Archive for December, 2009
Would reducing end-of-life care really cut healthcare waste?
One of the issues that has seem to come up over and over again this past year when discussing healthcare reform and the costs associated with healthcare is the notion that care that costs more is not always “better” care–that is, certain areas of the country that spend more on its patients don’t always have better quality outcomes. Atul Gawande, MD, wrote a revealing article earlier this year in The New Yorker about why McAllen Texas is the second most expensive healthcare market in the country, after Miami (although McAllen has much lower household incomes). This article threw the topic of spiraling costs of healthcare into the limelight and brought to the forefront the idea that there are healthcare systems that exist in the U.S. that manage its resources much more wisely. Additionally, providing end-of-life care to patients that elongates their lifespan by a few weeks or months, often with poor quality, has been tagged as one way that costs could be reigned in.
However, I saw this article in the New York Times last week that highlighted U.C.L.A Medical Center which would be pointed out as one of the healthcare facilities that does not focus on reducing waste, but aims to offer patients all of the options they might want. And, they did a study with some other facilities that have the same philosophy to show that in fact, spending more money does save lives.
Both sides of the debate refer to research from the Dartmouth Atlas of Health Care, a project that examines how medical resources are used. The problem that those at U.C.L.A-type facilities see in its data is it only uses Medicare data of people who have died to form opinions of whether spending money on end-of-life care, rather than those who have lived because of utilizing that care.
Check out the New York Times article, it brings up another valid side to the argument.
Top 7 Patient Safety Monitor blog posts of 2009
I thought it’d be interesting to take a look back through 2009 and see which blog posts garnered the most page views. The following seven posts are it, and what strikes me most about this list is that it’s not completely made up of newsy announcements or write ups–the most popular blog posts were about simple solutions for keeping patients safe.
- Uniforms by Color: Can they aid in caregiver identification?: This post brought up the idea of dressing hospital staff members in different color according to the type of job they have (nurses wear one color scrub, pharmacists wear another, physical therapists another, etc.).
- Positive Deviance proven to lower MRSA rates: In March the Robert Woods Johnson Foundation and the Plexus Institute announced that it had research to show that using the Positive Deviance technique can lower MRSA rates. The technique involves empowering staff members to think of unique ideas to solve a problem, and giving them the resources to do so.
- National Quality Forum endorses set of medication management measures: Earlier this year the National Quality Forum endorsed a set of 18 measures to better manage over-the-counter and prescription medications and improve the safety of using such medications. The standards focus on helping patients improve their adherence to prescription regimens.
- New infection control product monitors hand hygiene: This post highlighted a new product that keeps tabs on staff members’ adherence to hand hygiene principles. It only works if staff members wear some sort of badge that monitors how often they wash or sanitize their hands. This post may be number four on the most read list, but if there was a list of posts that garnered the most comments, this one would top it. Some readers thought the idea was a great one, but would be too expensive to carry out. Others thought the product invaded the privacy of staff members a little too much.
- RI hospital commits fifth wrong-site surgery since January 2007: This post detailed the wrong-site surgeries that occurred at Rhode Island Hospital in Providence between early 2007 and November 2009. After the latest offense the state’s Department of Health got involved and mandated the hospital comply with some new rules, including installing video cameras and audio recorders in its operating rooms.
- Study examines incidence of inconsistent communication present with CPOE: The chance that an error may occur as the result of a discrepancy between the open notes field in a CPOE system and the actual CPOE order was examined in a study published earlier this year in the Archives of Internal Medicine. Researchers found that while the errors were uncommon, they do occur and some can be serious.
- How does your hospital color-code patient wristbands? This post brought to light the many groups out there within specific states, or even regions of states, that all denote different colors for patient wristbands to mean different things. There are many coalitions that have been successful in standardizing these colors.
Can the safety risks associated with organ donation be reduced?
One topic I don’t find myself researching and writing a lot about is the patient safety issues surrounding organ donation. The Wall Street Journal has a revealing story today that has put the issue on my agenda, however. THe story is about the dangers organ recipients face due to a precarious balance that those organizations collecting and distributing organs face. On the one hand, there is a long waiting list for most organs, and in fact 9,000 people die annually waiting for an organ. Therefore, time is of the essence, and there often is not the adequate amount of time to rigorously test organs for disease, parasites, cancer, and infection, and many organs that are not extremely healthy make it onto the list of those eligible to be received. However, there’s a growing number of people who suffer extreme severe reactions to organs that have been transplanted into them because the organs do in fact carry some sort of infection.
The United Network for Organ Sharing, which operates the U.S.’ organ transplants, has been tracking rates of reported infection since 2004 and found that only 1% of patients who receive an organ report also acquire a disease because of an infected organ. However, the group says that most likely patients underreport any such transmission.
The group’s latest project is the development of an organ donor ID system. The idea is to prevent the spread of disease via organ/tissue transplant. One such donor infected with Hepatitis C donated 91 different tissues and organs to 40 patients. Of those, eight patients became infected and two died from the disease.
To read more on this topic from the Wall Street Journal, click here.
Study: Surgical site infections can add $60,000 to patient’s treatment
During a recent study, surgical patients who contracted a surgical site infection (SSI) because of methicillin-resistant Staphylococcus aureus (MRSA) were at a greater risk for readmission, and death, and their elongated hospital stays cost $60,000 more than patients who did not develop a surgical site infection, reports HealthDay. The findings of the study were published in the December 15 PLoS One (journal). Researchers from Duke University Medical Center compared the 90-day outcomes of 659 patients with surgical site infections due to MRSA, patients whose surgical site infections were caused by MSSA (methicillin-susceptible Staphylococcus aureus), as well as patients without infection.
During the study, those patients who contracted a surgical site infection because of MRSA were 35 times as likely to be readmitted, and seven times as likely to die than patients without infection. Even compared with patients who had MSSA, MRSA patients were worse off, racking up six more hospital days and an extra $24,000 in hospital charges.
You can read more about the study by clicking here. When discussing SSIs at your facility, are the costs associated discussed with frontline caregivers? Do you think that those at the bedside should be made aware of the costs incurred by SSIs?
HealthLeaders Media publishes list of 20 people who make healthcare better
HealthLeaders Media publishes an annual list of 20 people who make healthcare better. This year’s list runs the gamut of healthcare executives, healthcare insurance staff, patients and consumers, and nurses and physicians who have gone above and beyond to improve healthcare. If you have time, check out the entire list.
I want to bring attention to one person on the list, Brian Jack, who was in charge of a research grant called Project RED, which stands for re-engineered discharge. We covered the project back in June 2009 in a Briefings on Patient Safety article. Jack and his team received a grant from the AHRQ to study where errors were occurring in the discharge process–not so much during discharge but after discharge, when 30% of patients are readmitted to the hospital. Project RED utilizes 11 interventions in a checklist at a patient’s discharge to make sure the patient understands his or her discharge instructions. Another key component is ensuring patients have a follow-up appointment booked within 24 hours. Hopefully this project, and others that emphasize the need to spend more time with patients during the crucial discharge process, will help reduce readmission rates.
Rates of hospitalization for potentially preventable conditions decline in patients age 65+
The Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) has found that the rates of hospitalization for potentially preventable conditions declined between 2003 and 2007 for people aged 65 and older. The latest statistical brief from HCUP outlines data showing that during this time period rates of hospitalization for these potentially preventable conditions declined faster for adults 65 and older than adults aged 18-64. The increased availability of outpatient services and methods for disease management may play a role in this decline.
The conditions mentioned in the brief include the following types of diabetes, chronic cardiac conditions, chronic respiratory conditions, and acute conditions:
- Short-term diabetes complications
- Long-term diabetes complications
- Uncontrolled diabetes
- Lower extremity amputation
- Hypertension
- Congestive Heart Failure
- Angina without procedure
- Chronic Obstructive Pulmonary Disease
- Adult asthma
- Bacterial Pneumonia
- Dehydration
- Urinary Tract Infection
Despite the reductions in the rates of hospitalization for some of these conditions for the over 65 population, overall, hospitalization rates for these conditions were higher for older adults than for the population aged 18-64, which may come as no surprise.
For specific rates of hospitalization for these conditions broken down by age, see pages 7-9 on the HCUP statistical brief.
AHRQ offers ten tips for keeping patients safe
For those hospitals looking for a concise list of actions to take to prevent adverse events and improve patient safety, the Agency for Healthcare Research and Quality (AHRQ) has created just that. The AHRQ has an extensive Web site for those wanting to learn about the prevention of medical errors. This list is one small part of the site, which contains all types of resources such as speeches, toolkits, studies, journal articles, and more.
The ten tips are:
- Prevent central line-associated blood stream infections
- Re-engineer hospital discharges
- Prevent venous thromboembolism
- Educate patients about using blood thinners safely
- Limit shift durations for medical residents and other hospital staff if possible
- Consider working with a Patient Safety Organization
- Use good hospital design principles
- Measure your hospital’s patient safety culture
- Build better teams and rapid response systems
- Insert chest tubes safely
Which of these tips has your hospital focused on in the past year? Which are you hoping to incorporate into your strategy for good patient care in 2010?
Click here to find the tips with full descriptions of why they made the list.
INQRI blog hosts two-week series in observance of “To Err is Human” anniversary
The Interdisciplinary Nursing Quality Research Initiative (INQRI) blog, one of my favorite places to go for nursing and quality improvement news, is hosting a two-week series of blog posts in honor of the 10 year anniversary of the “To Err is Human” report. As mentioned in a post earlier this week, the Institute of Medicine really started the modern day patient safety movement with this report that outlined where medical errors were occurring and how to stem the tide.
The series of blog posts has hosted commentary from national healthcare leaders as well as researchers and providers, all discussing any progress that has been made since the report was originally published. INQRI itself is a program funded by the Robert Woods Johnson Foundation that supports interdisciplinary teams of nurses in their efforts to improve patient care. It’s leaders, Mary Naylor, PhD, RN, FAAN and Mark Pauly, PhD, were part of a Q & A on the blog as was Janet Corrigan, PhD, MBA, president and CEO of the National Quality Forum. There is even a multimedia clip from the TV show “Grey’s Anatomy” illustrating the horror of discovering a medical error.
“Big Brother” may be keeping watch on patient safety practices
Maryland is using some of its funds from the American Recovery and Reinvestment Act to pay for “secret shoppers” to evaluate whether hospital staff members are washing their hands. A Rhode Island hospital is being forced to install video cameras by the state’s department of health to monitor its operating rooms because several wrong-site surgeries have occurred there in the past few years. These examples may be part of a new trend of hospitals using surveillance as a technique to improve patient safety, reports American Medical News.
The data from the Maryland project will not be made public, but will be shared with all participating hospitals. Hospitals will be able to compare the rates of compliance among groups of staff members, such as physicians and nurses.
The use of surveillance to improve patient safety can be effective, as long as it is used as a helpful aid, Mark Chassin, MD, MPH, president of The Joint Commission told American Medical News. However, he said, secret shoppers, video cameras, and other types of technology can only be successful if they are not also undermining the culture of an organization.
This balance is certainly a difficult one to strike. Has your organization employed any type of surveillance in an effort to improve patient safety? The use of hand washing monitors is probably the most common form of surveillance that I’ve heard of, and usually these are done in conjunction with some other sort of “fun” patient safety or infection control initiative a hospital. This type of surveillance mentioned in the American Medical News article takes the idea to a new level, and it will be interesting to see if it has a larger effect on patient safety than other tactics.
