Posted on June 28, 2016 by kmgarber
This is a study out of Johns Hopkins of 17 intensive care units at 7 hospitals – comparing practices related to reducing the central line-associated bloodstream infection (CLABSI) rate. High performers were defined as those with less than 1 infection per 1000 catheter-days over the period of at least one year. Low performers were defined as having over 3 infections per 1000 catheter-days.
I particularly like the tables and the appendices to this article. The tables identify characteristics of high-performers in bullet-point brevity for each of the following levels of hospital employees: senior leadership, ICU managers, infection prevention and quality improvement staff, and frontline staff. The appendices contain specific questions that make up a CLABSI Conversation – again differentiated between senior management, infection control / quality improvement staff, and ICU staff.
Source: Pham, J.C., and others. (2016, Apr.-June). CLABSI Conversations: Lessons from peer-to-peer assessments to reduce central line-associated bloodstream infections. Quality Management in Health Care, 25(2), 67-78. Click here for publisher’s website: http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2016&issue=04000&article=00001&type=abstract Posted by AHA Resource Center (312) 422-2050, firstname.lastname@example.org
Filed under: Benchmarking, Best practices, Patient safety, Posted by Kim Garber, Special care units | Tagged: central line-associated bloodstream infections, CLABSI, Intensive care units, Peer-to-peer assessments, Special care units | Leave a comment »
Posted on June 27, 2016 by kmgarber
It’s possible to begin to compile a list of chief pharmacy officers by using this search strategy on LinkedIn: https://www.linkedin.com/title/chief-pharmacy-officer. We notice right away that CPOs are employed at the big insurance companies and at large hospitals and health systems, among other organizations.
Here are some recent articles that address the value of creating a CPO position.
Gittlen (2016) is a brief news story about the experiences of the CPOs at RWJBarnabas Health (New Jersey), Ascension Health (St. Louis), and Froedtert Hospital (Milwaukee).
ASHP (2015) reviews the characteristics of pharmacists that make them good candidates for leadership positions.
ASHP (2004) pinpoints the beginning of the trend towards naming CPOs at health system headquarters.
Gittlen, S. (2016, June). The value of the chief pharmacy officer. HealthLeaders, 19(5), 32-34. Click here: http://www.healthleadersmagazine-digital.com/healthleadersmagazine/june_2016?pg=34#pg34
American Society of Health-System Pharmacists (ASHP). (2015, Jan. 9). Pharmacists in the c-suite offer new perspectives on patient care. ASHP Intersections. http://www.ashpintersections.org/2015/01/pharmacists-in-the-c-suite-offer-new-perspectives-on-patient-care/
American Society of Health-System Pharmacists (ASHP). (2004, Sept. 15). Hail to the chief…pharmacy officer. Pharmacy News. http://www.ashp.org/menu/News/PharmacyNews/NewsArticle.aspx?id=1658 Posted by AHA Resource Center (312) 422-2050, email@example.com
Filed under: Pharmaceuticals, Posted by Kim Garber | Tagged: Chief pharmacy officers, CPO | Leave a comment »
Posted on June 27, 2016 by dculbertson
The National Center for Health Statistics has just released updated numbers on emergency department use in the U.S. and the five most populous states Here are some key findings:
- The national ED visit rate in 2012 was 42 visits per 100 persons.
- The national percentage of ED visits resulting in an admission to the same hospital was 11%.
- Nationwide, 63% of all ED visits were made by adults aged 18-64; children accounted for 21% of visits and the elderly 65 and over for 16%.
- Private insurance was the expected primary source of payment for 29% of ED visits, and Medicaid or CHIP accounted for 25%.
Data is also available for California, Florida, Illinois, New York, and Texas.
Source: Hing E and Rui P. Emergency department use in the country’s five most populous states and the total United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 252, June 2016. https://www.cdc.gov/nchs/data/databriefs/db252.pdf
Posted by AHA Resource Center (312) 422-2050, firstname.lastname@example.org
Filed under: Ambulatory care, Benchmarking, Emergency department, Posted by Diana Culbertson | Leave a comment »
Posted on June 24, 2016 by kmgarber
The U.S. Agency for Healthcare Research and Quality (AHRQ) has a number of free databases on the web that can be used to take an interesting historical look at health care utilization data. I recently posted on this blog about hip fracture – and got an unusual number of hits! – so thought I might explore another aspect of the same topic here using some AHRQ data.
HIP REPLACEMENT: Inpatients discharged who had total or partial hip replacement, 1995-2013
- 267,034 (or 100.3 per 100,000 persons) in 1995
- 298,631 (or 105.8 per 100,000 persons) in 2000
- 371,754 (or 125.8 per 100,000 persons) in 2005
- 439,838 (or 142.2 per 100,000 persons in 2010
- 439,945 (or 156.2 per 100,000 persons) in 2013
The fine print: What is this exactly? First of all, these numbers represent inpatients only. The rates per 100,000 persons means per 100,000 resident population. The data source is the National Inpatient Sample based on the “CCS category” code 153: Hip replacement, total and partial. It is also possible to run data using ICD-9 codes or DRGs. The most current data year is 2013.
We notice from these data that both the actual number of inpatients who have had hip replacement and the rate per 100,000 persons are trending upward over time.
HIP REPLACEMENT: Ambulatory surgery?
AHRQ also has a database of ambulatory surgery procedures for 29 reporting states (representing two-thirds of the U.S. population). As of this writing, the database can be queried for just the year 2012 but, with an added nice feature, provides comparable inpatient data for the same states. Setting this database up for the same CCS category as above (153: Hip replacement, total and partial, all listed) shows that only about 3 percent of hip replacements were done on an outpatient basis in 2012.
Source: Agency for Healthcare Research and Quality. Welcome to HCUPnet. Click here for free access to this database http://hcupnet.ahrq.gov/ Posted by AHA Resource Center (312) 422-2050, email@example.com
Filed under: Benchmarking, Posted by Kim Garber, Surgical suite | Tagged: Agency for Healthcare Research and Quality, HCUPnet, Hip replacement surgery, Hospital utilization trends, Surgical utilization trends, Total hip arthroplasty, Total hip replacement surgery | Leave a comment »
Posted on June 22, 2016 by kmgarber
What is this study? A retrospective medical record review for 93 babies discharged from NICU at one hospital.
More about it: Researchers studied the care needed by babies who were discharged home from the neonatal intensive care unit at Rainbow Babies & Children’s Hospital (Cleveland) during a recent two- year period. Data on 71 babies who were technology dependent were compared with 22 who were not. Here are some findings:
Technology-Dependent Newborns Discharged from NICU
- 66 percent needed supplemental oxygen at home
- 46 percent needed feeding tubes at home
- 16 percent needed tracheostomy at home
- 16 percent needed mechanical ventilation at home
Newborns discharged home dependent on technology had an initial stay in the NICU of about 109 days compared to about 26 days for those discharged home non-dependent on technology.
Hospital readmission risk indicators for the technology-dependent group included: being female, having a gastrostomy tube or having initial lengthy NICU stay.
NICU-t0-home transition can be tricky. (2016, June). Managed Care, 25(6), 8. Click here: http://www.managedcaremag.com/archives/2016/6/nicu-home-transition-can-be-tricky
Toly, V.B., and others. (2016, June 7). Neonates and infants discharged home dependent on medical technology: Characteristics and outcomes. Advances in Neonatal Care, Click here: http://journals.lww.com/advancesinneonatalcare/pages/articleviewer.aspx?year=9000&issue=00000&article=99928&type=abstract
Filed under: Posted by Kim Garber, Special care units | Tagged: Neonatal intensive care units, NICU, Premature babies, Preterm babies, Very low birth weight babies | Leave a comment »
Posted on June 21, 2016 by kmgarber
What are the outcomes for patients who have had surgery after breaking a hip? This is a study of the Kaiser Permanente Hip Fracture Registry – looking at over 12,000 patients in California in 2009 through 2011. The registry data includes 33 medical centers and 474 surgeons. Here is a look at this data-rich article:
Characteristics of Patients with Broken Hips
- Two-thirds are female
- Two-thirds are 75 years or older
- Over half have 3 or more other medical problems (comorbidities)
- Two-thirds have hypertension
- 4-day length of stay (median)
- 6.2 percent death within 30 days
- 12.3 percent death within 90 days
- 12.2 percent readmission within 30 days
- 22.1 percent readmission within 90 days
- 11.4 percent contracted pneumonia
- 1.1 percent surgical site infection
- 12.1 percent low volume (less than 10 procedures / year)
- 68.4 percent medium volume (10 to 29 procedures / year)
- 19.5 percent high volume (30+ procedures / year)
- 1.7 percent low volume (less than 60 procedures / year)
- 35.3 percent medium volume (60 to 129 procedures / year)
- 63.0 percent high volume (130+ procedures / year)
Source: Inacio, M.C.S., and others. (2015, Sum.). A community-based hip fracture registry: Population, methods, and outcomes. The Permanente Journal, 19(3), 29-36. Click here for free full text: http://www.thepermanentejournal.org/files/Summer2015/Registry.pdf Posted by AHA Resource Center (312) 422-2050, firstname.lastname@example.org
Filed under: Benchmarking, Posted by Kim Garber, Readmission, Surgical suite | Tagged: 30-day readmission rates, 90-day readmission rates, Hip fractures, Patient outcomes | Leave a comment »
Posted on June 20, 2016 by kmgarber
According to the American Stroke Association website, ischemic stroke – in which a clot blocks a blood vessel – is by far the most common type of stroke, occurring in just under 90 percent of cases. If the stroke patient reaches care quickly enough, a good standard treatment is the administration of tissue plasminogen activator (tPA), but the key to improved outcomes is getting the drug administered quickly.
This was a study of 11,630 patients age 18 and over with ischemic stroke who arrived in the 14 emergency departments in the Kaiser Permanente Southern California health system from 2009 to 2013. Interestingly, a relatively small percentage of these patients were treated with tPA – under 3 percent in 2009 and a little over 6 percent in 2013. (The authors suggest that the reason that there was a low percentage of tPA administration was because patients were ineligible because they had not made it to the hospital in time for this therapy to be effective, or for other clinical reasons.)
During the 5 years of the study, Kaiser clinicians were able to shave time off of their door-to-imaging time – 46 minutes in the most recent year. Likewise, they were able to decrease their door-to-needle time to 67 minutes in the most recent year.
American Stroke Association. (2016). Click here: www.strokeassociation.org
Sauser-Zachrison, K., and others. (2016, Spring). Emergency care of patients with acute ischemic stroke in the Kaiser Permanente Southern California integrated health system. Permanente Journal, 20(2), 10-13. Click here: http://www.thepermanentejournal.org/files/Spring2016/KaiserPermanenteSouthernCalifornia.pdf Posed by AHA Resource Center (312) 422.2050, email@example.com
Filed under: Emergency department, Posted by Kim Garber | Tagged: Ischemic stroke treatment, Stroke door to needle time, Tissue plasminogen activator, tPA | Leave a comment »