Outcomes & Safety
10 Oct Safety-Net Hospitals Show Improvement in Hospital Readmissions, Modifications To Penalty Formula Still Needed
MedicalResearch.com Interview with: [caption id="attachment_28723" align="alignleft" width="182"]
Dr. Kathleen Carey[/caption]
Kathleen Carey, Ph.D.
Professor, Department of Health Law, Policy and Management
School of Public Health
Boston University
Boston MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ACA’s Hospital Readmissions Reduction Program (HRRP) imposes Medicare reimbursement penalties on hospitals with readmission rates for certain conditions if they exceed national averages. A number of observers have expressed serious concern over the program’s impact on safety-net hospitals, which serve a high proportion of low income patients who are more likely to be readmitted – often for reasons outside hospital control. Many have argued that the HRRP should adjust for socio-economic status. However, Medicare does not want to lower the standard of quality for these hospitals.
10 Oct Study Evaluates Hospital-at-Home For Low Risk Medical Conditions
Posted at 20:40h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Outcomes & Safety
MedicalResearch.com Interview with:
[caption id="attachment_28715" align="alignleft" width="200"]
Dr. Jared Conley[/caption]
Jared Conley, MD, PhD, MPH
Department of Emergency Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, MA 02114
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As the U.S. healthcare system seeks to improve the health of populations and individual patients, there is increasing interest to better align healthcare needs of patients with the most appropriate setting of care—particularly as it relates to hospital-based care (accounting for 1/3 of total U.S. healthcare costs).
Avoiding hospitalization—as long as safety and quality are not compromised—is often preferred by patients and the added benefit of potentially making care more affordable further promotes such care redesign efforts. There is a growing body of research studying alternative management strategies to hospitalization; we sought to comprehensively review and analyze this work. Alternative management strategies reviewed include outpatient management, quick diagnostic units, observation units, and hospital-at-home.
21 Sep Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions May Differ
MedicalResearch.com Interview with: [caption id="attachment_28026" align="alignleft" width="107"]
Dr. Su Golder[/caption]
Dr Su Golder PhD
Research Fellow
Department of Health Sciences
University of York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Serious concerns have emerged regarding publication bias or selective omission of outcomes data, whereby negative results are less likely to be published than positive results. There remains considerable uncertainty about the extent of unpublished data on adverse events beyond that reported in the published literature. We aimed to estimate the potential impact of additional data sources and the extent of unpublished information when conducting syntheses of adverse events.
We found that less published papers contain adverse events information. The median percentage of published documents with adverse events information was 46% compared to 95% in the corresponding unpublished documents. There was a similar pattern with unmatched studies, for which 43% of published studies contained adverse events information compared to 83% of unpublished studies.
We also found even when adverse events are reported in the published and unpublished versions of the same study that the numbers of adverse events do not always match The percentage of adverse events that would have been missed had each analysis relied only on the published versions varied between 43% and 100%, with a median of 64%.
Lastly we found that inclusion of unpublished data increased the precision of the pooled estimates (narrower 95% confidence intervals) in three-quarters of pooled analyses, but did not markedly change the direction or statistical significance of the risk in most cases.
21 Sep Quality Performance Measures Should Include Hypoglycemia Assessments
MedicalResearch.com Interview with: [caption id="attachment_28018" align="alignleft" width="166"]
Dr. Victor Montori[/caption]
Victor M. Montori, MD MSc
Knowledge and Evaluation Research Unit in Endocrinology
Mayo Clinic, Rochester, Minnesota
MedicalResearch.com: What is the background for this study?
Response: Hypoglycemia can acutely disrupt patients’ lives through symptoms ranging from bothersome to life-threatening; worsen quality of life; and hinder medication adherence and glycemic control. Hypoglycemia is now known to increase risk of mortality, cognitive impairment, and cardiovascular events. In order to improve the quality of diabetes care, healthcare organizations use publicly reported performance measures for quality measurement and improvement, and pay-for-performance initiatives. The degree to which existing performance measures are aligned with guidelines, particularly in regard to hypoglycemia avoidance, is uncertain.
19 Sep 33% Rise In ‘Last-Resort’ Antibiotics Use in Hospitals
MedicalResearch.com Interview with: [caption id="attachment_28031" align="alignleft" width="180"]
Dr. James Baggs[/caption]
James Baggs, PhD
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention
Atlanta, Georgia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We used medical claims data to estimate the amount of antibiotics used in US hospitals from 2006 - 2012. Data came from the Truven Health MarketScan Hospital Drug Database, which included about 300 hospitals and more than 34 million discharges. Antibiotic use in hospitals was very common with more than half of patients receiving at least one antibiotic during their hospital stay. Overall rates of antibiotic use in U.S. hospitals did not change over time; however, there were significant changes in the types of antibiotics prescribed.
Importantly, the types of antibiotics with the largest increases in use were the types of antibiotics often considered to be the most powerful. Of particular concern, there was a 37% rise in the use of carbapenems, commonly referred to as “last resort” antibiotics.
17 Sep Almost 5 Million Unnecessary Pap Smears Done Annually In Women With Hysterectomy
Posted at 20:58h
in Author Interviews, Cost of Health Care, OBGYNE, Outcomes & Safety, University Texas
MedicalResearch.com Interview with:
[caption id="attachment_28034" align="alignleft" width="200"]
Dr. Fangjian Guo[/caption]
Fangjian Guo, MD, PhD
Assistant Professor
BIRCWH Scholar
Department of Obstetrics & Gynecology
Center for Interdisciplinary Research in Women’s Health
The University of Texas Medical Branch
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: National guidelines consistently recommend against cervical cancer screening among women with a history of a total hysterectomy for a benign condition. These women are unlikely to develop high-grade cervical lesions. The goal of our study was to assess whether these guidelines are being followed. We examined the use of Pap testing among US adult women with a history of total hysterectomy for a benign condition and the roles of health care providers and patients in the initiation of Pap test use.
We found that in 2013, 32% of women who have had a hysterectomy received an unnecessary recommendation for cervical cancer screening from a health care provider in the past year; 22.1% of women with hysterectomy received unnecessary Pap testing. Although the majority of Pap tests were performed at a clinician’s recommendation, approximately one fourth were initiated by patients without clinician recommendations. According to standard 2010 US Census population figures, about 4.9 million unnecessary Pap tests are performed annually among women who have had a total hysterectomy for a benign condition. At approximately $30 per test, $150 million in direct medical costs could be saved annually if screening guidelines were followed for these women.
15 Sep AARP Discusses Medical Errors and Suggestions For Prevention
MedicalResearch.com Interview with: [caption id="attachment_27973" align="alignleft" width="200"]
Dr. Charlotte Yeh[/caption]
Charlotte Yeh MD FACEP
Chief Medical Officer
AARP Services, Inc
Dr. Charlotte Yeh is the Chief Medical Officer for AARP Services, Inc . In her role, Dr. Yeh works with the independent carriers that make health-related products and services available to AARP members, to identify programs and initiatives that will lead to enhanced care for older adults.
Dr. Yeh has more than 30 years of healthcare experience – as a practitioner and Chief of Emergency Medicine at Newton-Wellesley Hospital and Tufts Medical Center, as the Medical Director for the National Heritage Insurance Company, a Medicare Part B claims contractor, and as the Regional Administrator for the Centers for Medicare and Medicaid Services in Boston.
In this interview, Dr. Yeh comments on the September 2016 AARP Bulletin feature that focuses on twelve common health care blunders and how they can be avoided.
MedicalResearch.com: What is the background for this report? How big is the problem of medical errors?
Dr. Yeh: Medical errors first became widely acknowledged in 1999 with the publication of the landmark study by the National Academy of Sciences (IOM), formerly called the Institute of Medicine (IOM), estimating as many as 98,000 hospital in-patient deaths per year were caused by medical errors. More recently, a study from Johns Hopkins noted that medical errors may claim as many as 251,000 lives per year.
09 Sep Better Patient Safety Linked to Lower Hospital Readmission Rates
Posted at 01:13h
in AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Outcomes & Safety
MedicalResearch.com Interview with:
Sheila Eckenrode, RN, CPHQ
Project Manager
Medicare Patient Safety Monitoring System (MPSMS)
Qualidigm
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We sought to investigate the association at the hospital-level between 21 in-hospital adverse event rates and both mortality and readmission rates for Medicare Fee-For-Service patients with AMI. We used data from the Medicare Patient Safety Monitoring System (MPSMS), the nation's largest randomly selected hospital medical record-abstracted patient safety database, and data from the Centers for Medicare & Medicaid Services, which includes hospital performance on mortality and readmissions for over 4,000 Medicare-certified hospitals, to assess the association between hospital performance on patient safety and hospital performance on 30-day all-cause mortality and readmissions for Medicare fee-for-service patients discharged with AMI.
We found that hospital performance on patient safety is associated with hospital performance on mortality and readmission rates for AMI. Hospitals with poorer patient safety performance are likely to have higher 30-day all-cause mortality and readmission rates for these patients.
04 Sep Significant Decline in Readmissions After PCI in Medicare Patients
MedicalResearch.com Interview with: [caption id="attachment_27659" align="alignleft" width="125"]
Dr. Christian McNeely[/caption]
Christian A. McNeely, M.D.
Resident Physician - Internal Medicine
Barnes-Jewish Hospital
Washington University Medical Center
MedicalResearch.com: What is the background for this study?
Response: Prior research has demonstrated that readmission in the first 30 days after percutaneous coronary intervention (PCI) is common, reported around one in six or seven Medicare beneficiaries, and that many are potentially preventable. Since 2000, there have been significant changes in the management of coronary artery disease and the use of PCI. Additionally, in the last decade, readmission rates have become a major focus of research, quality improvement and a public health issue, with multiple resulting national initiatives/programs which may be affecting care. Therefore, in this study, we sought to examine contemporary trends in readmission characteristics and associated outcomes of patients who underwent PCI using the Medicare database from 2000-2012.
04 Sep No Evidence of Worse STEMI Outcomes During Off-Hours
Posted at 00:37h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Outcomes & Safety, Surgical Research
MedicalResearch.com Interview with:
Senthil Selvaraj, MD, MA and Deepak L. Bhatt, MD, MPH
Brigham and Women’s Hospital Heart & Vascular Center and
Harvard Medical School, Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There has been significant controversy in the effect of off-hours presentation in ST-elevation myocardial infarction (STEMI). Off-hours presentation has been associated with longer treatment time, an independent predictor of worse outcomes in STEMI, though a number of other studies have shown no difference as well. Moreover, little data has been generated from clinical trials, which has the advantage of comprehensive and adjudicated outcomes.
In our analysis of nearly 2,000 STEMI patients from the CHAMPION PHOENIX study (a randomized, controlled trial of cangrelor in percutaneous coronary intervention), we found that off-hours presentation was not associated with worse efficacy or safety outcomes at 48 hours or 30 days. More specifically, outcomes not typically reported in registry data, such as ischemia-driven revascularization and stent thrombosis, were not significantly different between the groups. Interestingly, treatment times were actually faster in the “off-hours” group as well.
31 Aug Clinical Interventions Reduced Hospital Readmissions After PCI Stent Surgery
Posted at 02:45h
in AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research
MedicalResearch.com Interview with:
[caption id="attachment_27509" align="alignleft" width="200"]
Dr. Jason Wasfy[/caption]
Jason H. Wasfy, MD, MPhil
Assistant Medical Director, Massachusetts General Physicians Organization
Director of Quality and Analytics
Massachusetts General Hospital Heart Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Reducing preventable readmissions after PCI is a way to both improve the quality of care for our patients and improve value for patients with coronary artery disease. Through a variety of tactics, we were able to reduce the 30 day readmission rate for patients after PCI by nearly half. Keep in mind that this is only the readmission rate to our hospital, so we will need to confirm these results with data including patients who may have been readmitted to other hospitals after a PCI at Mass General.
29 Aug ICUs Might Consider Avoiding Tap Water To Limit Pseudomonas Infections from Faucets
MedicalResearch.com Interview with: [caption id="attachment_27441" align="alignleft" width="200"]
Dr. Cohen Regev[/caption]
Dr. Cohen Regev, M.D
Head of the infectious diseases and infection control units
Sanz Medical Center, Laniado hospital
Netanya, Israel
MedicalResearch.com: What is the background for this study?
Response: During 3 months in 2012 we had a number of clinical isolates of Pseudomonas aeruginosa (PA) in our neonatal intensive care unit (NICU) and a high incidence of colonization among ventilated patients in our medical-surgical intensive care unit (MSICU). The origin of PA may be from various environmental sources (‘exogenous’), from the patients’ own microbiome (‘endogenous’), or from both. Since in NICUs the origin is usually exogenous, we investigated the sources of the bacteria, focusing on the faucets of these units, as they were previously incriminated as causes of outbreaks in ICUs.
The study was conducted in Sanz medical center, a 400-bed community hospital located in central Israel. In the NICU we obtained several environmental cultures from faucets using a bacterial swab by rubbing the tip into the distal part of the faucet. Aerators were dismantled from all faucets, cultured from their inner part using a swab and were not repositioned. Contaminated faucets were occasionally replaced or treated with enzymatic fluid and sterilization by Ethylene Oxide. During the intervention and since, neonates were bathed only with warmed sterile water, and tap water was allowed only for hand hygiene practices.
In the MSICU tap water was used only for bathing the patients. All other uses of tap water, such as drinking, moistening and mouth treatments, were allowed using only sterile water. The units' faucets were sampled on two different days concurrently with surveillance cultures of pharyngeal, sputum and urine from the patients.
Bacteria were identified with VITEK 2 (Biomerieux®) and typing was done by Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR.
09 Aug CareSkore Allows Hospitals To Do Risk Analysis and Care Planning in Real Time
MedicalResearch.com Interview with:
CareSkore co-founders:
Dr. Puneet Dhillon Grewal MD
CareSkore co-founder and Chief Medical Officer
Dr. Grewal is an Internal Medicine physician and Cardiologist. She had completed her residency from Rosalind Franklin University of Medical Science, and is currently a Cardiology Fellow at the same institution and
Jaspinder Grewal, MBA CareSkore co-founder and Chief Executive Officer,
a graduate from the University of Chicago Booth School of Business and a computer engineer. He has 13 years of experience working with large health systems , managing technology and operations.
MedicalResearch.com: What is the background for the CareSkore company? What is its mission and objectives?
Response: The Affordable Care Act, through penalties and bundled payments, requires hospitals and providers to be accountable for the quality of care they provide. For example, if a patient is readmitted to the hospital within 30-days after discharge, hospital reimbursement is reduced, and in many cases not paid at all.
In order to improve the quality of care, hospitals need to understand the clinical risk of patients, so that they can focus efforts on the patient most likely to face adverse events. The three biggest areas of improvement are readmissions, over utilization of services, and hospital acquired conditions (such as pneumonia and surgical site infections).
04 Aug Web-Based Handoff Tool Markedly Reduced Medical Errors
Posted at 00:39h
in Author Interviews, Brigham & Women's - Harvard, Electronic Records, JAMA, Outcomes & Safety
MedicalResearch.com Interview with:
[caption id="attachment_26595" align="alignleft" width="80"]
Dr. Stephanie Mueller[/caption]
Stephanie Mueller, MD MPH FHM
Division of General Medicine
Brigham and Women's Hospital
Boston, MA 02120
MedicalResearch.com: What is the background for this study?
Response: Failures in communication among healthcare personnel are known threats to patient safety, and occur all too commonly during times of care transition, such as when patient care responsibility is transferred from one provider to another (i.e., handoff). Such failures in communication put patients at risk for adverse outcomes.
27 Jul No Difference in Outcomes at 12 Weeks With Robotic vs Open Prostate Surgery
MedicalResearch.com Interview with: [caption id="attachment_26533" align="alignleft" width="139"]
Prof. Robert Gardiner[/caption]
Prof Robert A Gardiner AM
The University of Queensland Centre for Clinical Research
Royal Brisbane & Women’s Hospital, Herston
Brisbane,Australia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We wanted to determine whether one approach gave better results than the other at 12 weeks and 24 months after surgery with respect to the quality of life outcomes of urinary, sexual and bowel function and return to usual activities as well as oncological outcomes.
There was no significant statistical difference between the robotic and open surgical approach for these parameters at the early time-point of 12 weeks follow-up.
22 Jul With Some Exceptions, Care at Veterans’ Hospitals Comparable to Other Health Systems
MedicalResearch.com Interview with: Claire O’Hanlon, MPP Pardee RAND Graduate School and Courtney Gidengil, MD, MPH RAND Corporation MedicalResearch.com: What is the background for this study? Response: Providing high-quality health care is central to our nation’s commitment to veterans, but the quality of care provided in Veterans Affairs health care system (VA) is a longstanding area of concern. Part of the 2014 Veterans Access, Choice and Accountability Act (VACAA) mandated an independent assessment of VA’s health care capabilities and resources of the Veterans Health Administration, including a comprehensive evaluation of health care quality. As part of this evaluation we conducted this systematic review of journal articles that compare quality of care at the VA to other settings as an update to a 2009 review on this subject.20 Jul Statewide Collaboration Reduced Preventable Hospital Readmissions by 20%
Posted at 20:38h
in Author Interviews, Cost of Health Care, Health Care Systems, Hospital Readmissions
MedicalResearch.com Interview with:
[caption id="attachment_26313" align="alignleft" width="150"]
Dr. Thomas Meehan[/caption]
Thomas P. Meehan, MD, MPH
Associate Medical Director
Harvard Pilgrim Health Care
Qualidigm, Wethersfield
Quinnipiac University, North Haven
CT
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a national effort to decrease preventable hospital readmissions in order to improve both the quality and cost of healthcare. Part of this national effort includes local quality improvement projects which are organized and conducted by a variety of organizations working by themselves or with others. We describe one statewide quality improvement project which was led by a Medicare-funded Quality Improvement Organization and conducted with a hospital association and many other collaborators. We document our activities and a relative decrease in the statewide 30-day aggregate readmission rate among fee-for service Medicare beneficiaries of 20.3% over four and a half years. While we are extremely proud of our work and this outcome, we recognize that there are many factors that impacted the outcome and that we can’t claim sole credit.
15 Jul Hospital Wide Crew Resource Management Training Improves Communication and Teamwork
MedicalResearch.com Interview with: [caption id="attachment_26186" align="alignleft" width="142"]
Dr. Moffatt-Bruce[/caption]
Dr. Susan Moffatt-Bruce, MD PhD
Cardiothoracic surgeon
Associate professor of surgery and assistant professor of molecular virology, immunology and medical genetics
The Ohio State University Wexner Medical Center
Columbus, OH
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Crew Resource Management (CRM), a training for all health care providers, including doctors, nurses, staff and students, focusing on team communication, leadership, and decision-making practices, was implemented throughout a large academic health system - across eight departments spanning three hospitals and two campuses. All those in the health system, inclusive of those that took the training, took a survey measuring perceptions of workplace patient safety culture both before CRM implementation and about 2 years after. Safety culture was significantly improved after Crew Resource Management training, with the strongest effects in participant perception of teamwork and communication. This study was the first health-system wide CRM implementation reported in the literature.
13 Jul Pharmacist-Led Program Reduced Hospital Readmissions Through Improved Medication Adherence
MedicalResearch.com Interview with: [caption id="attachment_26091" align="alignleft" width="200"]
Jennifer Polinski[/caption]
Jennifer Polinski, Senior Director
Enterprise Evaluation and Population Health Analytics
CVS Health
Woonsocket, Rhode Island
MedicalResearch.com: What is the background for this study?
Response: Unnecessary and often preventable hospital readmissions are a growing and costly issue. An estimated one in seven patients discharged from a hospital is readmitted within 30 days, and startlingly, readmissions are associated with more than $41 billion in additional health care costs per year. In addition, evidence suggests that approximately 66 percent of hospital readmissions are the result of adverse health events related to medication non-adherence.
12 Jul Black Heart Failure Patients Have More Readmissions and Lower Mortality Than Whites
Posted at 11:39h
in Author Interviews, Heart Disease, Hospital Readmissions, JACC, NYU/NYMC, Race/Ethnic Diversity
MedicalResearch.com Interview with:
Matthew Durstenfeld MD
Department of Medicine
Saul Blecker, MD, MHS
Department of Population Health and Department of Medicine
New York University School of Medicine
NYU Langone Medical Center
New York, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Racial and ethnic disparities continue to be a problem in cardiovascular disease outcomes. In heart failure, minority patients have more readmissions despite lower mortality after hospitalization for heart failure. Some authors have attributed these racial differences to differences in access to care, although this has never been proven.
Our study examined patients hospitalized within the municipal hospital system in New York City to see whether racial and ethnic disparities in readmissions and mortality were present among a diverse population with similar access to care. We found that black and Asian patients had lower one-year mortality than white patients; concurrently black and Hispanic patients had higher rates of readmission. These disparities persisted even after accounting for demographic and clinical differences among racial and ethnic groups.
09 Jul Declining Admission Rates and 30-Day Readmissions Linked
MedicalResearch.com Interview with: [caption id="attachment_25938" align="alignleft" width="183"]
Dr. Kumar Dharmarajan[/caption]
Kumar Dharmarajan, MD, MBA
Assistant Professor of Medicine (Cardiology)
Cardiovascular Medicine: Center for Outcomes Research & Evaluation (CORE)
Yale School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Programs from the Centers for Medicare and Medicaid Services simultaneously promote strategies to lower hospital admissions and readmissions. However, there is concern that hospitals in communities that successfully reduce admissions may be penalized, as patients that are ultimately hospitalized may be sicker and at higher risk of readmission. We therefore examined the relationship between changes from 2010 to 2013 in admission rates and thirty-day readmission rates for elderly Medicare beneficiaries.
We found that communities with the greatest decline in admission rates also had the greatest decline in thirty-day readmission rates, even though hospitalized patients did grow sicker as admission rates declined. The relationship between changing admission and readmission rates persisted in models that measured observed readmission rates, risk-standardized readmission rates, and the combined rate of readmission and death.
17 Jun Weekend-Admitted Patients With Non-STEMI Heart Attacks Have Longer Admissions and Higher Mortality
MedicalResearch.com Interview with: [caption id="attachment_25270" align="alignleft" width="133"]
Dr. Sahil Agrawal[/caption]
Sahil Agrawal MD, MD
Heart and Vascular Center
St. Luke’s University Health Network
Bethlehem, PA 18015
MedicalResearch.com: What is the background for this study?
Dr. Agrawal: Patients admitted on a weekend have previously been known to have poorer outcomes compared to patients admitted on weekdays for various acute illnesses. With the advent of early fibrinolytic therapy and subsequently, emergent primary percutaneous coronary interventions (PCI), such discrepancies in outcomes have been largely resolved for ST-segment elevation myocardial infarctions (STEMI). In contrast, treatment of non-ST segment elevation myocardial infarction (NSTEMI) has remained less stringent such that invasive coronary angiography and potential intervention is often delayed for those presenting on a weekend rather than a week day. According to current ACC/AHA guidelines for NSTEMI, an early invasive strategy (EIS) is the preferred method of management unless barred by presence of contraindications (comorbid conditions) or patients’ preference. We were interested in investigating differences in utilization of EIS between patients admitted on a weekend versus those admitted on a weekday for an NSTEMI, and to evaluate the impact of such differences on in-hospital mortality in such patients.
09 Jun SurgiCount System Eliminates Risk of Retained Surgical Sponges
MedicalResearch.com Interview with:
Nate Miersma
Director of Surgical Safety
Editor’s note: As part of an ongoing series on health care safety, Nate Miersma discusses the use of Stryker’s SurgiCount system to reduce he incidence of retained surgical sponges.
[caption id="attachment_25065" align="alignleft" width="125"]
Nate Miersma[/caption]
MedicalResearch.com: What is the background of the Stryker Surgicount Safety-Sponge System?
Mr. Miersma: Retained surgical sponges are the number one reported surgical never event, occurring roughly a dozen times per day in the United States. SurgiCount helps hospitals eliminate retained sponges by supplementing and verifying the manual count of sponges using a unique bar code for each sponge.
• The traditional manual sponge-counting method expects nurses and surgical technicians to track sponges with extreme precision using only a whiteboard and dry-erase marker. Though the majority of nurses and surgical technicians are experienced and thorough, the fast-paced, high-pressure environment of an operating room creates the risk for false-correct counts caused by distraction, exhaustion or personnel changes. At a rate of 11 times per day, the ‘white board while multi-tasking’ method clearly isn’t sufficient.
• When using SurgiCount, a nurse or surgical technician scans the barcodes to enter them into the computer’s backup count. During the closing count at the end of the procedure, a nurse or surgical technician scans each bar code again, while the computer tracks which sponges have been counted out and which remain. If the counts do not match, the SurgiCount scanner identifies which sponge or sponges are still unaccounted for, and directs staff to resolve the count by locating the outstanding sponge or sponges. Numerous clinical studies indicate that the primary cause of retained surgical sponges is false-correct counts. SurgiCount ensures that these false-correct counts no longer occur during the busy closing process.
• The scanner never gets tired or distracted, and can’t accidentally count the same sponge out twice, or count out a sponge which was accidentally introduced to the case possibly from another room, or from a sponge which was hidden and left over from a previous case.
01 Jun Computerized Triggers May Help Prevent Delays in X-Ray Reports
Posted at 23:16h
in Author Interviews, Baylor College of Medicine Houston, CHEST, Medical Imaging, Outcomes & Safety, Radiology
MedicalResearch.com Interview with:
[caption id="attachment_24835" align="alignleft" width="132"]
Dr. Daniel Murphy[/caption]
Daniel R. Murphy, M.D., M.B.A.
Assistant Professor - Interim Director of GIM at Baylor Clinic
Department of Medicine
Health Svc Research & General Internal Medicine
Baylor College of Medicine
Houston, TX
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Murphy: Electronic health records (EHRs) have improved communication in health care, but they have not eliminated the problem of patients failing to receive appropriate and timely follow up after abnormal test results. For example, after a chest x-ray result where a radiologist identifies a potentially cancerous mass and suggests additional evaluation, about 8% of patients do not receive follow-up imaging or have a visit with an appropriate specialist within 30 days. Identifying patients experiencing a delay with traditional methods, like randomly reviewing charts, is not practical. Fortunately, EHRs collect large amounts of data each day that can be useful in automating the process of identifying such patients.
We evaluated whether an electronic “trigger” algorithm designed to detect delays in follow up of abnormal lung imaging tests could help medical facilities identify patients likely to have experienced a delay. Of 40,218 imaging tests performed, the trigger found 655 with a possible delay. Reviewing a subset of these records showed that 61% were truly delays in care that required action. We also found that the trigger had a sensitivity of 99%, indicating that it missed very few actual delays.
31 May Mobility Program During Hospitalization Improved Post-Discharge Ambulation
MedicalResearch.com Interview with: Cynthia J. Brown, MD, MSPH, AGSF Parrish Professor of Medicine and Director, Division of Gerontology, Geriatrics, and Palliative Care Comprehensive Center for Healthy Aging University of Alabama at Birmingham Birmingham, Alabama 35294 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Brown: Low mobility is common during hospitalization and associated with loss of activities of daily living ability and community mobility. The objective of this study was to examine the impact of an in-hospital mobility program on post-hospital function and community mobility. Brown and colleagues, using a single blind randomized trial design, found that a mobility program that included offering assistance with ambulation linked with a behavioral intervention that focused on goal setting and addressing mobility barriers prevented loss of community mobility one month after hospital discharge. Those who received usual care experienced a clinically significant decline in community mobility. Functional status as measured by activities of daily living was not significantly different between the usual care and mobility program groups either before or after the hospitalization. Because low mobility in the hospital is associated with adverse outcomes including functional decline and nursing home placement even after controlling for illness severity and comorbid illness, these findings have potentially significant clinical implications.11 May Performance of Mammogram Readers Does Not Diminish With Time
MedicalResearch.com Interview with: [caption id="attachment_24117" align="alignleft" width="125"]
Dr. Taylor-Phillips[/caption]
Dr Sian Taylor-Phillips PhD
Assistant Professor of Screening and Test Evaluation
Division of Health Sciences
Warwick Medical School
University of Warwick
Coventry
MedicalResearch.com: What is the background for this study?
Dr Taylor-Phillips : Psychologists have been investigating a phenomenon of a drop in performance with time on a task called ‘the vigilance decrement’ since World War 2. In those days radar operators searched for enemy aircraft and submarines (appearing as little dots of light on a radar screen). People thought that the ability to spot the dots might go down after too much time spent on the task. Many psychology experiments have found a vigilance decrement, but most of this research has not been in a real world setting.
In this research we wanted to know whether there was a drop in performance with time on a task for breast screening readers looking at breast x-rays for signs of cancer. (Breast x-rays or mammograms show lots of overlapping tissue and cancers can be quite difficult to spot). This was a real-world randomised controlled study in UK clinical practice.
In the UK NHS Breast Screening Programme two readers examine each woman’s breast x-rays separately for signs of cancer. They look at batches of around 35 women’s x-rays. At the moment both readers look at the x-rays in the same order as each another, so if they both experience a drop in performance, it will happen at the same time. We tested a really simple idea of reversing the batch order for one of the readers, so that if they have a low ebb of performance it happens when they are looking at different women’s breast x-rays.
06 May Despite New Federal Regulations, Many Acute Care Drugs Still in Short Supply
MedicalResearch.com Interview with: [caption id="attachment_24202" align="alignleft" width="200"]
Dr. Serene Chen[/caption]
Serene I. Chen MD
Dr. Chen is an emergency medicine resident at Highland Hospital, in Oakland, California. She was a student at the Yale School of Medicine when this research was conducted.
MedicalResearch.com: What is the background for this study?
Dr. Chen: To address the rise in U.S. drug shortages, the Food and Drug Administration Safety and Innovation Act (FDASIA) was passed in 2012—and early evidence does suggest that the overall number of new shortages have decreased. However, we found that drugs that are frequently used emergency departments and other acute settings are still affected by more frequent and increasingly prolonged shortages.
05 May What Else Can Be Done To Reduce Medical Errors?
MedicalResearch.com Interview with: [caption id="attachment_24109" align="alignleft" width="142"]
Michael Daniel[/caption]
Michael Daniel
The Johns Hopkins University School of Medicine
M.D. Candidate 2016
Michael G. Daniel is a graduating medical student at the Johns Hopkins School of Medicine. He will be attending the Osler Internal Medicine Residency Training Program next year at the Johns Hopkins Hospital. His research focus is on Patient Safety, Quality, and Outcomes improvement.
Summary:
Medical error ranks as the third leading cause of death in the United States, but is not recognized in national vital statistics because of a flawed reporting process. Using recent studies on preventable medical error and extrapolating the results to the 2013 U.S. hospital admissions we calculated a mortality rate or 251,454 deaths per year.
MedicalResearch.com: What made you want to research this topic?
Response: I decided to study medicine because I wanted to improve patient health. However, I realized that improving patient health is not only about curing a disease but is sometimes about fixing the way we deliver healthcare.
MedicalResearch.com: Is this news surprising to you?
Response: Yes, because all previous estimates of medical error were much lower and when I started the research I couldn’t use the CDC statistics to get current data.
26 Apr Puerto Rican Medicare Advantage Enrollees Receive Lower Quality Care than Hispanics in States
MedicalResearch.com Interview with: [caption id="attachment_23789" align="alignleft" width="175"]
Dr. Rivera Hernandez[/caption]
Maricruz Rivera-Hernandez, PhD
Investigator
Department of Health Services, Policy & Practice
Center for Gerontology and Health Care Research
Brown University, Providence, RI
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Rivera-Hernandez: Over three-quarters of Medicare-eligible residents in Puerto Rico enroll in Medicare Advantage plans, making them the primary source of health care coverage for the island’s seniors. Puerto Rican Medicare Advantage plans have a long history of receiving lower payments than Medicare Advantage plans located in the United States.
The study’s purpose was to compare the quality of care provided to Medicare Advantage enrollees in Puerto Rico with that delivered to Medicare Advantage enrollees in the 50 states and the District of Columbia.
We found significantly worse quality for Puerto Rican Medicare Advantage enrollees compared to their US counterparts for 15 of the 17 quality indicators. These indicators measured whether patients received the recommended treatment and achieved desired outcomes in diabetes care, cardiovascular disease, and cancer screening and whether they received any inappropriate medications in 2011.