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EMERGENCY DEPARTMENT: Use of home-based care

Just over half of the 682 emergency physicians who responded to this 2015 survey indicated that they have chosen home-based care options (overseen by a nurse or physician) instead of observation stays or inpatient admissions for elderly patients who visit the emergency department.  This is not a frequent occurrence  – the majority of ED physicians reported doing this for 5 or fewer patients per month.  The most common barrier to home-based care after an ED visit was reported to be the sense of an unsafe or unstable environment at home.  Patients who were recommended most frequently for home-based care had these diseases or conditions:

  • cellulitis
  • urinary tract infection
  • diabetes
  • pneumonia, community acquired

Note: This is a medical journal article reporting the results of a survey.  The authors are with West Health Institute (La Jolla, CA) and UC San Diego Medical Center.

Source: Stuck, A.R., and others. (2017, November). National survey of emergency physicians concerning home-based care options as alternatives to emergency department-based hospital admissions. The Journal of Emergency Medicine, 53(5), 623-628.  Click here for free full text: http://www.jem-journal.com/article/S0736-4679(17)30488-2/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

CULTURE: How to use guiding coalitions to change organizational culture

How to change hospital culture through the use of a quality collaborative approach was explored in this research study of 10 hospitals that are part of the Mayo Clinic Care NetworkThe project centered on reducing mortality for heart attack patients but the findings shed light on how to effect culture change within organizations generally, even beyond health care provider settings.  The authors examine what worked and what didn’t in the culture change project.  Here are some of their findings as to what is important:

  • Having diverse representation on the guiding coalition
  • Fostering an environment of “discovery, learning and teaching” among guiding coalition members
  • Learning how to manage conflict and how to sustain engagement

Of the 10 hospitals studied, 6 were found to have made significant positive shifts in organizational culture.

Source: Bradley, E.H., Brewster, A.L., McNatt, Z., and others. (2017, November 3). How guiding coalitions promote positive culture change in hospitals: A longitudinal mixed methods interventional study. BMJ Quality & Safety. Click here open access free full text: http://qualitysafety.bmj.com/content/early/2017/11/02/bmjqs-2017-006574.long  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

The Importance of Health Insurance Coverage

Why is health insurance coverage important?

  • It improves access to care
  • It’s associated with improved health outcomes
  • It supports appropriate health care utilization
  • It improves individuals’ and families’ financial well-being

A new briefing from the American Hospital Association discusses each of these facets on the impact of health coverage on consumers and the overall health system. The report also provides recent data trends on the number of insured and uninsured and a reference list for further information.

Source: The importance of health coverage. American Hospital Association, Nov. 2017. http://www.aha.org/content/17/importance-of-health-coverage-report.pdf

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

 

READMISSIONS: 7-day and 30-day rates for U.S., 2014

In 2014, the U.S. 7-day readmission rate was 5 percent and the 30-day rate was 14 percent, according to this new report released by the U.S. Agency for Healthcare Research and Quality (AHRQ).  The data are derived from the Healthcare Cost and Utilization Project (HCUP) and are based on all-payer data – not limited to Medicare data.

This Statistical Brief provides data on the most frequent causes of readmission at both of those points in time.  The most frequent causes are similar at 7 days and at 30 days.  Here is the list for 7-day readmissions, in rank order:

  1. Schizophrenia and other psychotic disorders (9 percent)
  2. Alcohol-related disorders (7.5 percent)
  3. Congestive heart failure, nonhypertensive (7.4 percent)
  4. Heart valve disorders (7.3 percent)
  5. Hypertension with complications, secondary hypertension (7.2 percent)

Here is the list for 30-day readmissions, in rank order:

  1. Congestive heart failure (23.2 percent)
  2.  Schizophrenia and other psychotic disorders (22.9 percent)
  3. Respiratory failure; insufficiency; arrest, adult (21.6 percent)
  4. Alcohol-related disorders (21.5 percent)
  5. Deficiency and other anemia (21.2 percent)

This report also provides a breakout of the most common causes of readmission by payer type (Medicare, Medicaid, private insurance and uninsured).

Note: These readmission rate percents represent readmissions per 100 index inpatient stays.

Source: Fingar, K.R., Barrett, M.L., and Jiang, H.J. (2017, October). A comparison of all-cause 7-day and 30-day readmissions, 2014. Statistical Brief, 230.  Click here for free full text: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb230-7-Day-Versus-30-Day-Readmissions.jsp  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

OPIOIDS: Neonatal abstinence syndrome treatment

The national incidence of NAS [neonatal abstinence syndrome] increased from 3.4 to 5.8 per 1,000 hospital births between 2009 and 2012…”

Babies born to mothers who have taken opiates may experience withdrawal symptoms after they are born.  In Kentucky, care for these newborns is usually provided in the neonatal intensive care unit.  In 2014, a task force was convened to develop a best practice treatment protocol.  This study, done at the University of Louisville Hospital, evaluated this new protocol for babies carried to term, finding a decrease in the number of days that the infants needed morphine therapy and a decrease in the need for adjunctive pharmacologic therapy.  Length of stay was shortened by 9 days and hospital charges were about $27,000 lower per patient.

Source: Devlin, L.A., Lau, T., and Radmacher, P.G. (2017, October 10). Frontiers in Pediatrics. 5(216).  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641300/pdf/fped-05-00216.pdf

FACILITY DESIGN: How healthy is the indoor environment?

…it is estimated that people in developed countries now spend 90 percent of their lives indoors.”

What is known about the effect of microorganisms found indoors on health is reviewed in this technical report published by the National Academies Press.  Among the topics covered are air sources, water sources and building surfaces.  Physical and chemical interventions that may help to reduce problems caused by hazardous microbes are covered.

Source: National Academy of Sciences, Engineering, and Medicine. (2017). Microbiomes of the built environment: A research agenda for indoor microbiology, human health, and buildings. Washington, D.C.: The National Academies Press.  Click here for free full text: https://www.ncbi.nlm.nih.gov/books/NBK458827/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ANTIMICROBIAL STEWARDSHIP: Staffing ratio for hospitals

The recommendation for staffing of a comprehensive antimicrobial stewardship program in a hospital setting was developed based on a study done in 12 Veterans Health Administration hospitals.  The recommended staffing guideline is:

  • 1 FTE pharmacist per 100 occupied beds

Source: Echevarria, K., and others. (2017, November). Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Administration. American Journal of Health-System Pharmacy. 74(21), 1785-1790. Click here for publisher’s website: http://www.ajhp.org/content/74/21/1785.long  Posted by AHA Resource Center (312) 422-2050, rc@aha.org