VHIG Digest: Volume 1, No. 4
By Tim Lockney, VMS II
In the News
1. IHI Forum Reflections: 10 ‘Aha’ Moments (12/9)
A near-record number of almost 6,000 plus physicians, hospital chiefs, nursing executives and others responsible for quality and patient satisfaction attended the Institute for Healthcare Improvement’s 22nd annual quality forum this December, the first IHI forum to be held since the passage of the Patient Protection and Affordable Care Act. More than previous IHI forums, this one provided far more input from the patient perspective, and even included a morning devoted to Patient Activists and Partners in Quality and Safety. The idea was to empower activists to tell the healthcare system how it must change to lower cost, reduce waste, and improve their care without harm, and not mince words doing so. Many hospital chiefs say they are now preparing to put patients on their boards. When attendees were asked what they were most excited to change when returning home, here is what some of them said:
“Hospitals need to promote a culture of patient safety, and most organizations, ours included, have an opportunity to elevate that. There’s going to be more time spent at board meetings on quality and safety, and at management meetings, more accountability.” – Bob Ladenburger, president and CEO of Exempla Healthcare, a 1,000-bed three-hospital system in Denver
“My ‘aha’ moment was to learn that having a respiratory therapist instead of a nurse teach medication and inhaler use to patients with COPD could prevent readmissions. Often, physicians don’t know the system well enough to know what medications are covered and which ones aren’t, but respiratory therapists do. We’ve had to have medications changed because patients were never really getting the right ones. And in addition, patients can use inhalers incorrectly for years.” – Trish Cruz, manager of evidence-based care in the Quality Management Department at 525-bed St. Joseph Hospital,Orange, CA
“Our environmental services staff is responsible for general cleaning, like mopping floors and emptying trash and visual aesthetics. But they’re also responsible for ‘terminal bed cleaning,’ which is needed whenever we discharge a patient, and until that’s done, the emergency department bottleneck can’t be cleared. When someone suggested that there should be two types of environmental services teams, it would greatly improve patient flow. Several of us who attended that session looked at each other and said ‘Why didn’t we think of that?’ ” – Debbie Robins, patient safety officer at 626-bed Shands Healthcare of the University of Florida in Gainsvilleand Jacksonville
2. Beat the bug: Hospital ‘germ inspectors’ keep bacteria in check (12/6)
To thwart a potential bacteria infiltration, more hospitals are dispatching infection preventionists to patrol corridors in search of infection safety violations, the AP/Washington Post reports. About 1.7 million hospital-acquired infections are reported each year, adding about $20 billion in health care spending and causing nearly 99,000 patient deaths. The federal government is now moving toward tying infection rates to a facility’s reimbursement, with a goal of cutting certain infection rates by 50%. Some hospitals employ infection preventionists, who ensure that all hospital visitors and employees—including physicians, nurses and even janitors—follow infection prevention protocol. Currently, there are only about 8,000 to 10,000 infection preventionists in U.S. health care facilities. The infection preventionist at University of Maryland Medical Center (UMMC)—who is part of a four-person specialist team—”patrols the ICU like a cop” to prevent bacteria from spreading. For example, she monitors catheter insertion and ensures that employees and visitors wear a bright yellow gown and purple gloves before entering a patient room. The infection preventionists—in tandem with other hospital efforts—have helped UMMC’s ICU remain free of central-line infections for 24 weeks. Hospital-wide, central-line infection rates have decreased by 70% across the past year.
3. “Error-free” hospitals scrutinized
California public health officials are scrutinizing hospitals that claim to be error-free, questioning whether nearly 90 facilities have gone more than three years without any significant mistakes in care. Eighty-seven hospitals — more than 20% of the 418 hospitals covered under a law that took effect in 2007 — have made no reports of medical errors, according to the California Department of Public Health. The high percentage has raised concerns that errors have gone unreported. Some patient advocates say it is an indication that hospitals are unwilling to police themselves…Jamie Court, president of the Santa Monica-based advocacy group Consumer Watchdog, called it “almost inconceivable” that so many hospitals were error-free for the last three years State Sen. Elaine Alquist (D- Santa Clara), who wrote the medical error law, said she was concerned that errors are going unreported. “What are the chances that nearly a quarter of California’s hospitals didn’t have a single medication, surgical or safety error since the reporting requirement became law?” Alquist asked. Among the hospitals with no reported errors are about a dozen state facilities, accounting for more than 1,055 beds, including the massive Atascadero and Patton state hospitals.
In the Literature
1. Heterogeneous Artificial Agents for Triage Nurse Assistance
If you’re willing to wait five years, robots could help speed the ER triage process, according to Mitch Wilkes, associate director of the Center for Intelligent Systems and associate professor of electrical and computer engineering at Vanderbilt University. He is the lead author of a paper presented yesterday at the Humanoids 2010 conference held in Nashville. The main robots and agents of what the engineers call the “TriageBot System” would handle the 60 percent of patients in the ER who are not suffering life-threatening conditions. They would include a robot registration assistant to gather basic data and chief complaint, a robot “smart” chair featuring sensors to measure vital signs and generate a triage queue, and alert human staff of critical changes.
2. Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients.
Immunosuppressive medication non-adherence is one of the most prevalent but preventable causes of poor outcomes in adult renal transplant recipients, yet there is a paucity of studies testing interventions in this area. Using a randomized controlled trial design, 30 adult renal transplant recipients were screened for medication non-adherence using electronic monitoring. Fifteen non-adherent participants were randomized to receive either a continuous self-improvement intervention or attention control management. The six-month continuous self-improvement intervention involved the participant and clinical nurse specialist collaboratively identifying the person’s life routines, important people, and possible solutions to enhance medication taking. The participant then received individual monthly medication taking feedback delivered via a graphic printout of daily medication taking generated from electronic monitoring. The mean medication adherence score for the continuous self-improvement intervention group (n=8) was statistically significantly higher than the attention control group’s (n=5) mean medication adherence score (p=0.03). The continuous self-improvement intervention effect size (Cohen’s d) was large at 1.4. Participants’ perceptions of the intervention were highly favorable. The continuous self-improvement intervention shows promise as an effective and feasible approach to improve medication adherence in adult renal transplant recipients. A fully-powered study with a diverse sample is needed to confirm these preliminary findings.
Russel C, Conn V, Ashbaugh C, et al. Taking immunosuppressive medications effectively
(TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients. ClinTransplant,
2010 [Epub ahead of print.]