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Hospital Consult - January 2015

Hospital Access Management - Hospital Case Management - Hospital Employee Health
Hospital Infection Control - Hospital Peer Review - Healthcare Risk Management
Case Management Advisor
- IRB Advisor - Medical Ethics Advisor - Same-Day Surgery

ICU Infection Prevention Saves Lives and Money

NEW YORK – Here’s even more motivation to prevent nosocomial infections in the intensive care unit: Elderly patients admitted to ICUs are about 35% more likely to die within five years of leaving the hospital if they develop an infection during their stay.

That’s according to a study published recently in the American Journal of Infection Control. It further notes that prevention of two of the most common health care-acquired infections – sepsis related to central lines and pneumonia related to ventilators – not only increases the survival odds of the patents but also reduces the cost of their care by more than $150,000.

"Any death from preventable infections is one too many," said senior author Patricia Stone, PhD, RN, FAAN, director of the Center for Health Policy at Columbia University School of Nursing. "We've known for decades what works to prevent infections and save lives. Now, our study shows just how much money can be saved by investing in prevention."

For the study, researchers focused on infection prevention efforts and outcomes for 17,537 elderly Medicare patients admitted to 31 hospitals in 2002. An additional five years of Medicare claims data was then used to assess the long-term outcomes and health costs attributed to healthcare-acquired infections.

Overall, 57% of all the elderly ICU patients died within five years, but researchers found that previous ICU infections made death more likely. Of those who had developed central line-associated bloodstream infections (CLABSI), 75% died within five years. The rate was even higher for those who developed ventilator-associated pneumonia (VAP): 77% of those patients died during the time period.

With effective prevention programs for CLABSI, however, ICU patients in general gained 15.55 years of life on average. Infection prevention can be as simple as hand washing before handling the catheter and immediately changing the dressing around the central line if it gets wet or dirty according to the study.

Meanwhile, measures to prevent VAP resulted in an estimated gain of 10.84 years of life on average for all patients treated in the ICU. Again, the study cites basic procedures such as keeping patients elevated in bed, with the head higher than the feet, as simple precautions that can help prevent pneumonia.

With the ongoing cost of running an infection prevention program in the ICU is estimated to be about $145,000, the study found that prevention efforts reduced ICU costs by $174,713 per patient for each instance of CLABSI, and by $163,090 for VAP.

"This evidence points definitively to the value of investing in infection prevention," said lead study author Andrew Dick, PhD, senior economist at RAND Corporation.

Nearly All Hospitals Have Social Media Presence

PHILADELPHIA – Somewhere amid the cute cat videos and incessant tweets about Downton Abbey, the vast majority of U.S. hospitals also have a presence on social media, according to a new study.

The report, published recently in the Journal of Medical Internet Research, discusses the adoption and use of social media based on hospital characteristics.

“Use of social media has become widespread across the United States,” according to the study led by researchers from the University of Pennsylvania. “Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health.”

To determine usage, the researchers conducted a cross-sectional review of hospital-related activity on four social media platforms: Facebook, Twitter, Yelp, and Foursquare. The review included 3,371 U.S. hospitals which reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey.

In addition, the researchers analyzed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status.

Used to determine the extent of social media utilization was the number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews.

Results indicate that adoption of social media varied across hospitals with 94.41% having a Facebook page and 50.82% having a Twitter account. Nearly all hospitals, 99.14%, had a Yelp page (99.14%, 3342/3371) and almost all hospitals and check-ins on Foursquare (99.41%).

High utilization was most likely with large, urban, private nonprofit, and teaching hospitals, according to the study.

“Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics,” the authors write. “This preliminary investigation of social media adoption and utilization among U.S. hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services.”

Hospitals Designated for Ebola Treatment or Assessment

ATLANTA – With the first round of more than 30 hospitals designated as Ebola treatment centers by public health officials, the vast majority of returning travelers from Ebola-stricken countries now live within 200 miles of such a facility in the United States.

The national Centers for Disease Control and Prevention notes that an increasing number of U.S. hospitals are now equipped to treat patients with Ebola, giving nationwide health system Ebola readiness efforts a boost. The CDC reported that state health officials had identified and designated the first 35 hospitals with Ebola treatment centers and that facilities would be added to the list weekly.

“As long as Ebola is spreading in West Africa, we must prepare for the possibility of additional cases in the United States,” said CDC Director Tom Frieden, MD, MPH. “We are implementing and constantly strengthening multiple levels of protection, including increasing the number of hospitals that have the training and capabilities to manage the complex care of an Ebola patient. These hospitals have worked hard to rigorously assess their capabilities and train their staff.”

Hospital administrators collaborated with local health authorities to determine which facilities would be designated to serve as treatment facilities for Ebola patients. Those hospitals are staffed, equipped and have been assessed to have current capabilities, training and resources to provide the complex treatment necessary to care for an Ebola patient while also minimizing risk to health care workers.

Each hospital with an Ebola treatment center was assessed on-site by a CDC Rapid Ebola Preparedness (REP) team. The CDC REP team includes experts in all aspects of caring for a patient with Ebola, including staff training, infection control, personal protective equipment (PPE) use, and details such as handling and management of the trash from the patient’s room. More than 50 hospitals in 15 states and Washington, DC, had undergone REP assessments as of the beginning of December, the CDC said.

The additional Ebola treatment centers supplement the three national bio containment facilities at Emory University Hospital in Atlanta, Nebraska Medical Center in Omaha, and the National Institutes of Health (NIH) in Bethesda, MD, which the CDC said would continue to play a major role in the overall national treatment strategy, especially for patients medically evacuated from overseas.

The priority areas for Ebola treatment centers are jurisdictions served by the five international airports screening returning travelers for Ebola, cities with high proportions of returning travelers from West Africa, and cities with large populations of individuals from West Africa. Federal health officials explained that, because of the active monitoring program of returning travelers from countries where Ebola is present, they have a good idea of where travelers from affected countries in West Africa are going and where Ebola treatment centers are most likely to be needed.

CDC also released guidance for states and hospitals to use as they identify and designate an Ebola treatment center. The guidance covers the range of capabilities hospitals need in order to provide comprehensive care for patients with Ebola.

In addition to designated hospitals to treat Ebola patients, CDC now is working with state and local public health officials to identify Ebola assessment hospitals. Assessment hospitals would have the capability to:

  • evaluate and care for someone who is having the first symptoms of Ebola for up to 96 hours;
  • initiate and coordinate testing for Ebola and for other diseases alternative diagnoses; and
  • either rule out Ebola or transfer the individual to an Ebola treatment center, as needed.

A patient with possible Ebola only would be cared for by an assessment hospital until a diagnosis is confirmed. The patient then would be transferred to an Ebola treatment center.

CDC also released guidance for states and hospitals to use as they identify Ebola assessment hospitals.

Liability Claims Bigger Than Ever, But Not More Frequent

SCHAUMBURG, IL – Many hospitals have new programs to enhance management processes and urge early resolution when faced with a liability claim.

The programs typically promote full disclosure of medical injuries to patients and offer compensation if the injury was caused by negligence. The efforts haven’t turned the tide when it comes to hospital liability claims however.

“Some hospitals that have implemented this type of program have reported an overall reduction in litigation costs and a decrease in legal expenses. We have not seen an overall reduction materialize, however,” according to the ninth annual Zurich Healthcare Risk Insights (HRI) benchmark study.

Dollar amounts sought in claims have been on the upswing for most of the last decade, according to the study. For example, during an 8-year period, the percentage of hospital liability claims above $1 million increased 44%, with the increase for teaching hospitals was 62%.

Overall, the severity of claims from teaching and children’s hospitals remains much higher than the national average, which also has increased steadily, according to the study, which is based on data collected from healthcare facilities seeking quotes for professional liability insurance from Zurich over the past year. The study data comprises more than $22.8 billion in losses from all 50 states and Washington, DC.

Generally, claim severity from facilities in urban areas continues to be higher than those in rural and suburban locations, the study adds.

“At a time when the industry is experiencing dramatic change and uncertainty, it is essential for providers to accurately understand risk trends and their impact on patient safety and overall quality care,” said Glen E. Curley, head of Zurich North America’s Healthcare Professional Liability. “The study provides distinctive insights into trends that can help healthcare providers analyze various aspects of risk and develop enterprise strategies to enhance outcomes in the continuum of care.”

On average, claim severity has increased steadily since 2006, with periods of leveling off in both 2008 and 2010, according to the report, which says the implied long-term average annual trend was about 6% from 2006 to 2011. Illinois, New York and Pennsylvania all had claim severity higher than the national average; Pennsylvania has had a double-digit implied annual trend of 11% since 2003, for example.

Although claim amounts have risen, overall claim frequency continues to be stable from previous years and that will most likely continue, according to Zurich. Furthermore, average indemnity settlements don’t vary much, despite facility type, when looking at claims with indemnity between $25,000 and $150,000.

Interestingly, the study suggests a link between increases in claims from children’s hospitals and interest rates. The report notes a sudden increase in the severity of claims from children’s hospitals starting in 2007, concurrent with a decrease in the interest rate environment. The spike could be partially explained by the increase in the present value of life care plans — calculated using interest rates — often found as part of claims arising from children's hospitals, researchers suggest.

On the other hand, hospitals that tend to get hit with a lot of legal action, i.e. teaching and children’s hospitals, generally spend noticeably less on expenses to settle moderate claims, especially in more recent years, study authors point out.

“The more sophisticated claims management programs often found in these facilities may have a correlation with the decrease in claim expenses,” according to the report.


The Final CMS Standards on Infection Control Learn more and Register
Date & Time: Tuesday, January 27, 2015 from 10 – 11 AM PT
Credits: 1.5 Nursing Contact Hours | Speaker: Sue Dill Calloway, RN, MSN, JD | Location: Online

The Final CMS Worksheet on Infection Control Learn more and Register
Date & Time: Tuesday, January 27, 2015 from 10 – 11 AM PT
Credits: 1.5 Nursing Contact Hours | Speaker: Sue Dill Calloway, RN, MSN, JD | Location: Online

Save 15% when you purchase both infection control webinars
Use the coupon code: IC15 when checking out online or call 800-688-2421
Offer expires on Jan. 31st, 2015 – Not to be combined with other offers or promotions