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Search results for "Health Care Executives and Administrators"

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Book/Report

Saving Lives and Saving Money: Hospital-Acquired Conditions Update.

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Rockville, MD: Agency for Healthcare Research and Quality; December 2015. AHRQ Publication No. 16-0009-EF.

The Partnership for Patients initiative has led efforts to reduce hospital-acquired conditions (HACs), such as health care–associated infections and other never events. Since 2010, AHRQ has been tracking rates of HACs including adverse drug events, catheter-associated urinary tract infections, central line–associated bloodstream infections, pressure ulcers, and surgical site infections. This interim update demonstrates that HACs were reduced by 17% in 2014, indicating that the previously reported decline has been sustained. With this decrease in HACs, the analysis estimates that 87,000 fewer hospital patients died and $19.8 billion in health care costs were saved from 2011 to 2014. Although HACs persist despite incentives and strategies to eliminate them, these reductions indicate that hospitals have made substantial progress in improving safety.

Book/Report

2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013.

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Rockville, MD: Agency for Healthcare Research and Quality; October 2015. AHRQ Publication No.16-0006-EF.

Hospital-acquired conditions (HACs), some of which are never events, have been an important focus of patient safety initiatives, with reporting requirements and Medicare nonpayment leading to significant efforts to prevent these conditions. This update to a prior report from AHRQ details and confirms the declining rates in HACs between 2010 and 2013. The analysis indicated that hospitalized patients experienced 1.3 million fewer HACs over the 3 years (2011–2013) than if the HAC rate had remained at the 2010 level. Consequently, the report estimates a $12 billion savings in health care costs and 50,000 fewer hospital patient deaths. These improvements coincided with nationwide efforts to reduce adverse events, such as the Partnership for Patients initiative and Medicare payment reform. The remaining burden of HACs suggests continued investment in this patient safety problem is needed.

Book/Report

The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events.

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Cortese D, Abbott P, Chassin M, Lyon GM III, Riley WJ. Dallas, TX: Texas Health Resources Leadership; 2015.

Delayed diagnosis of infectious disease can negatively affect patients, care teams, and public health. Reviewing insights from a panel analysis of the well-known incident involving delayed diagnosis of Ebola virus, this report highlights the need to improve information transfer and emergency department safety culture to enhance diagnostic and infection prevention processes.

Journal Article > Study

Health care–associated infections among critically ill children in the US, 2007–2012.

Patrick SW, Kawai AT, Kleinman K, et al. Pediatrics. 2014;134:705-712.

This large cohort study of 174 hospitals examined rates of central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections in neonatal and pediatric intensive care units (ICUs) across the United States. Between 2007 and 2012, there were remarkable reductions in these hospital-acquired infections among critically ill infants and children. In pediatric ICUs, CLABSIs plummeted from about 4.7 to 1.0 per 1000 central-line days, while ventilator-associated pneumonias dropped from 1.9 to 0.7 per 1000 ventilator-days. The trends were similar in neonatal ICUs. The authors estimate that the decrease in CLABSI rates alone not only enhanced patient safety but also saved $131 million for these hospitals during the study period. A recent AHRQ WebM&M perspective focused on hospital infection prevention programs.

Book/Report

2015 MHA Patient Safety and Quality Annual Report.

Okemos, MI: Michigan Health & Hospital Association; October 2015.

This publication annually reports on the successful outcomes of the Michigan Keystone Center collaborative activities. Achievements covered in the current year include a reduction in patient readmissions and continued improvements in the incidents of central-line-associated bloodstream infections.

Journal Article > Commentary

State sepsis mandates—a new era for regulation of hospital quality.

Hershey TB, Kahn JM. N Engl J Med. 2017;376:2311-2313.

Delays in diagnosis and treatment of sepsis can have serious consequences. This commentary discusses successful programs, built on policy mandates, that aim to ensure effective standardized approaches are in place at health care facilities to prevent harm associated with sepsis.

Web Resource > Government Resource

National Healthcare Safety Network.

Centers for Disease Control and Prevention.

Health care–associated infection is a persistent patient safety problem. This website provides resources related to a national health care–associated infection and blood safety error monitoring program that allows organizations to identify areas of weakness and track the impact of improvements.

Journal Article > Study

Leapfrog Hospital Safety Score, Magnet designation, and healthcare-associated infections in United States hospitals.

Pakyz AL, Wang H, Ozcan YA, Edmond MB, Vogus TJ. J Patient Saf. 2017 Apr 27; [Epub ahead of print].

Health care–associated infections (HAIs) are a preventable safety problem. This cross-sectional study looked at hospital factors related to HAI incidence. Investigators explored whether the Leapfrog Hospital Safety Score, a composite safety score calculated from publicly reported measures, is associated with HAIs. They also examined the incidence of HAIs in hospitals with Magnet status, conferred by a nurses' trade association in recognition of a positive nursing work environment. Lower Leapfrog safety scores were associated with more Clostridium difficile infections but no differences in other HAIs, and Magnet status was associated with lower rates of methicillin-resistant Staphylococcus aureus infection but worse than expected performance on C. difficile infections. These mixed results do not indicate a strong or consistent relationship between global measures of safety and quality and specific adverse events. A past PSNet interview with Leah Binder, President and CEO of The Leapfrog Group, discussed the development of the Hospital Safety Score.

Audiovisual

The War on Error: Common Diagnostic Errors.

Medscape. 2016–2017.

Improving diagnosis has recently been recognized as a primary focus for patient safety. This collection highlights particular clinical areas of concern such as neurology and infectious disease. The articles offer expert commentary and review strategies to avoid common reasoning errors.

Journal Article > Study

A hybrid methodology for modeling risk of adverse events in complex health-care settings.

Kazemi R, Mosleh A, Dierks M. Risk Anal. 2017;37:421-440.

This study aimed to use modeling, a strategy to detect safety hazards, to characterize the risk of pressure ulcers and catheter-associated infections. Investigators developed a risk model that combined systems dynamics and Bayesian belief networks to assess organizational and nonorganizational factors that contribute to risks. The model performed well when validated against clinical data, suggesting wider applications of risk modeling may have practical patient safety applications.

Journal Article > Study

Eight years of decreased methicillin-resistant Staphylococcus aureus health care–associated infections associated with a Veterans Affairs prevention initiative.

Evans ME, Kralovic SM, Simbartl LA, Jain R, Roselle GA. Am J Infect Control. 2017;45:13-16.

This retrospective study demonstrated declines in methicillin-resistant Staphylococcus aureus health care–associated infections between 2007–2015. Researchers attribute these results to implementation of the Veterans Affairs MRSA Prevention Initiative. These findings underscore the success of patient safety practices in reducing health care–associated infections.

Journal Article > Study

Complication rates, hospital size, and bias in the CMS Hospital-Acquired Condition Reduction Program.

Koenig L, Soltoff SA, Demiralp B, et al. Am J Med Qual. 2016 Dec 19; [Epub ahead of print].

The Centers for Medicare and Medicaid Services (CMS) decision to withhold payment for certain hospital-acquired conditions has prompted widespread efforts to prevent such events, including health care–associated infections. Prior research suggests that academic centers and safety-net hospitals may be disproportionately affected by financial penalties imposed by CMS through various pay-for-performance initiatives. In this study, investigators analyzed how hospital size affected performance in the Hospital-Acquired Condition Reduction Program. They concluded that hospital size leads to bias when evaluating hospital performance, disproportionately penalizing larger hospitals when the expected complication rate for a particular event is low. The authors provide numerous suggestions for improving the evaluation of hospital performance within the program.

Journal Article > Review

Impact of Medicare's nonpayment program on hospital-acquired conditions.

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Thirukumaran CP, Glance LG, Temkin-Greener H, Rosenthal MB, Li Y. Med Care. 2017;55:447-455.

The Centers for Medicare and Medicaid Services policy on nonpayment for certain hospital-acquired conditions serves as a strong incentive to prevent adverse events during hospitalization. This observational study examined Medicare's nonpayment policy for conditions such as health care–associated infections. As with prior studies, investigators determined that the incidence of hospital-acquired conditions declined following implementation of nonpayment. For certain conditions, such as catheter-associated urinary tract infections, hospitals with a larger proportion of Medicare patients had greater improvements. The authors note the variation in rates of hospital-acquired conditions and differing magnitude of improvement. They recommend further study to understand how to achieve similar successes in reducing hospital-acquired conditions.

Journal Article > Review

Economic evaluation of quality improvement interventions for bloodstream infections related to central catheters: a systematic review.

Nuckols TK, Keeler E, Morton SC, et al. JAMA Intern Med. 2016;176:1843-1854.

Central line–associated bloodstream infections (CLABSIs) represent a key source of preventable harm to patients, and they are associated with increased morbidity and mortality. Prior research has shown that interventions to reduce CLABSIs result in significant cost savings to the health system but may decrease profit margins for hospitals. This systematic review examined the economic value of quality improvement efforts to reduce CLABSIs and catheter-related bloodstream infections (CRBSIs). Based on results from 15 studies, investigators concluded that hospital spending on CLABSI and CRBSI prevention efforts is worthwhile, leading to significant hospital savings as well as marked reductions in bloodstream infections. A PSNet perspective discussed the role of infection prevention in patient safety.

Patient Safety Primers

Failure to Rescue

Failure to rescue is both a concept and a measure of hospital quality and safety. The concept captures the idea that systems should be able to rapidly identify and treat complications when they occur, while the measure has been defined as the inability to prevent death after a complication develops.

Journal Article > Study

Costs and consequences associated with misdiagnosed lower extremity cellulitis.

Weng QY, Raff AB, Cohen JM, et al. JAMA Dermatol. 2016 Nov 2; [Epub ahead of print].

Misdiagnosis is common and can lead to unnecessary care, overuse, and increased costs. According to this study, misdiagnosis of cellulitis may result in anywhere from 50,000 to 130,000 unnecessary hospitalizations annually, leading to hundreds of millions of dollars in needless health care spending.

Newspaper/Magazine Article

Hospitals installed more sinks to stop infections. The sinks can make the problem worse.

Branswell H. STAT. October 25, 2016.

Hospitals have sought to improve hand hygiene with interventions such as room design and sink placement. This news article reports how installation of sinks to enable more frequent handwashing has had unintended consequences and could actually contribute to the spread of bacteria.

Journal Article > Commentary

Antimicrobial stewardship and patient safety.

Zukowski CM. AORN J. 2016;104:354-356.

Antimicrobial stewardship has been highlighted as a strategy to improve antibiotic use in order to reduce hospital-acquired infections. This commentary discusses antimicrobial stewardship teams, their impact in the surgical setting, and the role of nurses in ensuring appropriate use of antibiotics.

Journal Article > Study

Operating room traffic as a modifiable risk factor for surgical site infection.

Wanta BT, Glasgow AE, Habermann EB, et al. Surg Infect (Larchmt). 2016;17:755-760.

Surgical site infections are an important type of health care–associated infection that safety efforts aim to prevent. This case-control study compared patients matched on age, gender, and elective procedure who developed surgical site infections with those who did not. Although investigators hypothesized that having additional personnel in the operating room would lead to higher likelihood of infection, after adjusting for patient- and procedure-related factors, they found this was not the case.

Journal Article > Review

Prevention by design: construction and renovation of health care facilities for patient safety and infection prevention.

Olmsted RN. Infect Dis Clin North Am. 2016;30:713-728.

The environment of care facilities can affect teamwork, patient-centeredness, and spread of infection. Exploring the impact of room and unit construction on health care–associated infection, this review describes infection control risk assessment recommendations that should be applied during construction or renovation of care environments and advocates for infection preventionists to be involved throughout the process. A PSNet perspective discussed the role of the physical environment in patient safety improvement.

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