Safety First

Study: Hospital quality initiatives show promise, room for improvement

Though quality improvement activities appear to be widespread among hospitals, these activities vary in method and impact, according to a study released last week by the Health Research & Educational Trust, an American Hospital Association affiliate, and the Boston University Health Policy Institute. Among 470 hospital chief quality officers surveyed, 97% reported that QI activities had a positive affect on patient care outcomes, but only 28% agreed that patient satisfaction was at the level it should be.

Overall, hospitals in which CQOs perceived high levels of patient care quality were more likely than others to have embraced QI as a strategic priority, fostered staff training and involvement in QI methods and engaged in an array of QI activities and clinical QI strategies. HRET Interim President John Combes said, “This is the first study to examine the state of hospital QI activities since the Institute of Medicine recommended seven years ago a complete reform of the U.S. health care system.”

The study was supported by a grant from the Commonwealth Fund.

More than 75% of ER patients don’t understand physician instructions

A new study published in the Annals of Emergency Medicine says that more than 75% of patients in the emergency room (ER) don't adhere correctly to discharge instructions given by a physician. This is because most do not understand the instructions. Additionally, most patients don't realize that they don't understand the discharge instructions, which can create for an even more dangerous situation.

The study was done by interviewing 140 English-speaking patients after they had visited two ERs in Michigan. This topic is not new—studies around patients' lack of comprehension of their discharge instructions after visiting the ER were done in the 1990s as well. However, new communication techniques were thought to have helped raise comprehension rates.

To view the study, click here.

[ via Patient Safety Monitor ]

AMA members call some CMS no-pay events unrealistic

Physicians criticize CMS’s latest list of “never events” in an article on the American Medical Association (AMA) Web site.

In the article, some physicians said it’s unreasonable to believe physicians can prevent certain conditions on the no-pay list, for example urinary catheter infections.

Furthermore, some physicians believe the regulations will divide medical teams if blame for the developed condition is uncertain.

In the article, the AMA suggests CMS require hospitals comply with a set of evidence-based care guidelines. Under that system, if a patient develops a condition even when guidelines are met, payment could still be received for the additional care.

To read the full article click here.

Why Incident Investigations Fail to Improve Patient Safety

For more than 10 years, health care organizations have been doing root cause analysis (RCA) investigations following a sentinel event, yet untoward incidents are still occurring. What's even more frustrating, hospitals experience repeat events involving the same problematic process that was supposedly already fixed.

For the full story, click here.

WHO launches safe-surgery checklist initiative

The World Health Organization launched a surgical checklist initiative that it says improves adherence to evidence-based practices and helps to reduce complications and mortality among patients. Developed in the Safe Surgery Saves Lives collaboration led by the Boston-based Harvard School of Public Health, the checklist aims to ensure that surgeons and operating teams confirm pre- and post-surgical processes and follow evidence-based guidelines during procedures. Eight hospitals around the world, including the Seattle-based University of Washington Medical Center, participated this year in a pilot review of the checklist’s effectiveness. The WHO recommends facilities implement the use of its checklist in operating rooms to promote patient safety.

Medical teams complied with proven standards of care 68% of the time after implementing the checklist, according to WHO officials. They announced preliminary results from the pilot study as they released the checklist. The list includes three phases—“sign in,” “time out” and “sign out”—in which each task must be checked off before the operation can proceed or conclude.

The checklist establishes basic surgical safety standards that can be applied in all healthcare settings worldwide, and it fosters communication among medical staff and patients, said E. Patchen Dellinger, physician and vice chairman of the UWMC department of surgery, who led the pilot effort in his hospital. “Working on the checklist was a welcomed opportunity,” he said.

[ via Modern Healthcare's Daily Dose, Jean DerGurahian ]

AHRQ reports wide range in healthcare efficiency measures

A report, prepared for the Agency for Healthcare Research and Quality (AHRQ), has found that there is little agreement as to how to measure efficiency in healthcare.

In the report, prepared by the RAND Corporation, the authors found that the definition of efficiency varies widely among all areas of healthcare and that there is virtually no crossover between measures and methodologies used to study and improve healthcare efficiency. Also, the study found a lack of validation and evaluation in the study of efficiency in healthcare.

A copy of the report can be found on the AHRQ Web site.

[ via CLTC Weekly ]

APIC: Health care facilities step up MRSA prevention strategies

According to a new poll by the Association for Professionals in Infection Control and Epidemiology, many health care facilities have taken additional action in the past year to prevent the spread of methicillin-resistant staphylococcus aureus. Strategies include staff and patient education; stepped-up hand hygiene, contact precautions, housekeeping and decontamination practices; targeted patient screening; better infection surveillance technology; and additional staff dedicated to infection control.

“This poll indicates that many institutions are moving in the right direction,” said APIC CEO Kathy Warye. The findings are based on a recent survey of more than 2,000 APIC members who work in hospitals and other health care facilities.

[ via AHA News Now ]

AHRQ: Health care efficiency measures vary widely

While significant progress has been made in the measurement of health care quality, there remains little agreement on how to measure efficiency – one of the Institute of Medicine’s six aims for improving health care, according to a recent report prepared for the Agency for Healthcare Research and Quality. The RAND Corp. study found that definitions of efficiency differ greatly among health care payers, providers, purchasers, consumers and regulators.

The authors also found almost no cross-over between the measures and methodologies in peer-reviewed studies and those in use by health care institutions and providers working toward improved efficiency. They said measures developed by researchers and those in common use both lack validation and evaluation, and that virtually none of them includes a quality component.

[ via AHA News Now ]

AHA backs NQF framework for culturally competent care

The American Hospital Association on June 9 expressed its support for the National Quality Forum’s proposed endorsement of a framework and preferred practices for measuring and reporting culturally competent care. “We agree that the domains of the framework – leadership; integration into management systems and operations; patient-provider communication; care delivery and supporting mechanisms; workforce diversity and training; community engagement; and data collection, public accountability, and quality improvement – delineate the core competencies of culturally competent care,” AHA said in a comment letter.

The letter also applauds NQF’s proposed endorsement of the Health Research & Educational Trust Disparities Toolkit to collect race, ethnicity and primary language data from patients. “Without accurate information, we cannot begin to determine what disparities in care may exist,” AHA said.

The toolkit was developed with support from national experts and has been extensively tested in hospitals. HRET is an AHA affiliate.

[ via AHA News ]

Children more likely to suffer hospital infection than adults

Children suffer many hospital acquired infections, reports The St. Louis Post Dispatch. The study found that 6,600 out of 430,000 children hospitalized in 2006 at 38 children's hospitals around the country had complications from care after examining thousands of medical records looking for adverse events. Children are more susceptible than adults to suffer complications of hemorrhaging and postoperative infections, though less likely to suffer others, like bedsores, which adults often contract.

Safety efforts are often focused on adults; however, hospitals are becoming more aware of the need to identify and prevent hospital-acquired infections in children, the article says.

For more information, click here.

[ via Quality Improvement Monitor ]