Archive for March, 2009
Gulf Coast leads nation in pushing health records online
Although Hurricane Katrina will most be remembered for the devastation it brought to the New Orleans area, it did force the area to become much more open to the idea of using electronic health records. In fact, the Gulf Coast is leading the nation now in moving patient records into an online format. The need to do so became apparent when residents of the area were forced to move to other regions of the country, often without knowing which medications they were taking or what their treatment regimen consisted of. Additionally, many paper records were completely lost.
The Mississippi Coast Health Information Exchange (MCHIE) is helping the areas physicians and hospitals get a jump start on the Federal initiative to convert patient records to electronic records. You can read more about this initiative from The SunHerald by clicking here.
Has your hospital or facility become of an RHIO (Regional Health Information Organization)? How have staff members and patients alike taken to the initiative?
Cost of electronic health records a deterrent for hospital use
We’ve heard much about electronic health records over the past few months, especially since the U.S. government intends to spend a significant amount of money helping hospital systems install them. And it turns out, an overwhelming majority of hospitals and hospital systems will need that money to even make a foray into the electronic world. The New England Journal of Medicine published a study yesterday that shows that overall, a meager 1.5% of hospitals in the U.S. have a fully functional, top of the line electronic health system. A slightly larger percent (7.6) of hospitals have some sort of EHR functioning in at least one or a few areas, and computer-physician order entry is used by 17% of hospitals.
The main reason that only 1.5% of hospitals are using EHRs is the cost, the article says. Also, those involved in researching the topic think that although there is going to be a lot of money available to help implement more fully-functioning EHRs, the current lack of EHRs will be a significant barrier to moving ahead with healthcare goals that depend electronic health information technology. Interoperability–having EHRs among many hospitals and hospital systems that can talk to each other–is another big concern.
Although this number is a lot lower than I thought, it does not completely surprise me. Most staff members at hospitals with whom I speak either do not have EHRs, or have one for the emergency department, or another department–not for the entire hospital.
Joint Commission reserves the right to change its mind
Just when you thought you were up to speed on the Joint Commission’s latest revised standards, the accreditor went and revised its revisions.
On January 5, mere days after its 2009 hospital standards went into effect, the Joint announced more than 150 revised standards changes. Now, after discussions with CMS, the Joint cut those revisions in half after determining that the requirements were already covered under existing standards or elsewhere in the survey process.
Read about the latest changes here, and find a crosswalk of the January and March changes here.
Stay tuned for further analysis.
Culture of safety issue apparent with sleepy surgeon
The Massachusetts Department of Public Health has reported that a surgeon at Beth Israel Deaconess Medical Center in Boston, MA nodded off during surgery in June 2008. The patient involved sued the team of doctors working on him, as well as some nurses, and has already settled out of court. You can read the details of the day in this Boston Globe article, but what struck me most about the story was how many times the nurse involved in the case tried to get the surgeon’s attention and suggest that he take a break; she even called the plastic surgery department (the department in which the doctor worked). However, according to the report, the surgeon left inexplicably later on that day, without the influence of a more senior staff member.
Sine the incident, the hospital has educated all nurse managers about the proper protocol for handling staff members who might not be performing at the top level (as was the case in this instance). The vice president for quality at the hospital says that protocol for handling a disruptive and/or impaired staff member is to call a supervisor for resolution.
What has been your own experience in this area? Have you ever felt that you needed to speak to a fellow staff member’s supervisor to ensure that patients received the safest care available during their hospital stay? This incident is certainly not isolated and represents how difficult it can be to speak up about a disruptive staff member, an impaired staff member, or perhaps a sleepy staff member. Have you received training or education on this topic? Building a solid culture of safety takes time and support from the highest levels of the hospital. This instance shows that even for a hospital that is actively addressing culture of safety issues, there is still room for improvement.
Healthcare gets a social media makeover
Are you a Twitterer? Can’t get through the day without constantly posting and reading “Tweets” on your mobile device? Yeah, me neither.
But an increasing number of folks are hooked on the social media network, which allows users to send out quick, 140-character updates on what they’re doing and what they’re interested in. Twitter and other forms of social media like blogs, instant messaging, and video chat are also ways for doctors and patients to stay in touch on a more regular basis.
Twitter’s also making inroads into healthcare, with the advent of small group practices like Brooklyn’s Hello Health, which allows patients to “visit” doctors online as well as in person. The practice started a year ago and already has 300 enrollees and just opened a second office last month.
There are valid concerns being raised about patient privacy being violated by physician blog posts and Tweets, but in general, the incorporation of social media into healthcare is seen as a good thing. What do you think?
Positive Deviance proven to lower MRSA rates
The Robert Wood Johnson Foundation and Plexus Institute today announced the results of a Positive Deviance program, trialed to see the effects it had on MRSA rates. The story caught my eye because I’ve written a couple of stories about Positive Deviance for Briefings on Patient Safety in 2007 and 2008, and the idea always struck me as something so simple, yet so empowering. Positive Deviance solicits ideas for solving a problem from those who deal with that problem often and may think of a solution that might be considered “out of the norm,” but one that works. It’s an approach that attempts to gather behavioral change from those frontline workers who solve problems with the same resources as their peers.
Using Positive Deviance to lower MRSA rates has succeeded, as it was announced at the annual scientific meeting of the Society for Healthcare Epidemiology of America this past weekend. The study began in 2006 and introduced the idea of Positive Deviance into three hospitals from different parts of the country. Each hospital was to use Positive Deviance to help carry out the following three actions:
- screening all patients admitted to a pilot unit for MRSA
- isolating all patients who tested positive
- rigorously adhering to hand hygiene and contact precautions
A team from the Centers for Disease Control and Prevention analyzed the data from these facilities to show a reduction in MRSA rates between 26 and 62%.
This video clip from CBS News shows how one transporter helped his hospital adhere to hygiene and contact precautions (sorry about the commercial before the news).
Could this technique be something your hospital implements? Have you thought of using Positive Deviance for tackling other issues at your facility, not just MRSA?
You can find out more about Positive Deviance by visiting the Positive Deviance Initiative Web site.
Press Ganey report assesses culture of safety
The Patient Safety and Quality Healthcare Web site posted news yesterday on Press Ganey Associates, Inc.’s recently released report on the culture of safety that had some interesting finds in it. Though it was released a week ago in conjunction with Patient Safety Awareness Week, I thought Patient Safety Monitor readers would find this Safety Culture Pulse Report worthy of note.
Data was collected from 42,378 healthcare employees, and gives insight into what your staff might be thinking. Here are some of the results:
- New employees (those who worked less than one year at a hospital) reported the highest level of safety focus in their hospital; veteran employees (six to 10 years of employment at a hospital) had the lowest sense of safety.
- Similarly, employees who worked fewer hours a week (less than 20) reported the highest sense of a focus on safety; employees with 60 hours per week or more under their belt had lower perceptions of safety focus at their hospital.
- As the size of the facility increases, healthcare providers’ perception of safety decreases.
- Biggest threats to patient safety culture, according to employees, are assessing blame for medical errors instead of addressing system failures and mistakes made during patient handoffs.
PSM readers, as always, please share any comments on these findings. Anything surprise you here?
Joint Commission releases more FAQs
The Joint Commission has released another set of FAQs, this time addressing some emergency management, environment of care, and Universal Protocol concerns. Though you can see the full list of FAQs by clicking here, I’m going to highlight the FAQs for the Universal Protocol, as it most relates to patient safety, has been a major trouble spot for hospitals, and is a topic we’ve talked about in other Patient Safety Monitor Blog posts.
- Bilateral procedures: The Joint Commission has addressed the issue of performing site marking for a bilateral procedure by saying it’s not required, but it is recommended. The intent of the Universal Protocol has been to specifically note the correct side of the patient for those surgeries requiring laterality, but this new FAQ was released in acknowledgement that it is possible to perform the wrong bilateral procedure.
- Documenting the timeout: The Joint Commission has addressed the outcry it received from the field about how onerous a requirement it was to require each element of the timeout be documented individually. This FAQ specifies that it is acceptable to create a check box or brief note that documents that all parts of the timeout were completed. This simple documentation must be in the same part of a patient’s record for each patient, and the components of the full time out have to be listed elsewhere (like in a policy or procedure), but one check box will comply with the Universal Protocol.
Has your facility struggled with the 2009 Universal Protocol? Do these recent FAQs clear up any issues you may have been having with documentation?
NQF urges adoption of Safe Practices
The National Quality Forum this week rolled out its 2009 Safe Practices for Better Healthcare, a series of 34 evidence-based practices including catheter-associated urinary tract infection, multidrug-resistant organisms, and organ donation.
To get the word out, the NQF is launching a year-long webinar series will begin in April to provide Safe Practices implementation strategies and commentary from experts in the field. The practices are based on six years of work defining and refining strategies to improve patient safety. Several previously endorsed practices were updated based on new evidence, including practices in areas such as the pharmacist’s role in medication management and pressure ulcers, and an entire chapter on healthcare-associated infections.
You can download the report here.
Doctor and nurse cell phones contaminated with MRSA, other bacteria
Here’s something to think about before answering that call: After testing the cell phones of 200 doctors and nurses working in ORs and ICUs, researchers in Turkey found that 95% of cell phones tested had bacteria on them, according to redOrbit news service.
Researchers from the Ondokuz Mayis University in Turkey published the study in a recent issue of BioMed Central’s Annals of Clinical Microbiology and Antimicrobials. The study found that one out of every eight cell phones showed traces of methicillin-resistant Staphylococcus aureus (MRSA). It also found that only 10% of staff members regularly cleaned their phones. Researchers worry that phones could help spread infections to already sick patients.