Archive for October, 2009

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?

New Jersey hospital claims 9-minute ED wait time

How did Palisades Medical Center in North Bergen, NJ reduce its wait-time for the emergency department (ED) to nine minutes, down from one hour? A story in yesterday’s Chicago Tribune highlights Palisades for its plan to reduce patient wait times by reorganizing how patients are seen when they enter the ED. When a patient who doesn’t have severe injuries comes to the ED , he or she is treated by a rapid evaluation unit–a team of two nurses, a physician, and a technician–and triaged. This frees up the ED’s main staff members and equipment for more seriously injured patients. These less-severe patients add up to 60% of all patients treated at Palisades’ ED. Palisades Medical Center.

Nationwide, patients who visit the ED for treatment wait an average of 37 minutes just to be seen, nevermind treated. The biggest culprit for long wait times is the inability to find inpatient  beds for already admitted ED patients, which in turn makes it difficult to admit more patients to the ED.

You can find the article from the Chicago Tribune here.

Has your facility had to examine its ED admission process in the name of patient flow? Have you come up with any unique solutions to this issue?

One facility employs ‘scribes’ to ease transition from paper to electronic records

Today’s USA Today has an interesting article about one hospital’s transition to an electronic system from using paper records. The University of Virginia Medical Center has been employing scribes to aid doctors in capturing the necessary information that comes out of a consult or appointment with a patient. The scribes follow physicians to these consults and use laptops to type notes into the electronic medical record (EMR). Then the physicians sign off that the information is correct after he or she has finished speaking with the patient. That way physicians can give all of their attention to their patients and don’t have to worry about filling in fields in the EMR.

Leah Binder, CEO of the Leapfrog Group, told the paper that this model may work for now at the facility, but she doubted it would see widespread adoption. This is because there’s a chance for mistakes to enter the patient’s record, even if physicians read over the record.

The article said this was the only facility in the country to use scribes during the paper-to-electronic switch. Have you ever heard of this idea? Has your hospital developed some other creative method for easing the transition?