Hospital Consult - November 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
Communication After Dark Strongly Influences Pediatric Hospital Ratings
BOSTON – A new pediatric hospital study proves, once again, why improving hospital quality can’t be a 9-to-5 issue.
The report, published recently in the journal Pediatrics, found that how nighttime providers communicate with parents and the perceptions of communication and teamwork among the medical team have a strong influence on their satisfaction with care provided to their children.
Boston Children’s Hospital researchers and colleagues note that night teams of hospital providers have become more common in the wake of resident physician duty hour changes.
For the study, the team conducted a prospective cohort study of 471 parents of pediatric inpatients ages 17 and younger from May 2013 to October 2014. Parents were asked to rate their overall experience, understanding of the medical plan, quality of nighttime doctors’ and nurses’ communication with them, and quality of nighttime communication between doctors and nurses.
With 398 surveys completed, an 84.5% response rate, 42.5% of parents reported a top overall experience. Analysis showed that top-rated overall experience was associated with higher scores for communication and experience with nighttime doctors, odds ratio (OR) 1.86; for communication and experience with nighttime nurses, OR 6.47; and for nighttime doctor-nurse interaction, OR 2.66.
The highest ratings were for the items related to whether nurses listened to their concerns – 70.5% strongly agreed – while the lowest were for regular communication with nighttime doctors, rated excellent by 31.4%.
For 2015, 30% of a hospital’s performance score used to calculate its Medicare incentive payment is based upon an extensive patient experience survey, and, because 1% of a hospital’s Medicare payments in 2015 are related to its performance – increasing to 2% in 2017 – hospitals are especially concerned about increasing patient satisfaction ratings.
“As hospitals seek to improve the patient-centeredness of care, improving nighttime communication and teamwork will be valuable to explore,” the authors point out.
Medication Errors More Common Than Expected in Surgical Procedures
SAN DIEGO – Hospital seeking to decrease medication errors and adverse drug events need to put their surgical suites under scrutiny.
That’s according to a study, presented at the recent ANESTHESIOLOGY 2015 conference in San Diego and published online by the journal Anesthesiology, which found that some sort of mistake or adverse event occurred in every second operation and in 5% of observed drug administrations.
Considering that the study of more than 275 operations was at Massachusetts General Hospital (MGH), a leader in healthcare quality, study authors advise that other hospital take a close look at their surgical procedures.
"We found that just over one in 20 perioperative medication administrations resulted in a medication error or an adverse drug event," said lead author Karen C. Nanji, MD, MPH. "Given that Mass General is a national leader in patient safety and had already implemented approaches to improve safety in the operating room, perioperative medication error rates are probably at least as high at many other hospitals.”
For the analysis, the research team observed 225 anesthesia providers – anesthesiologists, nurse anesthetists, and resident physicians – during 277 randomly selected operations conducted at from November 2013 to June 2014. Every medication administration was documented from the time a provider took responsibility for a patient in the preoperative area until the patient arrived in the recovery room or intensive care unit. The observers were especially alert for any medication errors, defined as any type of mistake in the process of ordering or administering a drug, or adverse drug event that caused harm or injury to a patient, whether or not it was caused by an error. The team also conducted chart review.
Results indicate that 124 of the 277 observed surgeries included at least one medication error or ADR. Of the almost 3,675 medication administrations in the observed operations, 193 events, involving 153 medication errors and 91 ADRs were recorded either by direct observation or by chart review. Almost 80% of the events were determined to have been preventable.
Study authors note that one-third of the observed medication errors led to an ADR, with the remaining having that potential. Yet, 20% of the ADRs were not associated with medication error.
Errors most frequently observed were:
- mistakes in labeling, incorrect dosage
- neglecting to treat a problem indicated by the patient's vital signs
- failure to document correctly.
With 30% of the errors considered significant, 69% serious and less than 2% life-threatening, none were fatal. Error rates were similar among anesthesiologists, nurse anesthetists and residents but more common with longer procedures, especially those lasting more than six hours and involving 13 or more medications, according to the results.
"While the frequency of errors and adverse events is much higher than has previously been reported in perioperative settings, it is actually in line with rates found in inpatient wards and outpatient clinics, where error rates have been systematically measured for many years," Nanji said. "We definitely have room for improvement in preventing perioperative medication errors, and now that we understand the types of errors that are being made and their frequencies, we can begin to develop targeted strategies to prevent them."
Hospitalized Young Women Less Likely to Get Optimal STEMI Interventions
BOSTON – Are young women with ST-elevation myocardial infarction (STEMI) victims of sex discrimination in hospitals or is something else going on?
That is the question raised by a new study in the Journal of the American College of Cardiology, which finds that younger women were less likely to receive life-saving angioplasty and stenting to restore blood flow to blocked arteries than men. In addition, reports the study team led by researchers from Brigham and Women's Hospital and Harvard Medical School, those female patients had longer hospital stays and higher rates of in-hospital mortality.
According to background information in the article, the recommended treatment for STEMI, the deadliest type of heart attack caused by a prolonged blockage of blood supply in the heart, is immediate stenting to restore blood flow. Previous research has found that older women presenting with STEMI also are less likely to receive revascularization and have worse outcomes relative to their male counterparts.
For this study, researchers used the Nationwide Inpatient Sample database to examine 632,930 STEMI patients between the ages of 18 and 59 from 2004-11. Results indicate that women with acute myocardial infarction were less likely to have presented with STEMI than men – odds ratio (OR) 0.74. They also were less likely than men to receive percutaneous coronary intervention, OR 0.74; coronary artery bypass grafting, OR 0.61 or thrombolysis, OR 0.80.
On the other hand, overall trends in angioplasty and stenting increased in both men and women during the study period.
The death rate for hospitalized young women with STEMI was 4.5%, compared to 3% of men. Length-of-stay also was slightly longer for women than men – 4.35 days vs. 4 days on average.
One reason for the difference in LOS, according to the researchers, is that men might have been more likely than women to die before arriving at the hospital, which also might help explain the higher rate of in-hospital mortality for younger women.
Other reasons for the disparity in revascularization use, study authors suggest, is that younger women were less likely to have chest pain, which could lead to a delayed recognition of STEMI. Females also have twice the risk of bleeding with procedures to restore blood flow, compared to men, and that could have led to some women not receiving guideline-specific interventional therapies, they write.
"Despite guidelines directing use of stenting in heart attack patients, younger women are receiving this life-saving treatment method less than younger men," senior author Deepak L. Bhatt, MD, MPH, explained. "Our research shows that there is a great opportunity and need to improve national heart attack care processes and outcomes and address these sex disparities in providing care to younger heart attack patients."
EHR Implementation Linked to Improved Quality Indicators in ICUs
MONTREAL – Implementation of an electronic health record system appeared to help reduce central line-associated bloodstream infections (CLABSI) and mortality rates in a large tertiary care hospital’s surgical intensive care unit.
The study, presented at the recent CHEST 2015 conference in Montreal, said the introduction of an EHR did not have an effect however, on length of stay, Clostridium difficile colitis incidence, or readmission rates.
The retrospective chart review by researchers from Icahn School of Medicine at Mount Sinai in New York focused on quality indicators for 3,742 patients admitted to the SICU two years before (Jan. 1, 2009, to Dec. 31, 2010) and two years after (Jan. 1, 2012, to Dec. 31, 2013) implementation of an Epic EHR system. Data from the 12-month period of transition to EHR was excluded.
Results indicate the rate of CLABSI per 1,000 catheter days was 85% lower and overall SICU mortality was 28% lower. EHR implementation also resulted in a significant increase in the average number of coded diagnoses from 17.8 to 20.8.
“After EHR implementation, there was no significant difference in multiple key quality of care indicators in the SICU. There were significant reductions in CLABSI rates and SICU mortality,” the authors write. “Ongoing quality improvement endeavors may explain the changes in CLABSI and mortality, but these trends invite further study of the possible impact of EHRs on quality of care in the ICU.”
Background data in the presentation abstract notes that “health information technology, and specifically the electronic health record (EHR), is increasingly viewed as a means to provide more coordinated, patient-centered care.”
“Considering the large investment into electronic health records and the high costs associated with ICU care, it’s important to develop EHRs that improve ICU quality of care,” according to the researchers.
Another recent study suggests how that might be accomplished. The research conducted at Children's National Health System in Washington, DC, demonstrates the effectiveness of an EHR querying tool created to assess compliance with a pediatric ICU Safety Bundle. Updated every five minutes, a real-time visual display showed data on presence of consent for treatment, restraint orders, presence of urinary catheters, deep venous thrombosis prophylaxis, Braden Q score, and medication reconciliation.
“A unit-wide dashboard can increase awareness for potential interventions, affecting patient safety in the PICU in a dynamic manner,” study authors write in the Joint Commission Journal on Quality and Patient Safety.
Upcoming Live Hospital [Webinars]
*FREE* Human Trafficking in Healthcare: Awareness & Combating
[Live] November 12 Credits: 1 CNE
Advance Directives Update: What Every Healthcare Provider Should Know
[Live] November 12 Credits: 2 CNE
Advancing Patient Safety in the ED: Risks, Challenges and Corrective Initiatives
[Live] November 17 Credits: 2 CNE
CMS CAH CoP Update: Drugs, Pharmacy & Nursing
[Live] November 19 Credits: 2 CNE
Uncovering Patient Safety and the 'Just Culture' Theory
[Live] December 2 Credits: 2 CNE
Prevention and Management of an OR Fire
[Live] December 3 Credits: 1.5 CNE
Diarrhea in the Acute Care Setting
[Live] December 3 Credits: 1 CME & 1 CNE
The New CMS Worksheet and Discharge Planning Standards
[Live] December 8 Credits: 1.5 CNE
Identifying and Addressing Burnout
[Live] December 10 Credits: 1.5 CNE
