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General interest items edited by Janice Flahiff

[Reblog] Germs. The pseudoscience of quality improvement

hmmm…position justifications? power plays?

C-Dif

From the 7 December 2014 post by Karen Siebel, MD at the HealthCare Blog

No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind.  But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies.  As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.

Here’s an example.  An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result.  Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees.  Some are paying attention to the new rule, and many others are ignoring it.  One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.

The Joint Commission, of course, loves nothing more than to make up new rules, based sometimes on real data and other times on data about as substantial as fairy dust.

A year or two ago, another new rule surfaced, mandating that physicians’ personal items such as briefcases must be placed in containers or plastic trash bags if they are brought into the operating room.  Apparently someone thinks trash bags are cleaner.

Now one anesthesiology department chairman has taken this concept a step further, decreeing that no personal items at all are to be brought into the operating room–except for cell phones and iPods.  That’s right, iPods, not iPads.  This policy (of course) probably won’t be applied uniformly to high-ranking surgeons or to people like the pacemaker technicians who routinely bring entire suitcases of equipment into the OR with them.

What’s particularly irrational about this rule is that cell phones likely are more contaminated with bacteria than briefcases or purses, even if they’re wiped off frequently.

 

Instead of creating more and more rules governing the care of all patients, perhaps we need to focus on the subsets of patients and case types that we already know are at higher risk, and examine what additional steps we need to take on their behalf.

 

 

 

December 9, 2014 Posted by | health care | , , , , , , , | Leave a comment

[Press Release] Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

From the US Health and Human Services press release

Hospital-acquired conditions decline by 17 percent over a three-year period

A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013.  This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative.  Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013.  This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.

“Today’s results are welcome news for patients and their families,” said HHS Secretary Sylvia M. Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely.  HHS will work with partners across the country to continue to build on this progress.”

Today’s data represent demonstrable progress over a three-year period to improve patient safety in the hospital setting, with the most significant gains occurring in 2012 and 2013. According to preliminary estimates, in 2013 alone, almost 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.

Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others.  HHS’ Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of a number of avoidable hospital-acquired conditions compared to 2010 rates and used as a baseline estimate of deaths and excess health care costs that were developed when the Partnership for Patients was launched. The results update the data showing improvement for 2012 that were released in May.

“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal – improving patient care,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “We have built an ‘infrastructure of improvement’ that will aid hospitals and the health care field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”

Additional Information

December 5, 2014 Posted by | health care | , , , , , | Leave a comment

Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily

Infection control practices not adequately implemented at many U.S. hospital ICUs, study finds — ScienceDaily.

Date:  January 29, 2014
Source:  Elsevier
Summary:  U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study.

From the news article

U.S. hospital intensive care units (ICUs) show uneven compliance with infection prevention policies, according to a study in the February issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

“Establishing policies does not ensure clinician adherence at the bedside,” state the authors. “Previous studies have found that an extremely high rate of clinician adherence to infection prevention policies is needed to lead to a decrease in healthcare-associated infections. Unfortunately, the hospitals that monitored clinician adherence reported relatively low rates of adherence.”

The survey also assessed structure and resources of infection prevention and control programs, evaluating characteristics such as staffing, use of electronic surveillance systems, and proportion of infection preventionists with certification.

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. Many of these infections occur in the ICU setting and are associated with an invasive device such as central line, ventilator, or indwelling urinary catheter. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. The estimated annual costs associated with HAIs in the U.S. are up to $33 billion.

 

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February 1, 2014 Posted by | health care | , , , , , , , , | Leave a comment

Researchers propose social network modeling to fight hospital infections

This image shows a Intensive Care Unit.

This image shows a Intensive Care Unit. (Photo credit: Wikipedia)

 

From the 22 October 2013 EurkAlert

 

Researchers propose social network modeling to fight hospital infections

 IMAGE: This is an illustration of dense (left) and sparse (right) patient ICU social networks. Patients in the circle that share a nurse are connected by lines (links), while patients that…

 

Click here for more information. 

COLLEGE PARK, Md. – Two researchers at the University of Maryland’s Robert H. Smith School of Business have teamed up with a researcher at American University to develop a framework to help prevent costly and deadly infections acquired by hospitalized patients. According to the Department of Health and Human Services (HHS), these transmissions strike one out of every 20 inpatients, drain billions of dollars from the national health care system and cause tens of thousands of deaths annually.

The research of Sean Barnes, Smith School assistant professor of operations management; Bruce Golden, the Smith School’s France-Merrick Chair in Management Science; and Edward Wasil of American’s Kogod School of Business, utilized computer models that simulate the interactions between patients and health care workers to determine if these interactions are a source for spreading multi-drug resistant organisms (MDROs). Their study shows a correlation of a “sparse, social network structure” with low infection transmission rates.

This study comes in advance of HHS’ 2015 launch and enforcement of a new initiative that penalizes hospitals at an estimated average rate of $208,642 for violating specific requirements for infection control. In response, the study’s authors have introduced a conceptual framework for hospitals to model their social networks to predict and minimize the spread of bacterial infections that often are resistant to antibiotic treatments.

The authors manipulated and tracked the dynamics of the social network in a mid-Atlantic hospital’s intensive care unit. They focused on interactions between patients and health care workers – primarily nurses – and the multiple competing factors that can affect transmission.

“The basic reality is that healthcare workers frequently cover for one another due to meetings, breaks and sick leave,” said Barnes. “These factors, along with the operating health care-worker-to-patient ratios and patient lengths of stay, can significantly affect transmission in an ICU… But they also can be better controlled.”

The next step is to enable hospitals to adapt this framework, which is based on maximizing staff-to-patient ratio to ensure fewer nurses and physicians come in contact with each patient, especially high-risk patients.

“The health care industry’s electronic records movement could soon generate data that captures the structure of patient-healthcare worker interaction in addition to multiple competing, related factors that can affect MDRO transmission,” said Barnes.

The study, “Exploring the Effects of Network Structure and Healthcare Worker Behavior on the Transmission of Hospital-Acquired Infections,” appears in a recent issue of the peer-reviewed IIE Transactions on Healthcare Systems Engineering. The study was partially funded by the Robert H. Smith School of Business Center for Health Information and Decision Systems.

 

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A full copy of the study is available at: http://www.tandfonline.com/doi/abs/10.1080/19488300.2012.736120?journalCode=uhse20#.UmV9WPmsjlN

 

 

 

October 23, 2013 Posted by | health care, Medical and Health Research News | , , , | Leave a comment

   

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