Archive for March, 2010

Joint Commission announces field review for med rec

The Joint Commission has announced the field review of its revised medication reconciliation requirement, which it has designated as National Patient Safety Goal (NPSG) 03.07.01.

The field review comes after The Joint Commission announced it would make the existing medication reconciliation goal (NPSG one with which hospitals had to comply, but about which they would not be surveyed. The 2010 NPSGs contain language about medication reconciliation, but the field has widely expected an announcement about what will become of the goal.

The accreditor had previously said it would update the goal because it had received feedback from the field indicating that hospitals felt the goal was too difficult to implement. Last February, The Joint Commission said it would “evaluate and refine the expectations for accredited organizations.” The field review is the result of this refinement.

The revised goal is designed to work in tandem with other medication management requirements. It requires providers to maintain and communicate accurate information regarding a patient’s medications. Specifically, the goal would require hospitals to:

• obtain medication information from patients at admission
• compare that information with the medications ordered for the patient and identify discrepancies
• communicate to the patient at discharge information about the medications he or she should be taking
• impress upon the patient the importance of managing his or her medications outside of the facility.

The Joint Commission is asking for feedback from the field through May 11, although it would prefer feedback by April 30. The standard will be tested in the field prior to implementation. If you’d like to offer your feedback, and to see the full text of the proposed goal, visit The Joint Commission’s page about the field review.

Do you have any initial reaction to this proposed med rec goal? My sense from the field that any change would be a good one, and this seems to really simplify the goal.

Thomson Reuters releases list of 100 Top Hospitals

Thomson Reuters has released its annual list of 100 Top Hospitals based on quality outcomes. The study examines data concerning ten different quality measures, including mortality, patient safety, average length of stay, and post-discharge mortality and readmission rates for various conditions. The data are pulled from the following resources:

• Medicare Provider Analysis and Review (MedPAR)
• Medicare Cost Report
• Centers for Medicare and Medicaid Services (CMS) Hospital Compare

According to Thomson Reuters, if all Medicare patients received the level of care offered at the 100 facilities on its Top Hospitals list, there would be 98,000 fewer deaths, 197,000 fewer complications, and a savings of $5.5 billion annually.

The list also denotes The 100 Top Hospitals “Everest Award” winners. These hospitals represent the fastest rate of long-term improvement. All of the winners can be found here. Did your facility make the cut?

Don Berwick to lead CMS

Rumors were circulating last Friday, March 26th, that Don Berwick, MD, the leader of the Institute for Healthcare Improvement (IHI) would be named the new administrator of the Centers for Medicare & Medicaid Services (CMS). Those rumors have been confirmed today, and President Obama will officially nominate Berwick to head up the CMS, according to the New York Times. Berwick has been a crusader in the quality improvement movement, inspiring thousands of healthcare providers through his work at the IHI and elsewhere.

A senate committee hearing would be required to confirm Berwick as administrator of the CMS, which has not had a permanent leader since 2006. As head of the CMS Berwick would inherit a great deal of responsibility for carrying out the healthcare reform that passed last week.

I, for one, think this is an exciting announcement and great development for the healthcare of the nation. I think the IHI under Berwick’s leadership has proven itself to be a leader in providing solutions for healthcare organizations concerned with quality. Hopefully he can take this same preoccupation with quality (which is probably why he was picked) and mesh it with the political and budgeting know-how needed for this position.

You can read the full New York Times article by clicking here.

Just the facts: Women account for 6 out of 10 hospital stays

I was paging through the HCUP Facts and Figures Report (most recent data is from 2007) and thought just highlighting the differences in male and female hospital discharges would be interesting to look at on the blog. First of all, 60% of all discharges are of female patients, about 23.2 million hospital stays. This is because more than one-fifth of female hospital stays are related to pregnancy and childbirth. Males accounted for 16 million hospital stays in total.

When examining stays related specific conditions, it’s not surprising to find that the five of the top 10 diagnoses for males and females were related to heart conditions. These include coronary artery disease, congestive heart failure, acute myocardial infarction, cardiac dysrhythmias (irregular heart beat) and non-specific chest pain. Of these, males were discharged more often for coronary artery disease and acute myocardial infarction (62.4% and 59.6% respectively, vs. females). Females had a slight edge on the other conditions, but they were almost even between males and females.

Other conditions that made the top 10 for hospital stays in 2007 (for males and females):

• pneumonia
• mood disorders
• septicemia

The three reasons for hospital stays for males and females that grew the most between 1997 and 2007 were skin and subcutaneous tissue infection, osteoarthritis, and septicemia (blood infection).

To find the full list of facts, see the Healthcare Cost and Utilization Project Facts and Figures report for 2007.

New and different challenges emerge between patient and physician with Internet advances

A recent commentary in the New England Journal of Medicine summarizes well the problems and benefits that the Internet has brought to American healthcare. Written by Pamela Hartzband, MD, and Jerome Groopman, MD, the commentary describe the Internet as the technological advance that has had the most profound effect on their clinical practices since they have been physicians. Because of its ability to provide vast amounts of true and misinformation, the Internet has given patients the ability to inform themselves about potential sicknesses for the better or for the worse. Hospitals have used the Internet to connect with patients more often and more efficiently; this too can have negative and positive consequences.

From a patient safety standpoint, I think learning how to harness the power of the Internet and all of the information contained on it is going to be one of the major challenges in the next ten years. Also, physicians and healthcare organizations will have to decide how they themselves view the Internet and want to interact with it. If patients cannot decipher what is true and what is false, is it physician’s responsibility to inform them? Perhaps this will become the job of a care manager- to act as a liaison to the patient and also keep in touch with physicians and caregivers about the information patients are seeking.

How do you view the Internet in conjunction with patient care? Is it a hinderance or an opportunity for improved care?

MA physician invents infection-preventing stethoscope cover

A Massachusetts physician has designed a new disposable plastic sleeve to fit over a stethoscope, The Boston Globe reports. Physicians responsible for examining patients who have communicable diseases have been guarding their stethoscopes with latex gloves for years, but the latex solution often does not work well, failing to adequately protect the instrument and fitting the stethoscope awkwardly. Richard Ma, creator of the “Stethguard,” the name of the plastic sleeve, says that his invention will help prevent the spread of infection via stethoscope.

Although the rate that infections are spread in a hospital via stethoscopes is unknown, adding another barrier to the spread of infection—specifically those that are hospital-acquired—is vital in helping patients leave the hospital quicker and save facilities money. The CDC advises that all stethoscopes be cleaned between patients, but that often does not happen, according to The Globe. Physicians also shy away from using designated stethoscopes for patients who carry infections, because they do not function as well as their own.

To read more about the Stethguard in the Boston Globe, click here.

Do you think the physicians at your facility would take to an infection prevention product like this?

C-diff infections may be on the rise, according to one study

A study released recently showed that c-diff infections often outnumber MRSA infections in hospitals, reports the New York Times.  C-diff, short for Clostridium difficile, is a superbug resistant to many medications that usually ward off infection. Although C-diff is not new to hospital staff members, it is a newer name for the public, which has mostly  heard about the MRSA superbug. C0diff comes from spores found in feces and can cause diarrhea, as well as colitis.

The study of 28 hospitals in the southeast found that the rate of hospital-acquired C-diff infections was 25% higher than the rate of hospital-acquired MRSA infections. However, MRSA is still seen to be the bigger threat because it causes 18,000 deaths each year. Experts say that MRSA rates are actually on the decline, though, and C-diff will be an infection to worry about in the years to come.

As soon as I had read the New York Times article on C-diff, I stumbled on this Medical News Today piece, about a C-diff trial at the Mayo Clinic. The trial involved cleaning high-touch surfaces in a unit on which rates of C-diff were high with spore-killing bleach. The process did not seem to upset the flow of care too harshly. Results showed that the new process helped lower C-diff rates by more than 30% on the units with the highest rates prior to the study, which far exceeded researchers hopes.

Are you seeing C-diff more often at your own facility? Has your hospital instituted any type of prevention plan different from that of your general infection control processes?

Three words for patient safety

I came upon a patient safety project done by Abington (PA) Memorial Hospital (AMH) this morning that I wanted to share on the blog. The staff at AMH used the “Your Three Words” segment from the Good Morning America program to brainstorm a patient safety project for the facility. Although I’m not a Good Morning America watcher, I looked up the program and found that it asks viewers to communicate their feelings on a specific topic in three words.

AMH took this idea and asked staffers to communicate their thoughts about patient safety related to their jobs in three words. The result is a nearly five-minute long video, which you can find here. This is another creative way to involve everyone who works at a facility in patient safety!

As a writer/editor who communicates about patient safety, I think my three words would be:

Educate, Inform, Interact

At least that’s what I try to do to/with my audience! What would your three words be? How do you incorporate patient safety into your job each day?

Three lessons from France on reducing HAIs

My colleague Janice Simmons at HealthLeaders Media attended 5th Decennial International Conference on Healthcare Associated Infections 2010 where she learned about France’s efforts to reduce HAIs. Since 2004, the country has been using robust mandatory public reporting as a means of preventing the spread of HAIs. Although the French healthcare system and the American healthcare system are set up differently (France has universal government provided healthcare and the United States… well that’s being reformed as I type, but it is not universal and is provided by private insurers for the most part), there are some principles for preventing HAIs that could apply to the U.S.

The article lists out three in particular, which include:

• Make public reporting mandatory
• Create targeted objectives
• Promote other priority initiatives

These concepts are nothing new to the U.S., and in fact, they are already in use. However, I do think the wide use of public reporting is one lesson that the U.S. should take to heart. Some states require this, but not enough.

Check out the full article to read more details of the three lessons mentioned above.

Report says medical students need increased training on patient safety

The Lucian Leape Institute at the National Patient Safety Foundation released a report last week calling for an increased focus on patient safety in medical school curricula. The report, Unmet Needs: Teaching Physicians to Provide Safe Patient Care, details 12 recommendations for reforming the current medical education curricula to incorporate these vital aspects of providing safe patient care.

The report says that not only do medical school students need to learn about patient safety, they also need to understand communication techniques and how to work in a team, as well as the science of safety. Based off a series of roundtables in which leading experts in the field participated, the report called out the practice of medical schools devoting much of student’s time in the classroom to learning about the clinical practice of medicine, among other things. However, there are other skills necessary to deliver good medical care, and the authors hope that the report will influence medical schools to adopt new and different curricula as a result.

To learn more about the report, see this HealthLeaders Media article that I wrote last week.

I think this report is a step in the right direction, because, as it mentions, residents are learning some of the poor culture and attitude behaviors from their physician teachers during medical school, and not the importance of practicing within a culture of safety. Understanding human factors and how to work in a team is something that should be woven into the industry. It only makes sense to incorporate this education into medical school curriculum.

What are your thoughts?