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ICUs: How do high-performing hospitals reduce CLABSI rates?

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, rc@aha.org

CHIEF PHARMACY OFFICERS (CPOs): Who has them? What is the value added?

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.

Sources:

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, rc@aha.org

New CDC Data on Emergency Department Use

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, rc@aha.org

TRENDS: nearly 450,000 hip replacements each year

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, rc@aha.org

NICU: Length of stay 109 days for technology-dependent babies at Rainbow Babies & Children’s

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.

Sources:

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

HIP FRACTURES: Patient characteristics, outcomes, surgical volume: Data from Kaiser Permanente registry

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

Patient Outcomes

  • 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

Surgeon Characteristics

  • 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)

Hospital Characteristics

  •   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, rc@aha.org

STROKE: Kaiser Permanente studies door-to-needle time

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.

Sources:

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, rc@aha.org

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