Recent Articles
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.
Patients’ Bill of Rights found to be difficult for patients to understand
Found this story via KevinMD, and it caught my eye because I know how hard hospitals, and patient education managers in particular, work to make sure their own patient safety and education literature is written at an 8th grade level. Turns out the Patients’ Bill of Rights (this is the American Hospital Association’s (AHA) original version), of which many states have modified and made their own versions, is tough to read for many patients. This HealthDay article points out some examples of how some of the rights listed could be modified to be written in a manner that most patients would understand (at an 8th grade reading level).
The report, which was based off of a study published in the Journal of Internal General Medicine, shows that there is great variability among state versions of the Patient Bill of Rights, and that most did not take into account the average reading level in the U.S. Additionally, most were only written in English and didn’t cover the 12 themes originally listed in the AHA’s Bill of Rights. Part of the problem is that there is no Federal Patients’ Bill of Rights, making it difficult to standardize what should be included and how one should be written. The AHA published “The Patient Care Partnership” in 2006 to replace their Bill of Rights to address what should be part of the information exchange during a patient’s hospital stay.
Has your hospital made sure its Patients’ Bill of Rights is understandable by all patients?
Many Medicare patients readmitted to hospitals, study says
A study out today from The New England Journal of Medicine shows that 20% of Medicare patients are readmitted to the hospital at which they recently stayed within a month. That percentage jumps to 34 when looking at a three month time period. The data, which pulls from Medicare claims collected between 2003 and 2004, show that more and more discharge is becoming a time at which it is crucial to have a good communication plan in place among caregivers and patients.
Hospitals may soon have a financial incentive to make patient care at discharge a priority. The Wall Street Journal Health Blog reports that part of President Obama’s Medicare budget plan involves not further reimbursing hospitals for patients who are readmitted for the same condition that they had at discharge. Of course, there are many factors to why patients are readmitted: being extremely sick, and perhaps having a primary care doctor who jumps to hospitalization rather than other treatment could lead to repeat visits. A stronger continuum of care that involves better communication on the part of all of a patient’s doctors would also help lower these rates. Also, involving the patient and his or her family (and evaluating if they are health literate) in the discharge process would help lower readmission rates, researchers say.
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.