Author Archive for Heather Comak
Heather Comak is a Managing Editor at HCPro, Inc., where she is the editor of the monthly publication Briefings on Patient Safety, as well as patient safety-related books and audio conferences. She is also is the Assistant Director of the Association for Healthcare Accreditation Professionals. Contact Heather by e-mailing hcomak@hcpro.com
Thank you nurses!
It’s National Nurses Week from May 6 through May 12. We here at the Patient Safety Solutions Blog wanted to take a posting to say thanks for all of the hard work, long hours, and dedication that you put in to making sure your patients receive safe, reliable care. Formally recognized sine 1991, this week gives healthcare organizations a chance to also say thanks.
The American Nursing Association has a landing page up dedicated to the observance and offers some ideas on how to celebrate it. Some of the suggestions include holding a facility-wide celebration, hosting a press conference for local media, distributing RN pins for all of the nurses in your organization, and even holding a candlelight vigil in honor of nurses.
Is your organization doing anything to commemorate National Nurses Week 2009?
AHRQ reports show quality improvement for hospitals, but existing disparities in minority care
The Agency for Healthcare Research and Quality yesterday released two reports that summarize many of the issues with which healthcare professionals and specifically those in quality improvement struggle.
The National Healthcare Quality Report for 2008 highlights strategic areas to measure whether the quality of care in the U.S. is getting better–or not. Although quality within hospitals improves annually by 3%–the most out of all care settings, some of the findings related to patient safety within hospitals are nothing short of a rude awakening:
- One in seven adult patients is the victim of at least one medical error
- Hospital compliance with the six core indicators in the report have declined about 1%
- 40% of all hospital-acquired infections are the result of catheter-associated urinary tract infections
You can find the full report here for futher details. The report details some suggestions for the future, such as standardizing patient safety measures and better collecting patient safety data.
The National Healthcare Disparities Report, also released yesterday, shows that disparities do indeed still exist as far as access to healthcare and quality of healthcare goes. For African Americans, Asians, Hispanics, Alaska natives/ American Indians, and poor people, 60% of quality measures either stayed the same or got worse. Some progress is being made, however, in reducing the occurrence of certain illnesses that disproportionately affect one minority.
WHO announces new hand hygiene campaign
Piggy backing off its “Clean Care is Safer” campaign launched in 2005, The World Health Organization (WHO) announced its latest initiative on May 5th. Titled “Save Lives: Clean Your Hands,” the initiative attempts to illustrate how deadly failing to use proper hand hygiene practices can be. Several events took place around the world on May 5th in honor of the initiative’s launch.
The WHO has also posted lots of tools on it’s Web site for those hospitals interested in the initiative, including case studies, videos, and a graphic display touting the “Five Moments for Hand Hygiene” that specifies the five most important times bedside caregivers can perform hand hygiene. They also offer advice on how to educate staff members, a method for gathering feedback on any hand hygiene initiatives started in a facility, and a sample action plan for those hospitals who need guidance.
The concept of cleaning our hands to prevent the spread of infection is not new, yet it’s something that is just not done enough in the healthcare setting. The WHO’s new spin might spur on some creative ideas within your own facility. Has your hospital signed up to be a a part of this new initiative? More than 4,500 hospitals worldwide have done so.
Survey: Patients happy with physicians, want specific recommendations
A new survey out from the Deloitte Center for Health Solutions shows that most patients still want their doctor’s honest opinion and recommendations for care. However, more and more patients want their physicians to offer more treatment options and also offer the ability to shop around for care. A recent article in American Medical News highlighted some of the survey’s findings.
Interesting to note is the fact that the third of patients who describe themselves as “content and compliant” with their own care are older patients who may have different priorities than younger patients. Sources in the article suggest that doctors try to keep up with the times and adapt to patients’ needs by offering online follow-up information and resources.
One other perhaps unsurprising find, given the economy, is that a greater number of patients think about cost when it comes to deciding on a treatment.
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.
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.