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Top 10 Patient Safety Concerns for Healthcare Organizations for 2016

The ECRI Institute has released its annual ranking of the top patient safety concerns for healthcare organizations. Based on a review of its patient safety organization [PSO] database of reported safety events, its PSO members’ root cause analyses and research requests, and a vote by an expert panel, these are currently the top issues:

  1. Health IT configurations and organizational workflow that do not support each other
  2. Patient identification errors
  3. Inadequate management of behavioral health issues in non-behavioral-health settings
  4. Inadequate cleaning and disinfection of flexible endoscopes
  5. Inadequate test-result reporting and follow-up
  6. Inadequate monitoring for respiratory depression in patients prescribed opioids
  7. Medication errors related to pounds and kilograms
  8. Unintentionally retained objects despite correct count
  9. Inadequate antimicrobial stewardship
  10. Failure to embrace a culture of safety

Source: Top 10 patient safety concerns for healthcare organizations 2016: executive brief. ECRI Institute, April 2016. www.ecri.org/patientsafetytop10 [free registration required]

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

Top 10 Issues Facing Community Hospital CEOs

Last month the American College of Healthcare Executives released the results of its annual CEO survey on the top concerns confronting community hospitals. The most pressing concerns of the CEOs in 2015 were:

  1. Financial challenges
  2. Patient safety and quality
  3. Governmental mandates
  4. Personnel shortages
  5. Patient satisfaction
  6. Physician-hospital relations
  7. Access to care
  8. Population health management
  9. Technology
  10. Reorganization [mergers, acquisitions, restructuring, partnerships]

Financial challenges has remained the top concern when compared to 2013 and 2014 surveys. Transition from volume to value, Medicaid reimbursement, bad debt, and increasing costs were among the financial challenges most often mentioned. Engaging physicians in improving the culture of safety/quality and in reducing clinically unnecessary tests and procedures were top concerns related to patient safety and quality.

Access to care and reorganization were new to the top 10 list in 2015, and personnel shortages rose to 4th place on the list, up from the 10th spot in 2014.

Source: Top issues confronting hospitals in 2015. American College of Healthcare Executives, Feb. 2, 1016. http://ache.org/pubs/research/ceoissues.cfm [press release: http://ache.org/pubs/Releases/2016/top-issues-confronting-hospitals-2015.cfm]

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

Patient and Family Engagement Resource Compendium

A new resource compendium links users to key resources on patient and family engagement. The resources, each briefly described, are grouped into these categories:

  • Leadership
  • Organizational assessments
  • Patient and family advisory council/committee: resources for hospitals
  • Partnering to improve the quality of care
  • Engaging patients and families during the hospital stay
  • Health literacy: resources for providers
  • Health literacy: resources to help patients communicate with providers and manage medications
  • Health literacy: resources to help patients prevent adverse events in the hospital
  • Shared decision making
  • Engaging to reduce disparities

The compendium also explains how the resources can help in getting started with a new program or initiative, and it ends with a general bibliography of additional article references.

Patient and family engagement resource compendium. Health Research & Education Trust, Dec. 2015. http://www.hret-hen.org/topics/pfe/20160104-PFEcompendium.pdf

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

Unplanned Revisits Following Ambulatory Surgery

The outpatient counterpart for hospital inpatient readmissions is revisits. Even though two-thirds of surgeries  are done on an outpatient revisit, less quality of care data has been available for unplanned revisits following outpatient surgery than for unplanned readmissions after an inpatient operation. Here are some initial benchmarks from one research team that looked at ambulatory surgeries performed in hospital-owned settings that had low surgical risk:

  • All-cause revisits within 30 days of ambulatory surgery: 95 per 1000 operations
  • Most revisits were to emergency departments: 59 per 1000 operations
  • Revisits to inpatient surgery setting: 27 per 1000 operations
  • Two-thirds of the revisits [65 per 1000 operations] were for complications related to the procedure, while the remaining revisits were attributed to unrelated conditions.

The authors indicate more research is needed to determine which of the ambulatory surgery complication revisits may be preventable.

Sources:

Steiner CA and others. Return to acute care following ambulatory surgery. JAMA 314(13):1397-1399, Oct. 6, 2015. http://jama.jamanetwork.com/article.aspx?articleid=2449176

AHRQ study: ambulatory ‘revisits’ occur frequently, often due to complications. AHRQ Electronic Newsletter, no. 497, Dec. 8, 2015, p. 3. http://content.govdelivery.com/accounts/USAHRQ/bulletins/129ba69

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

All-Cause Readmissions by Payer and Age, 2009-2013

A new report from the Agency for Healthcare Research and Quality examines all-cause readmission rates and costs for 2009-13. Here are some of the findings:

  • The overall readmission rate for all payers combined stayed about the same 14.0 per 100 readmission for all five years.
  • However, readmission rates for Medicare patients aged 65 and over [which have the highest readmission rates] declined 6.1%, from 17.3 per 100 admissions in 2009 to 16.2 in 2013.
  • For the uninsured, the readmission rate increased by 8.9% over five years, up to 11.1% per 100 admissions in 2013.
  • The average cost of a readmission was more than the average cost of an index admission for every payer category. For all payers combined, the readmission cost was about $3000 higher than the admission.

Additional data is provided for all-cause readmission rates, readmission numbers, and readmission costs by payer, patient age, and maternal status.

Source: Barrett ML and others. All-cause readmissions by payer and age, 2009-2013. HCUP Statistical Brief [Agency for Healthcare Research and Quality], no. 199, Dec. 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb199-Readmissions-Payer-Age.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.

Sources:

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

Related:

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.

Sources:

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