OPERATING ROOMS: How Mass General ramped up again after procedures were deferred during early days of pandemic

During the early days of the pandemic, hospitals were asked to defer non-essential surgery to free up resources for the care of SARS-CoV2 patients. Within 4 weeks, Massachusetts General Hospital (Boston) had deferred 6,500 surgical procedures – dropping to 15 percent of previous surgical volume. How the hospital devised an orderly methodology to triage surgical patients who were waiting to be rescheduled is described. This safe and swift methodology allowed the hospital to ramp back up from 10 to 58 operating rooms running each day – at 750 cases per week, a full schedule. How surgeons were assigned time as capacity changed is also discussed.

Source: Brumit, R. and others. Recovering an Operating Room Schedule During a Global Pandemic: A Method for Safe and Swift Increases in OR Volume During Times of Crisis. Journal of Medical Systems 45(12). Full text free here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787880/pdf/10916_2020_Article_1687.pdf

PATIENT READMISSION: Home visits help post-discharge

Adult patients discharged from hospitals in the Cleveland Clinic Health System who were thought to be at high risk of readmission were studied. These patients were offered different combination of home visits made by advanced practice nurses and/or paramedics. No significant difference was found with 90-day readmissions, 180-day readmissions, emergency visits or patient mortality, but the 30-day readmission rate was lower in the study group compared to a matched group that did not receive the home visits.

Source: Anita D. Misra-Hebert, and others. “Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission.” Healthcare 9(1) (Mar. 2021). Full text free here: https://www.sciencedirect.com/science/article/pii/S2213076420301172

AMBULATORY CARE: How time of day affects quality of care and what to do about decision fatigue

Quality of care deteriorates over the course of the day due to the combination of shared cognitive biases, hurried visits, and mounting decision fatigue…”

Studies show that the quality of outpatient care decreases over the course of the clinic day. Patients seen later in the day are likely to have fewer appropriate services ordered and, also, more low-value inappropriate services ordered. A difference in diagnostic accuracy has also been found based on time of day. How to counteract this time-of-day trend by incorporating alerts into the electronic health record, by using social norm interventions, by optimizing use of telehealth and mail, and by changing payment models are discussed.

Source: Allison H. Oakes, and Mitesh S. Patel. “Time to Address Disparities in Care by Appointment Time.” Healthcare 9(1), (Mar. 2021). https://www.sciencedirect.com/science/article/pii/S2213076420301068

ORGANIZATIONAL INNOVATION: McKinsey consultants forecast what pandemic-driven change will look like

Business leaders tell us that the metabolic rate of their organizations has soared. Their companies have accelerated by adopting new ways to work.”

How much and in what ways will the pandemic push companies to adopt Silicon Valley-inspired nimble organizational concepts? What will the agile operational model look like in the near term? McKinsey thought leaders focus on change accelerations brought on by the pandemic and how things are changing more quickly than had been thought possible. A key set of three steps should be employed: to reflect, decide and then deploy at scale. Learnings from the pandemic will help organizations position themselves for greater uncertainty in the future.

Jost, Gregor, and others. “How COVID-19 is redefining the next-normal operating model.” The McKinsey Quarterly 1 (2021). Full text free here: https://www.mckinsey.com/business-functions/organization/our-insights/how-covid-19-is-redefining-the-next-normal-operating-model

PATIENT FALLS: Canadian study evaluates rubber flooring in long-term care setting

Falls are a major health concern for older adults world-wide, particularly in long-term care (LTC), where approximately 60% of residents fall at least once per year, and 30% of falls cause injury…”

The value of installing a synthetic rubber flooring (compliant flooring) over a concrete floor was compared to plywood over concrete in this randomized trial conducted at one long term care facility in British Columbia.  There were 74 private rooms in the intervention group and 76 in the control group in this 4-year study.  The researchers concluded that the rubber flooring was “not effective for preventing serious fall-related injuries in LTC.”  This article includes interesting tables showing details about the nearly 2,000 patient falls recorded over a 4-year period in this one Canadian facility.  The vast majority of falls occurred in the patient room (excluding the bathroom).  Falls were most likely to occur in the evening and least likely to occur in the afternoon.  There were 85 falls resulting in serious injury,

Source: Mackey, D.C., and others. (2019, June 24). The Flooring for Injury Prevention (FLIP) study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial. PLoS Medicine, 16(6).  Click here for free full text:  https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002843&type=printable  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: Diabetics with low blood sugar on last day of inpatient hospital stay are more likely to be readmitted

Potential approaches that may reduce the risk for readmission or death after discharge [for diabetes patients] include delaying patient release from the hospital until normoglycemia is achieved, modifying outpatient [diabetes] medications or advise patients to perform frequent glucose monitoring or use continuous glucose-monitoring devices.”

The relationship between low blood glucose levels and hospital readmission was studied in this large-scale analysis of over 800,000 admissions to Veteran Affairs hospitals over a period of 14 years. An inverse relationship was found – diabetic patients with low blood glucose levels (hypoglycemia) on the last day of a hospital inpatient stay were more likely to be readmitted to the hospital or to die within 180 days after discharge.

Source: Spanakis, E.K., and others. (2019, September). Association of glucose concentrations at hospital discharge with readmissions and mortality: A nationwide cohort study. JCEM. The Journal of Clinical Endocrinology & Metabolism, 104(9), 3679-3691. Click here for free full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642668/?report=printable  Posted by AHA Resource Center, (312) 422-2003, rc@aha.org

 

 

 

READMISSIONS: Hospital revisits data trends including emergency department visits and observation visits

Although readmissions for target conditions decreased from 2012 to 2015 in the US, total hospital revisits within 30 days of discharge steadily increased over that same period.”

Changes in total 30-day hospital revisits (including emergency department treat-and-discharge visits and observation stays as well as hospital readmissions) were studied for Medicare patients hospitalized with pneumonia, heart failure or acute myocardial infarction from January 2012 to September 2015.  A total of over 3 million original hospitalizations were studied.  Hospital readmissions decreased over the study period, but treat-and-discharge visits and observation stays increased.

Source: Wadhera, R.K., and others. (2019). Hospital revisits within 30 days after discharge for medical conditions targeted by the Hospital Readmissions Reduction Program in the United States: National retrospective analysis. BMJ. 366.  Click here for free full text:https://www.bmj.com/content/bmj/366/bmj.l4563.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

EMERGENCY: Which patients are likely to benefit the most from emergency care?

…we identified 51 condition groups most sensitive to emergency care, conditions where timely, high-quality emergency care is expected to make an impact on mortality and morbidity.”

A comprehensive list of emergency care sensitive conditions (ECSC) developed by an expert panel to represent adult patient conditions that are most appropriate for emergency care is the focus of this research article.  The conditions were then paired with national ED utilization data.  There were about 16 million (14 percent) of the roughly 114 million total ED visits in 2016 that were considered to be ECSC.  Here are the utilization data for the top 5 most frequent of these ECSC visits:

• 10.7 percent of all ECSC visits were related to sepsis and SIRS
•   7.9 percent were related to pneumonia
•   7.9 percent were related to chronic obstructive pulmonary disease
•   6.1 percent were related to asthma
•   5.7 percent were related to heart failure

You can also determine those conditions that are most likely to be admitted after presenting in the ED.  Here are the 5 highest:

• 94.8 percent of patients with sepsis and SIRS were admitted
• 88.1 percent with respiratory failure
• 83.9 percent with femur fractures
• 80.0 percent with cerebral infarction
• 79.7 percent with meningitis

Other patient disposition data and median emergency department charges are also included.

Source: Vashi, A.A., and others. (2019, August 7). Identification of emergency care-sensitive conditions and characteristics of emergency department utilization. JAMA Network Open, 2(8).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747479 Posted by AHA Resource Center (312) 422-2003 rc@aha.org

PARKINSON’S: Integrated practice unit (IPU) offers one-stop-shop model of care

The concept of an integrated practice unit (IPU) would offer patients with the same disease – Parkinson’s is explored in this article but the model has broader applicability – a team of specialists with appropriate resources at hand for the care of a complex chronic condition.  Several case examples of providers who are developing this type of care include:

• ParkinsonNet in The Netherlands
• Kaiser Permanente
• Van Andel Research Institute (Grand Rapids, MI) – based on the ParkinsonNet model
• Cleveland Clinic

The author identifies two components as critical for an IPU: patient-reported outcome measures and focus on value.

Sources: McKee, K. (2019, August 1). Creating “one-stop shop” care for Parkinson’s. NEJM Catalyst. Click here: https://catalyst.nejm.org/one-stop-shop-care-parkinsons/

Kaiser Permanente. Our care model.  Click here:  https://parkinsonscare.kaiserpermanente.org/our-care-model/

Van Andel Institute and ParkinsonNet explore partnership. (2015, June 2). News Release.  Click here: http://www.parkinsonnet.info/news/van-andel-institute-and-parkinsonnet-explore-partnership

Porter, M.E., Teisberg, E.O. (2019, June). Cleveland Clinic: Transformation and growth 2015. HBS Case Collection. Click here:  https://www.hbs.edu/faculty/Pages/item.aspx?num=36929  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

WORKFORCE: Shortage of hospital pharmacists lessening but could use more pharmacy techs with experience

The perceived shortage of pharmacists is in decline, while the perceived shortage of pharmacy technicians, especially those with years of experience, is increasing.”

Results of a nationwide survey of hospital pharmacy directors about workforce and staffing are reported in this article.  The good news is that there is a robust supply of entry-level hospital pharmacists.  Reportedly still in shortage are managers and experienced pharmacy technicians.

Source: Schneider, P.J., and others. (2019, August). ASHP national survey of pharmacy practice in hospital settings: Workforce-2018. American Journal of Health-System Pharmacy, 76(15), 1127-1141.  Click here for abstract: https://academic.oup.com/ajhp/article-abstract/76/15/1127/5532641?redirectedFrom=fulltext  Posted by AHA Resource Center (312) 422-2050 rc@aha.org