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SURGICAL SUITES: Guidelines on best practices to prevent surgical site infections

The number of unresolved issues in this guideline reveals substantial gaps that warrant future research.” (page E6)

Best practices in avoiding surgical site infections were studied by the Centers for Disease Control and Prevention with the assistance of the Healthcare Infection Control Practices Advisory Committee.  This guideline is based on the full text review of nearly 900 journal articles and studies.  The guideline is organized according to specific surgical practices – for example the efficacy of wearing a space suit during orthopedic surgery – and assigns each practice a rating on a continuum as to whether the practice is highly recommended, unresolved, or somewhere in between.  The rating on the space suits, for instance, is that it is unresolved.

Source: Berrios-Torres, S.I., and others. (2017, May 3). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection 2017. JAMA Surgery. Click here: http://jamanetwork.com/journals/jamasurgery/fullarticle/2623725  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MEDICAL SCHOOLS: Changing role of the dean

The medical school dean is evolving from the medieval guild master to a system executive.  In this contemporary version of the dean’s role, the dean is a major player in setting organizational direction for the medical school within the mission and vision of a larger system of care.”

This is a great article for anyone researching the historical role of the medical school dean and how this role may evolve in the near future.  It is informative in its content as well as providing extensive footnotes for further study.  The roles described include:

  • Medical guild master
  • Dean-CEOs, dean-presidents
  • System dean

A key feature of the next iteration, which the authors feel will be the system dean, the dean will be less the “quasi-autonomous CEO” and more a member of “a broader leadership team.”

Source: Schieffler, D.A., and others. (2017). The evolution of the medical school deanship: From patriarch to CEO to system dean. The Permanente Journal, 21(16-069). Click here: http://www.thepermanentejournal.org/files/2017/16-069.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY: Factors involved in multiple ED visits

Patterns of multiple ED visits are likely driven by patients’ health conditions and care needs rather than by PCP-related factors.  Multiple ED visits also appear to be complementary, rather than substitutionary, to physician office visits.  This implies that multiple ED visits are not indicative of discretionary use.  The finding also suggests PCP-focused interventions aimed at reducing ED use are unlikely to have a significant impact.”

This study tackled the question: To what extent could expanded primary care options, such as changing physician office hours, substitute for emergency department care?  The data included records on over 20,000 adult patients of the Geisinger Health Plan (a Danville, PA, HMO) who visited the emergency department more than once a year during the study period 2015 to 2016.  These more frequent emergency department users tended to be younger adults (under 40 years old), Medicaid recipients, and patients with multiple clinical issues.  The more frequent users were also found to be patients with a higher number of primary care visits and inpatient hospital admissions.

Source: Maeng, D.D., Hao, J., and Bulger, J.B. (2017). Patterns of multiple emergency department visits: Do primary care physicians matter? The Permanente Journal, 21, 16-063.  Click here: http://www.thepermanentejournal.org/files/2017/16-063.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

AMBULATORY SURGERY: 48 million procedures U.S. total

Effect of the Great Recession on utilization

Another reason that ambulatory surgery visit estimates could have decreased and ambulatory surgery procedures remained steady, could be the deep economic recession that began in 2007.  By 2010, when NHAMCS began gathering ambulatory surgery data in both hospitals and [ambulatory surgery centers], the economy had not fully recovered. (p. 5)

The U.S. National Center for Health Statistics provides nationally representative estimates of the utilization of hospital-based ambulatory surgery and non-hospital-affiliated ambulatory surgery centers.  These statistics are based on a sample survey that is taken occasionally, not every year.  Statistics have been published recently for 2010.

Why has ambulatory surgery increased over the years?

  • Improvements in anesthesia/analgesia
  • Development of minimally invasive techniques
  • Medicare reimbursement changes

How many ambulatory surgery procedures in 2010?

  • 25.7 million (53 percent) in hospitals
  • 22.5 million (47 percent) in independent ambulatory surgery centers
  • 48.3 million (100 percent) total ambulatory surgery procedures

Who pays?

  • The primary payer is private insurance (51 percent of visits)
  • Next is Medicare (31 percent)

How long are ambulatory surgery visits [duration]?

  • 57 minutes (average operating room time)
  • 33 minutes (surgical time)
  • 70 minutes (postop time)
  • There are more granular data showing the difference between hospitals and independent ASCs for this measure

Source: Hall, M.J., and others. (2017, February 28). Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. National Health Statistics Reports, 102.  Click here for free full text: https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

PHYSICIAN VISITS: Same day appointments with specialists

It is more common for health care providers to offer same-day visits to primary care physicians, but at least one health system is also offering same-day visits to specialists on a large-scale basis.  Allegheny Health Network (Pittsburgh, PA), an 8-hospital system with 250 outpatient clinics, started to offer this option in January 2017.  In the first few months, there have been 36,000 patients who scheduled a same-day appointment, with about one-third seeing specialists.  Patient satisfaction with this option is reported as being very high.

Sources:

Castellucci, M. (2017, April 3). Offering same-day doc visits. Modern Healthcare, 47(14), 32.  Click here for link to publisher: http://www.modernhealthcare.com/article/20170401/MAGAZINE/304019981

The Advisory Board. (2017, February 28). The 5 lessons Allegheny Health Network learned from offering same-day specialist appointments. The Daily Briefing. Click here: https://www.advisory.com/daily-briefing/2017/02/28/allegheny-specialist-same-day

Venteicher, W. (2017, January 19). Allegheny Health Network to schedule same-day doctors’ appointments. Trib Live.  Click here: http://triblive.com/news/healthnow/11804612-74/appointments-health-patients

Allegheny Health Network website has some FAQs about this service here: https://www.ahn.org/same-day

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

HOSPITALS: How many DSH hospitals are there?

Hospitals that serve a higher proportion of low-income patients are eligible to receive disproportionate share payments from state Medicaid programs.

DSH hospital: A hospital that receives disproportionate share hospital (DSH) payments and meets the minimum statutory requirements to be eligible for DSH payments: a Medicaid inpatient utilization rate of at least 1 percent and at least two obstetricians with staff privileges that treat Medicaid enrollees (with certain exceptions” (page 57)

In this report from the Medicaid and CHIP Payment and Access Commission (MACPAC), there is a table that quantifies the number of disproportionate share hospitals (DSH) in the United States as of 2012.

DSH Hospitals: Counts by Type of Hospital

  • 1,865 (55 percent) of Short-term acute care hospitals
  •    565 (42 percent) of Critical access hospitals
  •    129 (26 percent) of Psychiatric hospitals
  •      47 (58 percent) of Children’s hospitals
  •      32 (  7 percent) of Long-term hospitals
  •      32 (13 percent) of Rehabilitation hospitals

Counts by Location

  • 1,681 (40 percent) of urban hospitals
  •    989 (54 percent) of rural hospitals

Counts by Teaching Status

  • 1,921 (39 percent) of non-teaching hospitals
  •    392 (59 percent) of “low-teaching” hospitals
  •    357 (79 percent) of “high-teaching” hospitals

Source: Medicaid and CHIP Payment and Access Commission. (2017, March). Report to Congress on Medicaid and CHIP (pp. 57, 59). Washington, D.C.: MACPAC.  Click here for access: https://www.macpac.gov/wp-content/uploads/2017/03/March-2017-Report-to-Congress-on-Medicaid-and-CHIP.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

GOVERNANCE: How many members on governing board?

The average size of a health care governing board is 13 to 16 members, according to a 2015 survey conducted by The Governance Institute.  This article, written by a governance consultant, describes the traditional model for a hospital board – the community board model.  Reasons why health systems are exploring other models are discussed.  These other models include:

  • Mirror boards
  • Community board at the parent company level only
  • Board of experts
  • Committees only at the system board level
  • CEOs of subsidiary hospitals report directly to system CEO

Source: Stout, L.R. (2017, March-April). Breaking free from traditional models. Healthcare Executive, 32(2), 72-75.  Click here for publisher’s website: http://ache.org/HEOnline/digital/heonline_index.cfm  Posted by AHA Resource Center (312) 422-2050 rc@aha.org