VHIG Digest: Volume 2, No. 8
By Richard J. Clews, 2012, Vanderbilt University School of Nursing
In the News…
1. XX-ray: when enough is enough – April 12, 2011
State investigators in New York have found that some X-rays performed at SUNY are still over radiating premature babies after initial reports from the hospital indicated that they had corrected the indiscretion of performing full body X-rays when chest X-rays were ordered. The New York State Department of health is now deciding whether or not to conduct “spot checks” all over the state to determine the severity of the problem. These problems stem from 2007 when similar allegations came to fruition prompting SUNY to institute measures to protect infant’s exposure to radiation. Unfortunately it seems as though these procedures intended to protect the most vulnerable of patients has failed to work as intended.
http://www.nytimes.com/2011/04/13/nyregion/13radiation.html?_r=1&ref=radiationboom
2. Landmark vote in Florida…Medicaid no more? – April 27, 2011
Florida is poised to oust Medicaid and switch to an H.M.O based health care system in order to manage costs, reduce waste and minimize fraud. In just the past 11 years health related costs from Medicaid in Florida has increased 2 fold, prompting a new concept to be put forth in a landmark vote set to take place prior to the legislative body in Florida breaks for the summer in a week. The program would be largely based on a pilot program dating back 5 years. This would shift Florida from a largely fee for service to a managed care model. The question is will this work, and if so at what cost to patient safety and overall patient care, specifically due to the for profit nature of the H.M.O’s they would be shifting to.
http://www.nytimes.com/2011/04/28/health/policy/28medicaid.html?scp=8&sq=hospital&st=cse
3. Use only as Directed… – April 26, 2011
According to the National Community Pharmacists Association as much as three out of four medications prescribed in the USA is not taken as directed, contributing to as many as 1.9 million Emergency Department visits between 2004 and 2008. The FDA is toying with the idea of including a simple one page pamphlet which would contain consumer information as compared to the current multipage convoluted booklet that is included with all prescription medications. The idea would be to simplify the process and indicate the typical reason for the use of this medication along with dosing protocol. The verdict is out as to when or how this new plan will be rolled out, but seems to be a promising new area to manage patient safety and quality improvement which will affect almost everyone in the USA.
http://online.wsj.com/article/SB10001424052748703521304576279123606877448.html
In the Literature…
1. ICU intervention and reduction of MRSA, VRE
According to a recent article publication in the Archives of Internal Medicine, a cleaning intervention based on a new disinfectant, education, and targeted feedback could help reduce MRSA and VRE. This is an extremely important intervention in part because ICU patients are at particular risk of acquiring a nosocomial infection that could be highly resistant to a variety of antibiotics. The quality improvement project, which was conducted at The University of California Irvine School of Medicine, concluded that a reduction of MRSA from 3% to 1.5% over a two year period and reduction of 0.8% over that same time from in VRE. The study was funded and supported in part by the NIH, and would be provide a significant intervention for ICU’s to adopt around the country.
Emma Hitt, PhD. ICU Cleaning Intervention May Reduce MRSA, VRE Transmission http://www.medscape.com/viewarticle/740222
2. Hospitalists…good or bad?
A recent article published in the American Journal of Medical Quality tackles a new paradigm in medicine, the hospitalist. According to the authors, hospitalists can improve communication within the hospital setting and more importantly improve efficiency helping to reduce costs and standardize care. Hospitalists play a vital role in providing care in hospitals all over the United States, and using a survey method this study indicated that overall satisfaction scores was higher for hospitals that had hospitalists on staff when compared to facilities that did not. Interestingly enough, teaching hospitals with hospitalists on staff showed a significant satisfaction difference. This study suggests that it might behoove hospitals to move toward a hospitalist model in order to provide the most up to date, efficient and quality healthcare.
Bradley R. Fulton, Kathryn E. Drevs, Louis J. Ayala and Donald L. Malott, Jr. American Journal of Medical Quality 2011 26: 95 originally published online 1 March 2011
http://ajm.sagepub.com.proxy.library.vanderbilt.edu/content/26/2/95.full.pdf+html