AHRQ says that more patients are leaving against medical advice

More news from the AHRQ–this time, however, patients may be acting as a threat to themselves. An August report from the Healthcare Cost and Utilization Project says that between 1997 and 2007, the number of patients who left the hospital against medical advice rose 39%. Although the 368,000 people who did leave against medical advice represent only 1.2% of all hospital patients, the readmission rate for these patients is significantly higher than for the rest of the patient population—not to mention these patients immediately put themselves at high medical risk.

Patients leave against medical advice for many reasons. The report makes it clear that it’s necessary to get to the bottom of why patients might leave against medical advice, because that holds the key to making sure they complete their hospital stays in the future. Often the reasons may be related to external factors, like financial obligations or family emergencies versus perception of poor treatment, but it’s important to address these external factors as well in order to provide the safest care.

Have you had any experience with patients who left against medical advice? How have you addressed this issue as a medical staff?

AHRQ launches HAI information Web site

The Agency for Healthcare Research and Quality launched a Web page on Friday full of resources and information about preventing healthcare-acquired infections (HAI). The site pulls together tools and data from many different resources, including itself, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and Health and Human Services’ National Action Plan on HAIs. The site also contains links to other groups and resource material in which providers may be interested.

Click here to find the Web site.

Patient Safety Monitor Contest Update

This week’s creative entry into the Patient Safety Monitor Contest comes from Jeanette Tanafranca, RN, MSN, at Henry Ford Health System (HFHS) in Detroit, Michigan. HFHS has developed a Safety Champion program that is targeted towards the front line healthcare workers. The program, now with more than 80 safety champions, consists of front line caregivers who complete a three hour safety champion course.  These are staff members in housekeeping, radiology technicians, nurses, and physicians who have all made themselves available to act as liaisons for the rest of the staff and try to make patient safety a part of everyday processes and procedures.

As Jeanette describes, the goals of the program are:

1. Provide support for the implementation of basic safety concepts and strategies learned in Patient Safety 101 course
2. Share and spread internal best practices
3. Collaborative problem solving on mutual challenges
4. Build effective teams at the local level
5. Build trust to encourage all staff to “speak up”: Listen to concerns, provide support and follow-up for identified issues.

Many safety champions are also involved in the hospital’s communication campaign concerning patient safety and are create as well as learn from blog posts, newsletter articles, e-mail campaigns, and participating in Webinars.

In Jeanette’s own words, the unique aspect of our program is that we incorporate Human Factors training and strategies, which gives our Safety Champions a different perspective in their daily work.

Thanks for this entry, Jeanette, and thanks to all who have entered the Patient Safety Monitor Contest! The winner of the contest, who will receive a free copy of the Patient Safety Officer’s  Handbook, will be announced next week, so stay tuned, and as always, thanks for reading the Patient Safety Monitor Blog- it’s these great ideas that keep the blog going. 

Lancet op-ed says checklists are good, but not healthcare’s savior

In the past couple of years, much has been made of the use of checklists in the medical field to bring about better patient outcomes and keep patients safe. The most successful project to date that used checklists was the Keystone project in Michigan which used evidence-based methods to sharply reduce the central line infection rate in more than 100 ICUs in that state.

A new op-ed from The Lancet says that while this project showed how a checklist could be used to reduce infection, it was not simply the checklist that accounted for the project’s success. Many other factors worked together with the use of a checklist to reduce the infection rate; since the story was made public through the media, however, most of the project’s success has been attributed to using a checklist. The authors of the op-ed, Charles Bosk, Mary Dixon-Woods, Christine Goeschel, and Peter Pronovost, suggest that using this idea, that checklists are a simple solution to many patient safety problems, actually puts more patients’ safety at risk because of the lack of understanding of the many other factors that made this project  a success.

The authors discuss the many factors that were a part of the project’s success: a commitment from each hospital’s leadership team, hours of research and learning on the part of the team leaders identified by hospital leaders, months of meetings to hash out the best plan for moving forward, data collection and reporting on the part of infection control practitioners, and finally the cheklist as a means of keeping team members on track and fostering a good culture of safety.

Additionally, the op-ed’s authors bring up the point that not all problems can be solved even partially by using a checklist–it’s just better suited for some issues and not others.

You can read the full op-ed here (free registration may be required). It’s an interesting take on an idea that’s been well publicized and praised in the past couple of years.

Joint Commission sets new challenge for 2009-2010 flu season

In a follow up to its first ever successful Flu Vaccination Challenge, the Joint Commission has launched another challenge for the upcoming 2009-2010 flu season. The goal of the Flu Vaccination Challenge was to increase vaccination among healthcare workers to a rate of 43% or higher. That rate was based on a survey of healthcare workers from 2005-2006 about flu vaccination rates. Today the results of last season’s challenge were announced and 94% of participating hospitals met the goal, with 1.1 million healthcare workers being vaccinated.

For the next Flu Vaccination Challenge, The Joint Commission is asking healthcare facilities to push their staff members to be vaccinated at rates of 60,75, 0r 90%, depending on the vaccination rate for the facility was during the 2008-2009 season. The challenge is also being extended this year to healthcare workers in long term care and ambulatory settings.

The Centers for Disease Control recommends that all healthcare workers be vaccinated for the seasonal flu.

I’m curious- did any of your facilities participate in this challenge? How did you encourage your staff members to get vaccinated? The challenge is only for the seasonal flu, as opposed to the H1N1 virus, but I wonder if any sort of requirements concerning H1N1 vaccination will be addressed in the future?

You can find out more about this year’s challenge at www.fluvaccinationchallenge.com.

NYTimes op-ed discusses how to lower costs, increase quality in American healthcare

To boost quality and lower healthcare costs, it’s not necessary for the American healthcare system to adopt a foreign model, but rather to look to successful models that exist within the U.S. That’s the message from an op-ed piece that appeared this weekend in the New York Times, written by Atul Gawande, Donald Berwick, Elliot Fisher and Mark McClellan. These four healthcare leaders invited teams from ten regions of the country that were considered “high performing” to meet and discuss why residents in their areas received higher quality healthcare at a lower cost than the rest of the nation. 

Many of the teams interviewed used methods such as employing physicians at hospitals, studying the overuse of imaging technologies, and focusing on collaboration with various players in the healthcare community. The initiative, titled “How did they do that?” is a joint effort from the Institute for Healthcare Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, the Brigham and Women’s Center for Surgery and Public Health, the Engelberg Center for Health Care Reform at Brookings, and Re>Think Health, an initiative of the Fannie E. Rippel Foundation. You can find out more about the initiative and the meeting with the healthcare leaders and regional teams listed above by clicking here.

To read the op-ed piece, click here.

Patient Safety Monitor Contest Update: Last week’s winner

Last week’s winning entry into the Patient Safety Monitor Contest came from Thomas Sholty, lead protective services officer at Clarian Arnett Hospital in Lafayette, Indiana. Thomas’ entry concerned the steps his fellow staff members have taken to make sure that children receiving care at the hospital are being driven home in the safest manner once they are discharged–that is ensuring car seats are properly installed. Several staff members have received their Child Passenger Safety Technician Certifications and the hospital will be holding two separate car seat safety clinics in the coming months.

As Thomas described them:

During these clinics the staff members will provide free car seat inspections to anyone who requests one, will provide a free car seat to any child without one, and will exchange car seats for any child who has out grown theirs.

In addition, as previously mentioned, the hospital makes sure that any child being discharged from the facility has a proper car seat inspection, and if he or she did not have a car seat, the hospital will provide one for him or her. As Thomas so eloquently put:

With this program, we are effectively taking patient safety out the front door of our facility and onto the road, creating a safer community overall.

Thanks for entering, and stay tuned for this week’s creative entry on Friday–and the winner of the Patient Safety Monitor Blog contest next week! For those of you who would like to enter this week, please e-mail your entries to me at hcomak@hcpro.com.

Patient Safety Monitor Contest Update

Thanks for all of this week’s entries. I am out of the office today, but I’ll be sure to post a creative entry from this past week on Monday, 8/17. Hope you have a great weekend!

AHRQ spearheads effort to bring patient voice into error reporting

The Agency for Healthcare Research and Quality (AHRQ) is leading an effort to give patients a voice in error reporting. I wrote this article for HealthLeaders Media last week, and a longer version will be appearing in the September Briefings on Patient Safety. It discusses how the AHRQ is working with a couple of groups to design a consumer reporting system. 2009 brought us Patient Safety Organizations, formalized reporting opportunities for healthcare professionals, but often missing from the discussion about how medical errors occur is that of the patient. However, patients offer a viewpoint that is unique–one that observes the entire continuum of care. Healthcare providers are at the disadvantage of only knowing what happens when a patient is under his or her care, and not once that patient has moved on.

I spoke with Sue Sheridan, of Consumers Advancing Patient Safety, about her involvement with the project. Sheridan, a woman who has had two major medical errors occur to family members, has been a great voice in helping to design what a consumer reporting system might look like. She, along with 17 other experts that are part of a technical expert panel, are helping to advise and mold a possible consumer reporting system. The project also involves extensively interviewing patients and family members who have been victims of medical errors.

You can read the article by clicking here.  What are your thoughts about standardizing a method for collecting consumers’ error reports?

Consumer activist group’s list of ten patient safety reforms, could save 85,000 lives

In a new report titled “Back to Basics,” the consumer activist group Public Citizen has devised a list of ten patient safety reforms that, if done correctly, could save the lives of 85,000 patients, as well as $35 billion annually, reports HealthLeaders Media. Most of the reforms listed reiterate basic actions that caregivers are already aware of, as well as process and system changes that individual hospitals can make. Many are also conditions for which Medicare will no long reimburse hospitals.

The top five of these reforms are:

1. Use of a checklist to prevent avoidable death and injury during surgery
2. Use of best practices to prevent ventilator-associated pneumonia
3. Use of best practices to prevent pressure ulcers
4. Implementation of safeguards and quality measures to prevent medication errors
5. Use of best practices to prevent patient falls

To read more from HealthLeaders Media, click here.

These points don’t seem like anything extremely new to me, but it’s always a good reminder to see the same issues cropping up again and again.