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SURGICAL SUITE: Implementing ERAS at Kaiser Permanente

Engagement among patients and clinicians is excellent, and the ERAS team is working toward realizing the vision of enhanced recovery hospitals where the ERAS paradigm becomes the standard of care for the 190,000 adult inpatients hospitalized in KPNC each year.”

How Kaiser Permanente Northern California implemented an Enhanced Recovery After Surgery (ERAS) project in 20 KPNC medical centers is described in this lengthy, scholarly article.  The initiative began with colon surgery patients, but success in reducing inpatient length of stay and post-op complication rates has led to expansion of the ERAS model to other surgical patients.  This article is well illustrated with graphics which will be helpful to other providers working through similar implementation projects, including a sample “My Calendar: Recover Safely and Quickly” intended for colon surgery patients.

Source: Liu, V.X., and others. (2017, Summer). The Kaiser Permanente Northern California enhanced recovery after surgery program: Design, development, and implementation. The Permanente Journal, 21(3), 53-61.  Click here: http://www.thepermanentejournal.org/issues/2017/summer/6477-the-kaiser-permanente-northern-california.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Physicians per major gift officer

…each one-year increment of greater experience was associated with an additional $69,000 in donations per year…”

Finding quantitative data on major gift officers – and their workload – in the literature is unusual.  This study is based on a 2015 survey of seven academic medical centers.  The researchers had hoped to arrive at an optimal workload ratio, but although they found an average of just under 48 faculty physicians per major gift officer, they do NOT consider this average to be an optimal figure.  They did find a statistically significant relationship between a major gift officer’s experience and the amount of donations – as noted in the quote above – highlighting the not surprising importance of retaining staff who are experienced in fundraising.

Source: Wheeler, J.L., et al. (2017, Spring). How many physicians per gift officer? Healthcare Philanthropy Journal, 46(1), 26-32.  Click here for publisher’s website: https://www.ahp.org/Home/Resources_and_Tools/Journal/Home/Resources_and_Tools/Healthcare_Philanthropy_Journal.aspx?hkey=9d23727d-f194-43c6-85e2-cd1e6888419b   Posted by AHA Resource Center (312) 422-2050 rc@aha.org

 

FORECASTING: How to predict closure of rural hospitals

From January 2010 to December 2015, 63 rural hospitals closed, and over 1.7 million people are now at greater risk of negative health and economic hardship due to the loss of local acute care services.”

A model to predict financial distress and the risk of closure for rural hospitals is described in this scholarly article out of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.  The model was validated in that all of the selected financial performance indicators were found to be associated with the likelihood of hospital financial problems.  A surprise was that investor-owned rural hospitals were found to be more likely than expected to be in financial distress; although, this might be linked to their tendency to be located in southern states, which – as a region – are more likely to be struggling financially.

Source: Holmes, G.M., Kaufman, B.G., and Pink, G.H. (2017, Summer). Predicting financial distress and closure in rural hospitals. Journal of Rural Health, 33(3), 239-249.  Click here for access to the publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/jrh.12187/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

CARDIOLOGY: Higher volume linked to better outcomes

We demonstrate through a large regional database a positive relationship between volume and outcomes in interventional cardiovascular care.”

The volume-outcome relationship in health care has been studied quite a bit over the years – particularly related to various surgical specialties.  It is intuitively pleasing to think that if a surgeon, if a surgical team, if a hospital has a higher volume of … whatever… there will be better outcomes than providers who only see patients of this type now and then.  This study confirms this relationship for heart attack patients who were treated in the interventional cath lab.

The study analyzed outcomes data for 9,360 patients in the Dallas metro area who received care from 2010 to 2015.  Interestingly, for these patients who were diagnosed as having the most severe type of heart attack, 59 percent of patients arrived at the hospital either by themselves or transported by a family member; 39 percent arrived by ambulance.

Mortality in the facilities classified as low volume (less than 200 percutaneous coronary intervention procedures per year) was 9.55 percent.  Mortality in the intermediate and high volume facilities was almost identical – at 6.25 and 6.22 percent, respectively.

Source: Langabeer, J.R., Kim, J., and Helton, J. (2017, July-September). Exploring the relationship between volume and outcomes in hospital cardiovascular care. Quality Management in Health Care, 26(3), 160-164.  Click here for publisher’s website http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2017&issue=07000&article=00006&type=Abstract    Posted by AHA Resource Center (312) 422-2050, rc@aha.org

DISASTER PLANNING: What is hospital reverse triage?

With consideration of multiple strategies, pediatric hospital surge capacity may be considerably more robust than currently appreciated.

In a disaster situation, there is the need to free up space in hospitals to care for newly injured patients.  Reverse triage provides a way to estimate how much capacity might be made available by discharging inpatients earlier than had been planned.  This study, conducted at Johns Hopkins Hospital, studied pediatric patients during the period December 2012 through December 2013 to model the extent of possible reverse triage. The researchers found that using reverse triage as well as all other possible strategies to increase capacity could free up over 50 percent of capacity nearly immediately and 84 percent by the fourth day of a disaster.  Most of the pediatric patients who were considered appropriate for early discharge were in the child and adolescent psychiatric unit.

Source: Kelen, G.D., and others. (2017, February 6). Effect of reverse triage on creation of surge capacity in a pediatric hospital. JAMA Pediatrics. Click here: https://www.researchgate.net/profile/Gai_Cole/publication/313361752_Effect_of_Reverse_Triage_on_Creation_of_Surge_Capacity_in_a_Pediatric_Hospital/links/589cce42a6fdcc3e8bea401c/Effect-of-Reverse-Triage-on-Creation-of-Surge-Capacity-in-a-Pediatric-Hospital.pdf

EDs: What markets are more likely to have freestanding emergency departments [FSEDs]?

For hospital administrators, this research suggests that FSEDs are a practical strategic tool for expanding markets.”

Characteristics of health service areas in which hospitals are more likely to offer freestanding emergency departments (FSEDs) were studied based on data from 14 states during the period 2002 to 2011.

Market Characteristics: More Likely to Find FSEDs

  • Higher income
  • Younger and growing population
  • More specialists
  • More intense competition
  • Presence of other freestanding emergency departments
  • Higher market penetration rates for Medicare managed care

The study also drew conclusions about the characteristics of hospitals that are more likely to provide freestanding emergency departments.

Source: Patidar, N., and others. (2017, July-September). Contextual factors associated with hospitals’ decision to operate freestanding emergency departments. Health Care Management Review, 42(3), 269-279. Click here for publisher’s website http://journals.lww.com/hcmrjournal/Abstract/2017/07000/Contextual_factors_associated_with_hospitals_.9.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKING: Housekeeping cost per square foot

The relationship between patient satisfaction with care received in the hospital, as measured by the Medicare star ratings, and housekeeping cost was studied based on data from nearly 3,500 hospitals.  The authors of this very brief report note that the findings are intuitive – spend more money on housekeeping and patients will be more satisfied –  except for the oddly low cost per square foot for the 5-star rated hospitals.  Here are some of the reported findings:

Housekeeping Cost per Patient Day: 5-star is the best rating

  • $174.98 for 5-star rated hospitals
  • $103.82 for 4-star rated hospitals
  • $  85.16 for 3-star rated hospitals
  • $  75.98 for 2-star rated hospitals
  • $  75.93 for 1-star rated hospitals

Housekeeping Cost per Square Foot: 5-star is the best rating

  • $2.80 for 5-star rated hospitals
  • $6.73 for 4-star rated hospitals
  • $4.96 for 3-star rated hospitals
  • $3.83 for 2-star rated hospitals
  • $4.34 for 1-star rated hospitals

Source: The importance of a clean hospital room, according to patients. (2017, April). Healthcare Financial Management, 71(4), 78-79.  Click here for publisher’s website: https://www.hfma.org/Content.aspx?id=53567    Posted by AHA Resource Center (312) 422-2050, rc@aha.org