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VHIG Digest: Volume 2, No. 4

Posted by on Monday, March 14, 2011 in Digest, Our Blog and Digest, Volume 2.

By Jake McClure, VMS II

In the News

1. Wall Street Journal Reports Almost 5% of Americans Report Falling Asleep at the Wheel

A March 3rd article in the Wall Street Journal reported a scary statistic regarding Americans and their tendency to fall asleep while driving at the wheel. Based on numbers released by theCDC, of the 74,571 Americans surveyed, 4.7% admitted to either nodding off or falling asleep while driving in the prior 30 days. Those older than 65 reported these tendencies (2.0%) statistically more often than all other age groups: 18-24 years (4.5%), 25-34 years (7.2%), 35-44 years (5.7%), 45-54 years (3.9%), and 55-64 years (3.1%). Compared to those sleeping greater than 7 hours per night, those sleeping less than 7 reported nodding off or falling asleep while driving in the prior 30 days 7.3% of the time (versus 3.0%).

Full story here.

2. New York Times Reports FDA Orders Prescription Cold Drugs Pulled From Market

A March 2 posting on the New York Times detailed the FDA’s order of roughly 500 prescription medications used to treat coughs, colds and allergies be removed from the shelves. The FDA justified their order in saying that these prescription medications had never undergone a federal review of effectiveness and safety. Many of these medications had been on the shelves before a 1962 law requiring drugs to undergo review for effectiveness and safety. The decision is one of the latest in a FDA campaign to glean the shelves of pharmacies and remove unapproved medications. Officials from the FDA showed some concern regarding young child and infant health since some potential risks related to the ingredients in some of the over-the-counter cough, cold and allergy medications were also found in these prescription drugs. In addition, the FDA tested 6 medications that were labeled as extended-release formulations designed to release their active ingredients gradually over the first 8-12 hours. However, 3 of the 6 tested released 85% of their active ingredients in just 30 minutes. The FDA stresses that there are still plenty of cold, cough and allergy drugs available on the market that have been approved.

Full blog post

In the News

1. Bacterial Contamination After an 8-Hour Workday: A Randomized Controlled Trial

The culture of medicine is currently fearful of a time where antibiotic resistance renders treatment of formerly easily treatable infections almost impossible. That is why researchers at the University of Colorado chose to conduct a randomized control trial comparing methicillin-resistant Staphylococcus aureus (MRSA)contamination at the end of an 8-hour workday of physicians’ white coats with laundered, standardized, short-sleeved shirts.

Findings: There were no statistically significant differences found in the comparison of MRSA contamination of physician white coats with laundered short-sleeved uniforms. Also, there was no significant difference in contamination of skin of the wrists of physicians wearing either the white coat or laundered shirt. Regarding the rate of contamination, bacterial counts of the laundered uniforms were basically zero; however, within 3 hours of being worn, the bacterial counts were ~50% of what was counted at the end of the 8 hour workday. Thus, the data from this study does not support having physicians abandon the traditional wear of white coats for laundered, short-sleeve uniforms.

Burden M, Cervantes L, Weed D et al. Newly Cleaned Physician Uniforms and Infrequently Washed White Coats Have Similar Rates of Bacterial Contamination After an 8-Hour Workday: A Randomized Controlled Trial. Journal of Hospital Medicine. 2011 Feb 10.

An additional article covering this study.

2. Quality Improvement Initiative in Intensive Care Units and Hospital Mortality and Length of Stay

A recent publication from the British Medical Journal investigated the outcomes of the
Michigan Keystone ICU project regarding mortality and length of stay in Medicare patients. The ICU project was established with the goal of reducing central line-associated bloodstream infections and ventilator-acquired pneumonia in the ICU setting. To date, this quality improvement initiative reports having saved 1,830 lives and $271 million health care dollars in its five-year implementation. Peter Pronovost, a well-known researcher in the field of patient safety research, and others at Johns Hopkins used Medicare claims to assess outcome measures of the ICU project in a retrospective comparative study from October 2001 to December 2006. They compared the ICU outcomes from 95 different Michigan hospitals with 364 other Midwestern hospitals.

Findings: Following the implementation of ICU project, the study group was found to have significant reduction only in the post-implementation months 1-12 and 13-22 (odds ratio 0.83, p=0.041; odds ratio 0.76, p=0.007, respectively). Compared to the other Midwestern hospitals, there was no significance differences found in pre-implementation, project initiation or implementation phases. When the researchers investigated the outcome measure of length of stay, no significant differences were found between the study and comparison groups.

Lipitz-Snyderman A, Steinwachs D, Needham DM, et al. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis. BMJ. 2011 Jan 28.

An additional article covering this study.

3. Improving Patient Care in Cardiac Surgery Using Toyota Production System Based Methodology

Based on the Toyota premise that removing defects from a complex process will result in less variable outcomes of production and ultimately a higher quality product delivered to the consumer/customer, a heart surgery program was implemented to investigate how delivery of health care could parallel automobile production in decreasing variability and increasing quality of care delivered to the patient. The

Toyota production method (TPS) has improved their final product by reducing variability in their production process, and this methodology has been adopted and transplanted across industry lines. In the healthcare sector, this same concept was taught to the management team at a vascular center where 409 operations were ultimately performed between March 2008 and June 2010.

Findings: Regarding the mortality rate, according to data available from the

Society of Thoracic Surgeons, the risk-adjusted mortality rate from these cardiovascular operations was 61% lower than the mortality rate for the surrounding region. Also, the risk-adjusted rate for major complications was 57% lower than the regional rate. One operative death occurred in these 409 operations. Of the 409 operations, 253 were coronary artery bypass graft (CABG)procedures. Because many predicted complications were avoided in this subset of operations, $3,497 of cost savings per CABG procedure was reported.

Culig MH, Kunkle RF, Frndak DC, et al. Improving Patient Care in Cardiac Surgery Using Toyota Production System Based Methodology. Ann Thorac Surg2011;91:394Ð400.