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Patient & Family Engagement: a Survey of US Hospital Practices

Patient and family engagement is associated with better health outcomes, higher patient ratings of quality, and reduced use of health services. So what are hospitals doing to engage patients and their families?

Results of a survey point to current practices used by hospitals in the US. Twenty-five consensus engagement strategies were covered in the survey; they addressed organizational practices, bedside practices, and information access and shared decision-making.

Researchers found a large variation in hospital implementation of engagement practices. About half of hospitals fully used 9 or more of the 25 patient and family engagement practices.

Among the most widely adopted engagement practices were:

  • Written policies on patients’ rights to identify which personal contacts they’d like to have actively involved in their care
  • Policy for unrestricted visitor access to at lease some units
  • Formal policy to disclose and apologize for medical errors

The practices less widely adopted were:

  • Involvement of patients or family as educators when training clinical staff
  • Patient and family advisory councils meeting within the last year
  • Patients and family members sitting on the patient and family advisory council

The most common barrier to implementation by hospitals was identified as competing priorities.


Source: Herrin J and others. Patient and family engagement: a survey of US hospital practices. BMJ Quality & Safety online first, June 2015. http://qualitysafety.bmj.com/content/early/2015/06/16/bmjqs-2015-004006.full

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OSHA Guidelines for Preventing Workplace Violence for Healthcare Workers

Health care and other social service workers are four times more likely as other private sector workers to be injured on the job due to violence. There were 23,000 significant injuries from workplace assault in 2013, and over 70% of them involved health care and social service workers according to the Bureau of Labor Statistics.

To help reduce the risk, OSHA has updated its guidelines for preventing violence in the healthcare and social services workplace. The guidelines address identification and assessment of workplace violence hazards and discuss key components of violence prevention programs. Helpful checklists are included as assessment and program implementation aids.

Source: Guidelines for preventing workplace violence for healthcare and social service workers. U.S. Occupational Safety and Health Administration, April 2015. https://www.osha.gov/Publications/osha3148.pdf OSHA news release, April 2, 2015: https://www.osha.gov/newsrelease/nat-20150403.html

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Standardized Emergency Codes May Minimize ‘Code Confusion’

Hospitals use emergency codes to notify staff when immediate action is required, but different hospitals may use different codes. An adult medical emergency could be a code blue at one hospital or a code rescue, code stat, or code 99 at another facility. There are currently no standard codes used nationally, according to a new overview from the Pennsylvania Patient Safety Advisory.

Just in northeast Pennsylvania, a survey found 80 different codes in use grouped into 37 categories. This can result in code confusion among employees or emergency responders and put patients at risk.

Recently, plain language codes have been endorsed for emergency communications, based on recommendations from the U.S. Department of Homeland Security/Federal Emergency Management Agency and other groups.. Here are several examples of plain language codes suggested by the Iowa Hospital Association for implementation in the state this year:

  • Event: Fire
  • Plain language code: Fire alarm + location + action required
  • Event: Acts of violence
  • Plain language code: Active shooter + location + action required
  • Plain language code: Violent intruder + location + action required
  • Event: Stroke team activation
  • Plain language code: Stroke team + location


Wallace SC; Finley E. Standardized emergency codes may minimize “code confusion”. Pennsylvania Patient Safety Advisory 12(1):1-6, Mar. 2015.

Plain language emergency codes: implementation guide. Iowa Hospital Association, 2013? http://www.ihaonline.org/iMIS15/Images/IHAWebPageDocs/publications/Plain%20Language%20Document.pdf

National incident management system. U.S. Department of Homeland Security, Dec. 2008, page 29. http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf

Plain language frequently asked questions (FAQs). U.S. Department of Homeland Security, June 2010. http://www.dhs.gov/sites/default/files/publications/PlainLanguageFAQs.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Back to the Future: Volume as a Quality Metric

At one time, volume was the major measure of quality because other measures were lacking. Now volume is getting renewed attention, and it seems common sense if practice makes perfect. While it’s not quite that straight forward, as Dr. Ashish K. Jha, discusses in a JAMA Forum article, volume does indeed matter but other factors can impact outcomes as well.

Quality leaders from 3 major academic health systems — Dartmouth-Hitchcock Medical Center, The Johns Hopkins Hospital and Health System, and the University of Michigan Health System — have begun a Take the Volume Pledge campaign to define a minimum annual volume threshold for hospitals and surgeons for surgeries.

Recommended volumes for 10 surgical procedures are being proposed by the group:

proposed ann surg vol jun15

Dr Jha mentions 2 issues for setting surgical volume standards: what to do about new surgeons, and the argument that setting  thresholds may be self-serving for high-volume surgeons or hospitals.


Jha AK. JAMA Forum: Back to the future: volume as a quality metric. JAMA News, June 10, 2015. http://newsatjama.jama.com/2015/06/10/jama-forum-back-to-the-future-volume-as-a-quality-metric

Sternberg S. Low volume hospitals – what to ask. US News & World Reports, May 18, 2015. http://www.usnews.com/news/articles/2015/05/18/low-volume-hospitals-what-to-ask


Clark C Limits urged on surgeries by low-volume providers. HealthLeaders Media, May 20, 2015.

Sternberg S. Hospitals move to limit low-volume surgeries. US News & World Reports, May 19, 2015. http://www.usnews.com/news/articles/2015/05/19/hospitals-move-to-limit-low-volume-surgeries

Sternberg S and Dougherty G. Risks are high at low-volume hospitals. US News & World Reports, May 18, 2015. http://www.usnews.com/news/articles/2015/05/18/risks-are-high-at-low-volume-hospitals

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Hospital Readmissions for Psychiatric Conditions

The Agency for Healthcare Research and Quality has released two new reports focused on psychiatric readmissions.

The first is a statistical brief looking at readmission rates for psychiatric conditions. It indicates the 30-day readmission rate for schizophrenia in 2012 was 15.7%, while it was 9% for primary diagnoses involving mood disorders. This compares to a 3.8% readmission rate for all other non-mental health/substance abuse conditions.

The second report comes from AHRQ’s Effective Health Care Program. It identifies and evaluates the research on strategies to reduce hospital readmissions for psychiatric conditions. It found availability and implementation of strategies varied widely and concluded more research is needed to determine which are most effective, especially in settings with varying resources.

Psychiatric readmissions are probably undercounted, according to the report. More research on ways to accurately measure the most meaningful outcomes for psychiatric conditions is also needed.

In 2012, nearly one quarter of U.S. adults experienced some form of mental or substance abuse disorder.


Heslin KC and Weiss AJ. Hospital readmissions involving psychiatric disorders, 2012. HCUP (Healthcare Cost and Utilization Project) Statistical Brief, no. 189, May 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb189-Hospital-Readmissions-Psychiatric-Disorders-2012.pdf

Gaynes BN and others. Management strategies to reduce psychiatric readmissions. Effective Health Care Program Technical Brief no. 21,  May 21, 2015. http://www.effectivehealthcare.ahrq.gov/ehc/products/596/2082/psychiatric-readmissions-report-150521.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MERGERS: Consolidation of hospital clinical services has the most potential for cost savings

After a merger or acquisition involving hospitals comes the hard work of integrating and consolidating the legacy organizations.  Opportunities for cost savings can be found in these areas, based on the experience of The Camden Group:

  • Administrative functions (20 percent)
  • Support and infrastructure (25 percent)
  • Clinical areas (55 percent)

Oftentimes, however, the sheer difficulty of aligning the stakeholders tends to result in a concentration on change in only the administrative, support, and infrastructure areas.  This article describes a planning process called BPOE (business plan of operational efficiencies) which is a “bottom-up” approach that can be used to generate cost savings ideas.

Source: Klar, B., Shufelt, G.P. (2015, June). Charting a path to efficiencies following a merger. HFM. Healthcare Financial Management, 69(6), 63-69.  http://www.hfma.org/Content.aspx?id=31008  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPERATING ROOM IDEAS: Sequestration of bariatric cases

Ways that hospitals are analyzing operational and financial data related to the surgical suite are explored in this article.  One hospital discovered, as part of an analysis of turnover times, that bariatric surgery cases were associated with longer turnover times.  The hospital then experimented with grouping all bariatric cases into dedicated ORs — “a three-room wing of its own in the OR.”  This sequestration of bariatric cases caused an 8-minute improvement in turnover times for other cases.  Because support staff were now also dedicated to the bariatric service line, they were also able to decrease turnover times.  Another case described is of a hospital that found an effective way to communicate the results of data analysis in order to reduce costs associated with physician preference items.

Source: Rempfer, D. (2015, June). Using perioperative analytics to optimize OR performance. HFM. Healthcare Financial Management, 69(6), 82-85. Retrieved from http://www.hfma.org/Content.aspx?id=31004    Posted by AHA Resource Center (312) 422-2050, rc@aha.org


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