Archive for April, 2009
Adverse events may become public in New Jersey
A New Jersey bill currently going through legislature would make some information of “never” events available to the public online, according to an AARP Bulletin. Currently, New Jersey’s 73 acute care hospitals reports these never events under a confidential system. The public would be able to view data concerning 14 serious medical errors, including wrong-site surgery, post-surgical hemorrhage or infection, and blood transfusion problems.
The New Jersey Hospital Association supports this part of the bill, but is concerned about another part which would prevent hospitals and physicians from charging for treatments to repair mistakes-a section of the bill the New Jersey Medical Society, which represents physicians, opposes.
Urgent care centers prove their worth in wake of long ER lines
Lengthy wait times at emergency rooms (ER) around the country have given way to “urgent care centers,” alternatives to the ER for less severe ailments, reports the Los Angeles Times. In 2006, patients waited an average of 3.3 hours to be seen at the ER, according to a Centers for Disease Control and Prevention report. Urgent care centers offer those patients who do not have life threatening problems a chance to escape these long wait times and be treated medically faster than they would be by waiting to see a primary care physician.
The Urgent Care Association of America (UCAOA) reports that 8,000 urgent care centers existed as of 2008. However, these somewhat new options for care are for the most part unregulated. The UCAOA is drafting a list of what patients can expect at urgent care centers (hours, medical professionals who could work there, procedures that can be performed).
Insurers like the idea of urgent care centers because when patients visit urgent care centers, it often means insurers will not have to pay for what most likely would have been more costly ER visits. Many hospitals are scrambling to find ways to lessen ER wait-times for both patient satisfaction and patient safety needs. However, the LA Times article raises an important question—what if patients are unable to appropriately decide on the severity their symptoms?
Do you have any experience with urgent care centers in your community?
New study shows fewer patients see primary care doc while in hospital
A study published in today’s Journal of the American Medical Association highlights another interesting point about the continuum of care. I posted twice in the past couple of weeks about reducing rehospitalizations, (last week the CMS announced a pilot project to reduce readmissions) and often one indicator that a patient will avoid rehospitalization is if he or she already has a follow-up appointment booked with a primary care physician (PCP), or specialist after being discharged.
The new study shows that hospitalized Medicare patients age 66 and older are less often being visited by a PCP or other doctor with whom they have been in contact during the past year while during their hospital stays. The study examined enrollment and data claims and found that in 1996, 50.5% of patients in this age group were seen by at least one doctor with whom they’d had some contact with in the last year during a hospital stay. That percentage dropped to 39.8% in 2006. A similar trend occurs when looking specifically at visits by a PCP: in 1996 44.3 % of patients were visited by their PCP during a hospital stay and in 2006, only 31.9% were.
The authors of the study intended to examine the role of the continuum of care plays in keeping patients age 66 and older healthy. One reason for this decrease in visits by a PCP or specialist is the increase in the number of hospitalists that are present in hospitals today. Hospitalists often orchestrate a patient’s care while he or she is inside the hospital and may do some of the tasks that PCPs do when they visit a patient in the hospital.
About one-third of surgeons suffer from burnout, study suggests
A new study in the Archives of Surgery has found that 30 – 38% of surgeons across the country suffer from burnouts, according to a piece in Wall Street Journal’s Health Blog.
The study suggests that younger surgeons and female surgeons are at especially high risk for stress and burnout, and found that a number of factors lead to its cause, including:
- Length of training
- Long hours and large workloads
- Imbalance between career and family
- Feeling of isolation
- Grief or guilt over patient death
- Insufficient research time and funding
- High self-imposed expectations
- An inefficient and/or hostile work environment
The study describes an attitude among surgeons that long hours and heavy workloads are expected and emotional responses are not, which researches say feeds stress and burnouts. The study concludes that being overworked is counterproductive and leads to self-destructive behavior that may affect quality of care.
Joint Commission releases document on hand hygiene adherence
I’m sure many of you have had trouble not only getting staff members to comply with your facility’s hand hygiene rules, but also measuring their compliance, which can be just as tricky. Do you measure by observing secretly, by surveying staff members, or by product use? Guidance has finally come in the form of a 232-page document released by The Joint Commission yesterday. The monograph offers a more standardized framework to measuring hand hygiene compliance and offers guidance on when, why and how to measure how well staff members are adhering to proper hand hygiene protocol.
The document includes examples of measurement methods, and came to fruition after a two-year collaboration with a number of organizations, including the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), the World Health Organization (WHO), the Institute for Healthcare Improvement (IHI), and the National Foundation for Infectious Diseases (NFID).
CMS announces Care Transitions Project
The Centers for Medicare and Medicaid Services (CMS) has announced it will soon be launching a project aimed at reducing preventable rehospitalizations. This announcement comes just weeks after The New England Journal of Medicine published a study showing that 20% of Medicare patients were readmitted to a hospital within 30 days of being discharged, and 30% were readmitted within three months. You can find an earlier posting about this study on the Patient Safety Monitor Blog.
The effort, called the Care Transitions Project, will use 14 pilot cities to set up programs that improve healthcare processes so that patients, families/providers of care, and teams of caregivers have what they need to reduce the likelihood of rehospitalization.
“Rather than focusing on one global problem and trying to apply a one-size-fits-all solution across the country, Care Transitions experts will look in their own backyards to learn why hospital readmissions occur locally and how patients transition between health care settings,” said Barry M. Straube, MD, chief medical officer for CMS and director of its Office of Clinical Standards & Quality in a press release. “Based on this community-level knowledge, Care Transitions teams will design customized solutions that address the underlying local drivers of re-admissions.”
Each of the following 14 locations will be led by a state Quality Improvement Organization:
- Providence, RI
- Upper Capitol Region, NY
- Western PA
- Southwestern NJ
- Metro Atlanta East, GA
- Miami, FL
- Tuscaloosa, AL
- Evansville, IN
- Greater Lansing Area, MI
- Omaha, NE
- Baton Rouge, LA
- North West Denver, CO
- Harlingen, TX
- Whatcom County, WA
To find out more about the Care Transitions Project, click here.
Does “ethics checklist” have a place at your hospital?
In the last year, much has been made of the power of checklists. Peter Pronovost and his team from Johns Hopkins succeeded at proving a checklist used in Michigan ICUs helped reduce or prevent central line infection rates. Recently this was replicated in hospitals around the country. The World Health Organization (WHO) Surgical Safety Checklist was proven to reduce surgical errors by one third in operating rooms around the country, and has been incorporated into the IHI’s latest campaign.
Last month the British Medical Journal published a study about a new type of checklist–an ethics checklist. This article in American Medical News provides a more in-depth look at the checklist and uses. Some interesting questions come out of the use of this new checklist, which is currently being piloted at Washington Hospital Center in Washington, D.C. One of these is are checklists becoming an of-the-moment solution for many patient safety concerns?
The American Medical News article contains feedback from both Pronovost and Atul Gawande, director of the WHO initiative. Both agree that checklists alone will not change the behavior of healthcare workers. For specific interventions they have succeeded because of commitments to culture change and an understanding of why the checklist is useful.
The ethics checklist contains items such as ensuring patients’ ideas about treatment , end-0f-life wishes, and family situation/ interactions are all clear. Those who are piloting the checklist are excited about the potential it has to integrate ethics questions more easily into patient care.
MA report finds patient falls are most common error
Patient falls were the most common “serious reportable event” in Massachusetts hospitals in 2008, according to a new report released yesterday by the Massachusetts Department of Public Health.
There were 338 such events reported by Massachusetts hospitals last year, with falls making up 224 of them, the report found. Other events included medication errors and medical instruments left inside patients. The state found that the events led to 19 deaths.
To read the official press release, visit the Mass. DPH site.
Proposed patient safety group looks to aviation model to improve processes
A paper published in the most recent issue of Health Affairs highlights some of the areas in which patient safety could be improved by utilizing aviation principles. A new proposed patient safety group, the Public Private Partnership to Promote Patient Safety (P5S), seeks to improve healthcare and reduce medical errors by adopting the same techniques that the aviation industry used to reduce fatal accidents. The Commercial Aviation Safety Team (CAST) has been meeting regularly since the mid-1990s to collaborate as an industry on how to make it safer by analyzing accident reports and making recommendations.
A team of researchers led by Peter Pronovost, MD, spells out in its paper exactly what a team like CAST could do for healthcare. There are many different barriers present in bringing this model to healthcare, but the central idea—that the healthcare industry as a whole should work together to reduce sentinel events—remains the same. This model would include every part of the healthcare continuum- from staff practices within the hospital to the way in which medical equipment is manufactured.
Some of the barriers listed in the paper include:
- Funding—the aviation industry depended on group members to finance and send staff members to participate in CAST. The healthcare industry has fewer resources with which to use for initiatives like this. One option is government funding, and although the Agency for Healthcare Research and Quality supports this initiative, it is unlikely that the government would be able to provide full funding.
- Multiple stakeholders taking part—the many sectors of healthcare need to get on the same page and decide what they will work together on to improve quality of care.
- Differences from the CAST model—the aviation industry is somewhat less complex than the healthcare industry in that there are hundreds clinical areas that all have their own set of hazards.
- Convincing hospitals that patient safety is something that needs a large investment—it is difficult to persuade hospitals presently that taking part in an initiative like this without guaranteeing an immediate return on investment. Patient safety needs to be seen as something to which attention should be paid regardless of immediate financial return, although it is becoming apparent that the two are linked.
New York hospital to offer personal health records for patients
New York Presbyterian Hospital, which is responsible for caring for 20% of all of New York City’s patients at its clinics, will be launching a new personal health record program to help patients better manage their own care, reports The New York Times. Although certain health plans around the country have partnered with technology providers to offer their plan members the chance to fill out their own personal health records, this instance represents the first attempt by a hospital to do so with its patients.
At first it will just roll the plan out to heart patients, although eventually the hospital intends to involve many more patients. Patients will be trained on how to use the personal health record while they are in the hospital.
Although the Obama Administration’s focus is on improving electronic medical records, and not personal health records, the two both can simplify healthcare and keep patients safer, the article says.