake-proof” certainly ties in.

I suggest reading her column, it’s a good one. Do you see a larger waste reduction and process improvement effort taking place at your facility?

Should physicians be required to take cultural competency courses?

 It’s widely reported that racial and ethnic minorities receive less comprehensive healthcare than white patients. Some states have tried to address this by requiring physicians to undergo cultural competency training. Both California and New Jersey require such training and Maryland strongly recommends it. Nine other states are considering requiring some sort of cultural competency training.

However, an article in this week’s American Medical News points out that many physicians are opposed to such legislation mainly because it’s another topic around which they have to be educated. California and New Jersey have taken different approaches to mandating cultural competency training. California requires continuing medical education (CME) courses to contain information that is culturally and clinically relevant. New Jersey requires a specific amount of CME credits that must be earned in courses around cultural content as defined by the state medical board.

Some physicians opposed to the increased amount of cultural competence training wonder when the CME requirements will end and say that some requirements may not line up with what is clinically relevant. On the flip side, other physicians who are for such requirements say that without these mandates, most physicians would ignore the topic completely.

What does your state require? Do you think topic-specific CME mandates such as cultural competence are necessary for physicians? What about other healthcare workers?

AHRQ adds health literacy questions to CAHPS data set

The Agency for Research and Healthcare Quality (AHRQ) has released a set of 29 questions to be added to the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Clinician and Group Survey that address health literacy. The set of questions was created in conjunction with Healthy People 2010, a national health promotion and disease prevention initiative.  The questions touch on the following topics:

• Communication with doctors
• Communication about health problems and concerns
• Communication about medicines
• Communication about tests
• Communication about forms
• Disease self-management

Research shows that only 12% of adults are fully health literate. The AHRQ’s definition of health literacy  is “patients’ ability to obtain, process, and understand the basic health information and services they need to make appropriate health decisions.” In recent years there’s been a greater push to make it the part of the physician’s and clinical team’s responsibility to educate patients about their health issues. The questions were designed as an assessment tool to help clinicians measure if their efforts are paying off and patients are in fact becoming more health literate, and it was also designed to be a quality improvement tool.

To find the set of health literacy CAHPS questions, and more about them, click here. Do you think your facility would add these health literacy questions to its existing set of CAHPS questions?

Another reason to celebrate October: Next week is International Infection Prevention Week

The worldwide healthcare community will be observing International Infection Prevention Week (IIPW) next week, from October 18-24. The Association for Professionals in Infection Control and Epidemiology (APIC), which spearheads the effort in the U.S., is urging all states and Congress to recognize the week as a way of bringing attention to the work that infection preventionists do and the toll that infections take on patients in many healthcare settings.

The theme for IIPW 2009 is “Infection Prevention is Everyone’s Business.” In conjunction with this theme, APIC will be offering a couple of Webinars with special theme days during that week:

• Tuesday, October 20: Collaboration
• Wednesday, October 21: Hand hygiene
• Thursday, October 22: Surgical site infections/ operating room safety

Additionally, the group will announce the winner of the first annual Healthcare Administrator Award, which will be given to a healthcare executive who has demonstrated continuing support for infection prevention at his or her facility. The announcement, which kicks off the observance of IIPW, will take place at a ceremony on Friday, October 16, during a live Webcast at 1 pm Eastern time. Specific APIC chapters located in New York City, Dallas/Fort Worth, TX, and St. Paul/Minneapolis, MN, will be hosting their own satellite events in conjunction with Friday’s announcement.

Is your hospital doing anything to honor IIPW?

October celebrates Health Literacy Month, National Healthcare Quality Week

The month of October brings us two health-related events to celebrate: Health Literacy Month and National Healthcare Quality Week (October 18-24). Both events give healthcare workers and their organizations a chance to think about current practices and how to improve in the name of patient safety.

Health Literacy Month, which was started by Helen Osborne, MEd, OTR/L, a health literacy consultant, in 1999. This year’s theme is “Why Health Literacy Matters: Sharing Our Stories in Words, Pictures, and Sound” and is accompanied by an informative Web site (www.healthliteracymonth.org). Each day during the month of October a new health literacy “story” is added to the “stories section of the Web site. One of these highlights a couple of songs sung by Mache Seibel, MD, in honor of the month. You can find more of his songs at the Web site www.healthrock.com. Additionally, the Health Literacy site provides different resources and materials for the month.

National Healthcare Quality Week (NHQW) is being observed next week and the National Association for Healthcare Quality’s (NAHQ) Web sitecontains news about continuing education opportunities and events in honor of the week. The time is meant to highlight those healthcare workers whose quality work influences patient outcomes for the better. It also provides suggestions for ways that healthcare facilities can promote and publicize NHQW or any NHQW-related events being put on in the organization or larger community.

Are any of your facilities observing Health Literacy Month or National Healthcare Quality Week? What has your hospital done?