Hospital Consult - December 2014
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
Batten Down the Hatches: Busy Flu Season Expected for Hospitals
NASHVILLE – Hospitals might want to prepare for a busier than usual flu season this year.
One reason, according to the CDC, is about half the H3N2 flu viruses analyzed so far this influenza season are drift variants – viruses with antigenic or genetic changes that make them different from the viruses for which the season’s vaccine offers maximum protection.
Another is that, so far this year, the most common seasonal influenza is H3N2 viruses, which generally cause more severe flu illnesses, hospitalizations, and deaths than some other strains.
H3N2 viruses predominated during the 2012-13, 2007-08, and 2003-04 seasons, the three “moderately severe” seasons with the highest mortality levels in the past decade, according to the CDC.
“It’s too early to say for sure that this will be a severe flu season, but Americans should be prepared,” said CDC director Tom Frieden, MD, MPH. “We can save lives with a three-pronged effort to fight the flu: vaccination, prompt treatment for people at high risk of complications, and preventive health measures, such as staying home when you’re sick, to reduce flu spread.”
A recent study found that hospital encounters, including ED visits and admissions, increased for young children when H3N2 circulated.
“Influenza-related encounters were greater when influenza A(H3N2) circulated than during other years with median rates of 8.2 vs 3.2 hospitalizations and 307 vs 143 ED visits per 10 000 children, respectively,” according to the report published recently in the journal Pediatrics.
For the study, Vanderbilt University researchers examined the annual incidence of influenza-related health care encounters and vaccine uptake among children 6- to 59-months-old from 2000-01 through 2010-11 in Davidson County, TN.
They found that the proportion of fully vaccinated children increased from 6% in 2000-01 to 38% in 2010-11. During that period, influenza-related hospitalizations ranged from 1.9 to 16.0 per 10 000 children – a median of 4.5 – per year. Influenza-related ED visits, meanwhile, ranged from 89 to 620 per 10 000 children, median 143, per year.
“Significant decreases in hospitalizations and increases in ED visits over time were not clearly related to vaccination trends,” the authors write, although they noted the increase when H3N2 circulated.
Public health officials emphasized that even if the vaccine isn’t an exact match, it still is better than doing without. During the 2007-08 flu season, for example, the predominant H3N2 virus was a drift variant yet the vaccine had an overall efficacy of 37% and 42% against those types of viruses.
Depending on the formulation, flu vaccines protect against three or four different flu viruses. Even during a season when the vaccine is only partially protective against one flu virus, it can protect against the others, public health officials said.
Let’s Talk About It: System Reduces Medical Errors in Patient Hand-Offs
BOSTON – Injuries due to medical errors were reduced 30% in a multicenter study focusing on improvements in verbal and written communication between hospital staff during patient handoffs, according to a recent report.
For the study, researchers developed I-Pass, an original system of bundled communication and training tools for handoff of patient care between providers and found that it significantly increase patient safety without excess burden on existing clinical workflows. The study appeared recently in the New England Journal of Medicine.
According to the article, about 80% of the most serious medical errors can be linked to communication between clinicians, particularly during patient handoffs.
"This is the first multicenter handoff improvement program that has been found to reduce injuries due to medical errors," said the study's principal investigator and senior author, Christopher Landrigan, MD, MPH, of Boston Children's Division of General Pediatrics
He and fellow researchers from multiple medical centers designed I-PASS to:
- standardize communication and handoff training
- organize a verbal handoff process around the verbal mnemonic "I-PASS" (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, and Synthesis by receiver)
- computerize handoff tools to share patient information between providers using a standardized structure
- engage supervising attending physicians to observe and oversee handoff communications
The project also sought to promote the adoption of I-PASS as part of institutional process and culture.
"We recognized that it would take a great deal of work to make the handoff program a sustainable system and encourage its adoption across hospitals," explained lead author Amy Starmer, MD, MPH. "We partnered with experts in research, curriculum development and administration, as well as local faculty and executives at the nine centers to develop a comprehensive and multi-faceted handoff and communication program. Now the new I-PASS program works seamlessly with existing tools and is part of each institution's culture."
At each participating hospital, patient handoffs by medical residents were monitored and assessed for a 6-month pre-intervention period. Residents then were trained on I-PASS handoff processes and informed of the requirements of using the system. The monitoring and assessment continued for six months post-intervention.
Active surveillance was used to measure error rates, and printed handoff documents and audio recordings of the process were evaluated. Workflow was assessed through time-motion observations.
Across all medical centers after the introduction of I-PASS, with 10,740 patient admissions, the rate of medical errors decreased by 23% — from 24.5 to 18.8 errors per 100 admissions. At the same time, preventable adverse events decreased by 30% — from 4.7 to 3.3 errors per 100 admissions. The rate of non-preventable adverse events, however, did not change significantly — 3.0 and 2.8 events per 100 admissions.
“Site-level analyses showed significant error reductions at six of nine sites,” according to the authors. At the same time, they report, “No significant changes were documented from the pre-intervention period to the post-intervention period in the duration of oral handoffs (2.4 and 2.5 minutes per patient, respectively) or in resident workflow, including patient-family contact and computer time.”
In addition, medical residents' verbal and written communications at every center significantly improved as did residents' satisfaction with the quality of their patient handoffs, according to a post-study survey.
The authors suggest that, while the I-PASS bundle was tested with inpatient pediatric care, it could work in any hospital treatment setting – with the potential of lowering costs related to medical errors.
Hospitals wanting a copy of the curriculum can get it at no cost online at www.ipasshandoffstudy.com.
Case Management and Compliance Webinars Take Center Stage in 2015
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Quicker is Better to Avoid Blood Clots after Surgical Procedures
CHICAGO – The longer surgery lasts, the more likely patients are to develop a life-threatening blood clot.
That’s according to the first large-scale, quantitative national study of the risk across all surgical procedures, published recently in JAMA Surgery. More than 500,000 hospitalizations and 100,000 deaths are associated each year with blood clots, according to background in the article.
The authors from Northwestern University’s Feinberg School of Medicine suggest the results will help hospitals and surgeons better understand the potential risk of procedures. They also emphasize the importance of using aggressive preventative measures such blood thinners to reduce the risk of clots as well as imposing limits on longer surgeries by splitting up procedures.
For the study, researchers analyzed data from the American College of Surgeons National Surgical Quality Improvement Program to look at the association between surgical duration and the incidence of VTE. The study included more than 1.4 million patients who had surgery under general anesthesia at 315 U.S. hospitals from 2005-11.
Results indicate that 13,809 patients (0.96%) had a postoperative VTE; 10,198 patients (0.71%) experienced deep vein thrombosis; and 4,772 patients (0.33%) developed a pulmonary embolism.
Compared with a surgical procedure of average duration, according to the study, patients who underwent the longest procedures experienced a 1.27-fold increase in the odds of developing a VTE, while the shortest surgical procedures had lower odds.
"Minute by minute, hour by hour, the trend is much more pervasive and consistent than any of us believed it could be," said senior study author John Y. S. Kim, MD. "It was true across all procedures, specialties and hospitals."
Surgical time was shown to be a risk factor for VTE in three of the most common procedures – laparoscopic cholecystectomy, appendectomy and gastric bypass. Every additional hour of surgery duration increased the risk of developing a blood clot 18% to 26%, according to the study.
Overall, regardless of the surgical procedure, patients undergoing the longest surgeries had a 50% increase in the odds of developing a blood clot compared to the shortest.
“There may be times when we have the option of cobbling together a couple of surgeries,” Kim said. “If you know longer surgeries have a higher risk, depending on the variables, splitting up those surgeries may be the best option."
Fewer Deaths, Lower Costs with Reduction in Hospital-acquired Conditions
WASHINGTON, DC – Someone is doing a good job.
An estimated 50,000 fewer patients died in hospitals and about $12 billion in healthcare costs was saved due to the reduction in hospital-acquired conditions from 2010 to 2013, according to a report released by the Department of Health and Human Services (HHS).
The report not surprisingly credits provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative. It also notes, however, “This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events.”
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. Hospital patients experienced 1.3 million fewer of them from 2010 to 2013, a 17% decline in a 3-year period, according to preliminary estimates.
“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.”
The most significant gains occurred in 2012 and 2013. For example, in 2013 alone, nearly 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.
HHS’ Agency for Healthcare Research and Quality compared the incidence of a number of avoidable hospital-acquired conditions to 2010 rates and used as the baseline estimates of deaths and excess healthcare costs developed when the Partnership for Patients was launched.
“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.”
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