Larry Beresford

67

Number in minutes of publicly reported “door-to-balloon” times for heart attack patients who underwent primary percutaneous coronary interventions in U.S. hospitals in 2009, according to a new study in the New England Journal of Medicine.¹ Average time in 2005 was 83 minutes. Current guidelines recommend door-to-balloon of 90 minutes or less.

The 30-day mortality rates for studied patients, however, were unchanged over the same time period, suggesting that additional strategies are needed to reduce in-hospital mortality in this population.

Reference

1. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369:901-909.

67

Number in minutes of publicly reported “door-to-balloon” times for heart attack patients who underwent primary percutaneous coronary interventions in U.S. hospitals in 2009, according to a new study in the New England Journal of Medicine.¹ Average time in 2005 was 83 minutes. Current guidelines recommend door-to-balloon of 90 minutes or less.

The 30-day mortality rates for studied patients, however, were unchanged over the same time period, suggesting that additional strategies are needed to reduce in-hospital mortality in this population.

Reference

1. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369:901-909.

67

Number in minutes of publicly reported “door-to-balloon” times for heart attack patients who underwent primary percutaneous coronary interventions in U.S. hospitals in 2009, according to a new study in the New England Journal of Medicine.¹ Average time in 2005 was 83 minutes. Current guidelines recommend door-to-balloon of 90 minutes or less.

The 30-day mortality rates for studied patients, however, were unchanged over the same time period, suggesting that additional strategies are needed to reduce in-hospital mortality in this population.

Reference

1. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369:901-909.

Two Research, Hospital Innovations, and Clinical Vignettes (RIV) scientific posters presented at HM13 shed new light on the opportunities and challenges of hospitalist-run post-discharge clinics, which a growing number of hospitals have adopted in an attempt to smooth care transitions and prevent rehospitalizations.

The Denver VA Medical Center (VAMC) started its post-discharge clinic, located on a floor above its medicine wards, in 2003. Open two afternoons, the clinic sees up to 16 patients a week. Discharging housestaff are paged to meet their patients in the clinic as part of required afternoon activities, explains the poster’s lead author, Robert Burke, MD, a hospitalist at the VAMC and assistant professor of medicine at affiliated University of Colorado. Every patient is seen by a rotating, supervising hospitalist attending.

The clinic is able to see patients for their first post-discharge clinical encounter within five days on average, much sooner than either urgent care clinics (9.4 days) or primary care physicians (13.7 days).

However, data presented at HM13 found no reduction in readmissions for the VA clinic’s patients.¹ Dr. Burke suggests that this finding reflects the challenges of connecting patients to their PCPs after the clinic visit. “Also, it’s not a full, multidisciplinary clinic—just housestaff and attendings,” he says. “The patients we see in the clinic are very ill.”

A second poster from the same team presented data from a national survey of hospitalists’ attitudes regarding post-discharge clinics.² Three-quarters of 228 respondents believed that these clinics would reduce ED visits, but only 38% said that hospitalists should be seeing patients after discharge, and about 75% said doing so should require additional compensation for the physician.

“In my experience, I find it very valuable to see patients post-discharge as part of the larger continuum of care,” Dr. Burke says.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Burke RE, Prochazka AV. A VA hospitalist-run post-discharge clinic: patient outcomes and lessons learned [abstracts]. J Hosp Med. 2013;8 Suppl 1:691.
2. Ryan PP, Stickrath C, Burke RE. Post-discharge clinics: attitudes and experiences of hospitalists [abstracts]. J Hosp Med. 2013;8 Suppl 1:693.

Two Research, Hospital Innovations, and Clinical Vignettes (RIV) scientific posters presented at HM13 shed new light on the opportunities and challenges of hospitalist-run post-discharge clinics, which a growing number of hospitals have adopted in an attempt to smooth care transitions and prevent rehospitalizations.

The Denver VA Medical Center (VAMC) started its post-discharge clinic, located on a floor above its medicine wards, in 2003. Open two afternoons, the clinic sees up to 16 patients a week. Discharging housestaff are paged to meet their patients in the clinic as part of required afternoon activities, explains the poster’s lead author, Robert Burke, MD, a hospitalist at the VAMC and assistant professor of medicine at affiliated University of Colorado. Every patient is seen by a rotating, supervising hospitalist attending.

The clinic is able to see patients for their first post-discharge clinical encounter within five days on average, much sooner than either urgent care clinics (9.4 days) or primary care physicians (13.7 days).

However, data presented at HM13 found no reduction in readmissions for the VA clinic’s patients.¹ Dr. Burke suggests that this finding reflects the challenges of connecting patients to their PCPs after the clinic visit. “Also, it’s not a full, multidisciplinary clinic—just housestaff and attendings,” he says. “The patients we see in the clinic are very ill.”

A second poster from the same team presented data from a national survey of hospitalists’ attitudes regarding post-discharge clinics.² Three-quarters of 228 respondents believed that these clinics would reduce ED visits, but only 38% said that hospitalists should be seeing patients after discharge, and about 75% said doing so should require additional compensation for the physician.

“In my experience, I find it very valuable to see patients post-discharge as part of the larger continuum of care,” Dr. Burke says.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Burke RE, Prochazka AV. A VA hospitalist-run post-discharge clinic: patient outcomes and lessons learned [abstracts]. J Hosp Med. 2013;8 Suppl 1:691.
2. Ryan PP, Stickrath C, Burke RE. Post-discharge clinics: attitudes and experiences of hospitalists [abstracts]. J Hosp Med. 2013;8 Suppl 1:693.

Two Research, Hospital Innovations, and Clinical Vignettes (RIV) scientific posters presented at HM13 shed new light on the opportunities and challenges of hospitalist-run post-discharge clinics, which a growing number of hospitals have adopted in an attempt to smooth care transitions and prevent rehospitalizations.

The Denver VA Medical Center (VAMC) started its post-discharge clinic, located on a floor above its medicine wards, in 2003. Open two afternoons, the clinic sees up to 16 patients a week. Discharging housestaff are paged to meet their patients in the clinic as part of required afternoon activities, explains the poster’s lead author, Robert Burke, MD, a hospitalist at the VAMC and assistant professor of medicine at affiliated University of Colorado. Every patient is seen by a rotating, supervising hospitalist attending.

The clinic is able to see patients for their first post-discharge clinical encounter within five days on average, much sooner than either urgent care clinics (9.4 days) or primary care physicians (13.7 days).

However, data presented at HM13 found no reduction in readmissions for the VA clinic’s patients.¹ Dr. Burke suggests that this finding reflects the challenges of connecting patients to their PCPs after the clinic visit. “Also, it’s not a full, multidisciplinary clinic—just housestaff and attendings,” he says. “The patients we see in the clinic are very ill.”

A second poster from the same team presented data from a national survey of hospitalists’ attitudes regarding post-discharge clinics.² Three-quarters of 228 respondents believed that these clinics would reduce ED visits, but only 38% said that hospitalists should be seeing patients after discharge, and about 75% said doing so should require additional compensation for the physician.

“In my experience, I find it very valuable to see patients post-discharge as part of the larger continuum of care,” Dr. Burke says.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Burke RE, Prochazka AV. A VA hospitalist-run post-discharge clinic: patient outcomes and lessons learned [abstracts]. J Hosp Med. 2013;8 Suppl 1:691.
2. Ryan PP, Stickrath C, Burke RE. Post-discharge clinics: attitudes and experiences of hospitalists [abstracts]. J Hosp Med. 2013;8 Suppl 1:693.

A recent study in The Joint Commission Journal on Quality and Patient Safety describes unit-based Patient Safety Leadership WalkRounds conducted on six pilot units at the Children’s Hospital of Philadelphia (CHOP) and how they have helped clinical leaders identify and address safety concerns.¹ The WalkRound team, made up of at least one senior executive, a patient safety officer, and the manager of each unit, engages frontline staff in safety assessments and concerns.

The concept was developed by Allan Frankel, MD, director of patient safety at Partners Healthcare System in Boston, to increase awareness of safety issues by all clinicians, make safety a high priority for senior leadership, and act on the safety information collected from frontline staff.

At CHOP, the WalkRounds led to improved nurse-physician relationships, workflow, and medical safety, and uncovered previously unidentified safety concerns.

Reference

1.Taylor AM, Chuo J, Figueroa-Altmann A, DiTaranto S, Shaw KN. Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws. Jt Comm J Qual Patient Saf. 2013;39:396-403.

A recent study in The Joint Commission Journal on Quality and Patient Safety describes unit-based Patient Safety Leadership WalkRounds conducted on six pilot units at the Children’s Hospital of Philadelphia (CHOP) and how they have helped clinical leaders identify and address safety concerns.¹ The WalkRound team, made up of at least one senior executive, a patient safety officer, and the manager of each unit, engages frontline staff in safety assessments and concerns.

The concept was developed by Allan Frankel, MD, director of patient safety at Partners Healthcare System in Boston, to increase awareness of safety issues by all clinicians, make safety a high priority for senior leadership, and act on the safety information collected from frontline staff.

At CHOP, the WalkRounds led to improved nurse-physician relationships, workflow, and medical safety, and uncovered previously unidentified safety concerns.

Reference

1.Taylor AM, Chuo J, Figueroa-Altmann A, DiTaranto S, Shaw KN. Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws. Jt Comm J Qual Patient Saf. 2013;39:396-403.

A recent study in The Joint Commission Journal on Quality and Patient Safety describes unit-based Patient Safety Leadership WalkRounds conducted on six pilot units at the Children’s Hospital of Philadelphia (CHOP) and how they have helped clinical leaders identify and address safety concerns.¹ The WalkRound team, made up of at least one senior executive, a patient safety officer, and the manager of each unit, engages frontline staff in safety assessments and concerns.

The concept was developed by Allan Frankel, MD, director of patient safety at Partners Healthcare System in Boston, to increase awareness of safety issues by all clinicians, make safety a high priority for senior leadership, and act on the safety information collected from frontline staff.

At CHOP, the WalkRounds led to improved nurse-physician relationships, workflow, and medical safety, and uncovered previously unidentified safety concerns.

Reference

1.Taylor AM, Chuo J, Figueroa-Altmann A, DiTaranto S, Shaw KN. Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws. Jt Comm J Qual Patient Saf. 2013;39:396-403.

A University of California at San Francisco (UCSF) quality initiative targeting waste and overuse of healthcare resources plans to focus on four of five questionable treatments identified by the Society of Hospital Medicine for the ABIM Foundation’s Choosing Wisely campaign. The UCSF Division of Hospital Medicine’s High Value Care Committee grew out of efforts to operationalize a curriculum for teaching medical trainees about the actual costs of treatments they commonly order. UCSF hospitalist Christopher Moriates, MD, developed the curriculum when he was a resident.

The committee brings together physicians, who have historically focused on quality improvement, and finance administrators, who focus on cost reduction. Together they are pursuing performance improvement projects serving both goals, Dr. Moriates says. The committee identified six waste targets initially and has already reduced the use of ionized calcium blood tests, formerly administered to numerous patients at UCSF Medical Center whether they needed it or not, and the unnecessary use of nebulizers, by more than half.

“When the Choosing Wisely list came out, it fit with what we were doing, although I wasn’t sure that these things were problems for us,” Dr. Moriates explains.

The data, however, show that UCSF was significantly better than its peers for only one of the five treatments on the list: utilization of Foley catheters and corresponding rates of catheter-related urinary tract infections. The committee is focused on more judicious, evidence-based ordering of the other Choosing Wisely treatments: medications for stress ulcer prophylaxis, blood transfusions, continuous telemetry monitoring outside of the ICU, and certain lab tests.

Dr. Moriates recommends the Choosing Wisely list for other hospitals and hospitalists starting to tackle unnecessary medical treatments and tests. Data is essential to these efforts, he says, stressing the need to consider not just utilization rates but actual dollars spent.

“That shouldn’t be a major hurdle, given hospital information technology, but often it is,” he says, adding that waste initiatives are more successful when they are led by frontline champions, rather than just assigned by the department’s chair.

Read more about Dr. Moriates’ waste control efforts in HealthLeaders Media, and learn about another waste reduction strategy called the Teaching Value Project at www.teachingvalue.org.¹

^Reference

1. Clark C. How hospital practices are trimmed at UCSF. HealthLeaders Media. August 8, 2013. Available at: http://www.healthleadersmedia.com/content/QUA-295035/How-Hospital-Practices-are-Trimmed-at-UCSF##. Accessed September 21, 2013.

A University of California at San Francisco (UCSF) quality initiative targeting waste and overuse of healthcare resources plans to focus on four of five questionable treatments identified by the Society of Hospital Medicine for the ABIM Foundation’s Choosing Wisely campaign. The UCSF Division of Hospital Medicine’s High Value Care Committee grew out of efforts to operationalize a curriculum for teaching medical trainees about the actual costs of treatments they commonly order. UCSF hospitalist Christopher Moriates, MD, developed the curriculum when he was a resident.

The committee brings together physicians, who have historically focused on quality improvement, and finance administrators, who focus on cost reduction. Together they are pursuing performance improvement projects serving both goals, Dr. Moriates says. The committee identified six waste targets initially and has already reduced the use of ionized calcium blood tests, formerly administered to numerous patients at UCSF Medical Center whether they needed it or not, and the unnecessary use of nebulizers, by more than half.

“When the Choosing Wisely list came out, it fit with what we were doing, although I wasn’t sure that these things were problems for us,” Dr. Moriates explains.

The data, however, show that UCSF was significantly better than its peers for only one of the five treatments on the list: utilization of Foley catheters and corresponding rates of catheter-related urinary tract infections. The committee is focused on more judicious, evidence-based ordering of the other Choosing Wisely treatments: medications for stress ulcer prophylaxis, blood transfusions, continuous telemetry monitoring outside of the ICU, and certain lab tests.

Dr. Moriates recommends the Choosing Wisely list for other hospitals and hospitalists starting to tackle unnecessary medical treatments and tests. Data is essential to these efforts, he says, stressing the need to consider not just utilization rates but actual dollars spent.

“That shouldn’t be a major hurdle, given hospital information technology, but often it is,” he says, adding that waste initiatives are more successful when they are led by frontline champions, rather than just assigned by the department’s chair.

Read more about Dr. Moriates’ waste control efforts in HealthLeaders Media, and learn about another waste reduction strategy called the Teaching Value Project at www.teachingvalue.org.¹

^Reference

1. Clark C. How hospital practices are trimmed at UCSF. HealthLeaders Media. August 8, 2013. Available at: http://www.healthleadersmedia.com/content/QUA-295035/How-Hospital-Practices-are-Trimmed-at-UCSF##. Accessed September 21, 2013.

A University of California at San Francisco (UCSF) quality initiative targeting waste and overuse of healthcare resources plans to focus on four of five questionable treatments identified by the Society of Hospital Medicine for the ABIM Foundation’s Choosing Wisely campaign. The UCSF Division of Hospital Medicine’s High Value Care Committee grew out of efforts to operationalize a curriculum for teaching medical trainees about the actual costs of treatments they commonly order. UCSF hospitalist Christopher Moriates, MD, developed the curriculum when he was a resident.

The committee brings together physicians, who have historically focused on quality improvement, and finance administrators, who focus on cost reduction. Together they are pursuing performance improvement projects serving both goals, Dr. Moriates says. The committee identified six waste targets initially and has already reduced the use of ionized calcium blood tests, formerly administered to numerous patients at UCSF Medical Center whether they needed it or not, and the unnecessary use of nebulizers, by more than half.

“When the Choosing Wisely list came out, it fit with what we were doing, although I wasn’t sure that these things were problems for us,” Dr. Moriates explains.

The data, however, show that UCSF was significantly better than its peers for only one of the five treatments on the list: utilization of Foley catheters and corresponding rates of catheter-related urinary tract infections. The committee is focused on more judicious, evidence-based ordering of the other Choosing Wisely treatments: medications for stress ulcer prophylaxis, blood transfusions, continuous telemetry monitoring outside of the ICU, and certain lab tests.

Dr. Moriates recommends the Choosing Wisely list for other hospitals and hospitalists starting to tackle unnecessary medical treatments and tests. Data is essential to these efforts, he says, stressing the need to consider not just utilization rates but actual dollars spent.

“That shouldn’t be a major hurdle, given hospital information technology, but often it is,” he says, adding that waste initiatives are more successful when they are led by frontline champions, rather than just assigned by the department’s chair.

Read more about Dr. Moriates’ waste control efforts in HealthLeaders Media, and learn about another waste reduction strategy called the Teaching Value Project at www.teachingvalue.org.¹

^Reference

1. Clark C. How hospital practices are trimmed at UCSF. HealthLeaders Media. August 8, 2013. Available at: http://www.healthleadersmedia.com/content/QUA-295035/How-Hospital-Practices-are-Trimmed-at-UCSF##. Accessed September 21, 2013.

A new study in Pediatrics finds limited use for hospital readmission rates as a meaningful quality measure when it comes to pediatric patient care.

By examining 30- and 60-day readmission rates for 958 hospitals that admit children for seven common inpatient conditions, researchers found very few that could be considered either high or low performers. In addition, pediatric 30-day readmission rates overall were low, at less than 10% for all conditions.

Naomi Bardach, MD, MAS, department of pediatrics at the University of California at San Francisco and the report's lead author, emphasizes that her study was a statistical analysis of readmission rates without assessing whether they should be a focus for quality improvement. "They might be useful for larger efforts, such as multi-institution collaboratives to improve care for a given condition," Dr. Bardach says. "But it is clear that readmission rates are not useful for comparing individual hospital performance."

An accompanying editorial noted that delaying hospital discharges even by four hours in an attempt to forestall readmissions could prove more costly in the end.

Although much of the national focus on 30-day hospital readmissions has been on the Medicare-age population, the pediatric realm is getting more attention, Dr. Bardach says. For example, the Children's Health Insurance Program Reauthorization Act of 2009 funded seven research cooperatives to develop core measures for assessing the state of children’s healthcare quality. TH

Visit our website for more information about pediatric readmissions rates.

 

 

A new study in Pediatrics finds limited use for hospital readmission rates as a meaningful quality measure when it comes to pediatric patient care.

By examining 30- and 60-day readmission rates for 958 hospitals that admit children for seven common inpatient conditions, researchers found very few that could be considered either high or low performers. In addition, pediatric 30-day readmission rates overall were low, at less than 10% for all conditions.

Naomi Bardach, MD, MAS, department of pediatrics at the University of California at San Francisco and the report's lead author, emphasizes that her study was a statistical analysis of readmission rates without assessing whether they should be a focus for quality improvement. "They might be useful for larger efforts, such as multi-institution collaboratives to improve care for a given condition," Dr. Bardach says. "But it is clear that readmission rates are not useful for comparing individual hospital performance."

An accompanying editorial noted that delaying hospital discharges even by four hours in an attempt to forestall readmissions could prove more costly in the end.

Although much of the national focus on 30-day hospital readmissions has been on the Medicare-age population, the pediatric realm is getting more attention, Dr. Bardach says. For example, the Children's Health Insurance Program Reauthorization Act of 2009 funded seven research cooperatives to develop core measures for assessing the state of children’s healthcare quality. TH

Visit our website for more information about pediatric readmissions rates.

 

 

A new study in Pediatrics finds limited use for hospital readmission rates as a meaningful quality measure when it comes to pediatric patient care.

By examining 30- and 60-day readmission rates for 958 hospitals that admit children for seven common inpatient conditions, researchers found very few that could be considered either high or low performers. In addition, pediatric 30-day readmission rates overall were low, at less than 10% for all conditions.

Naomi Bardach, MD, MAS, department of pediatrics at the University of California at San Francisco and the report's lead author, emphasizes that her study was a statistical analysis of readmission rates without assessing whether they should be a focus for quality improvement. "They might be useful for larger efforts, such as multi-institution collaboratives to improve care for a given condition," Dr. Bardach says. "But it is clear that readmission rates are not useful for comparing individual hospital performance."

An accompanying editorial noted that delaying hospital discharges even by four hours in an attempt to forestall readmissions could prove more costly in the end.

Although much of the national focus on 30-day hospital readmissions has been on the Medicare-age population, the pediatric realm is getting more attention, Dr. Bardach says. For example, the Children's Health Insurance Program Reauthorization Act of 2009 funded seven research cooperatives to develop core measures for assessing the state of children’s healthcare quality. TH

Visit our website for more information about pediatric readmissions rates.

 

 

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.¹

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website. TH

Larry Beresford is a freelance writer in San Francisco.

 

Reference

1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.

 

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.¹

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website. TH

Larry Beresford is a freelance writer in San Francisco.

 

Reference

1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.

 

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.¹

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website. TH

Larry Beresford is a freelance writer in San Francisco.

 

Reference

1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.

 

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website at www.hospitalmedicine.org/marquis.

 

---

Larry Beresford is a freelance writer in San Francisco.

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website at www.hospitalmedicine.org/marquis.

 

---

Larry Beresford is a freelance writer in San Francisco.

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website at www.hospitalmedicine.org/marquis.

 

---

Larry Beresford is a freelance writer in San Francisco.

The proportion of U.S. hospitals projected to offer palliative-care programs by 2014, according to the most recent survey of the industry by the Center to Advance Palliative Care.⁷ The report estimates a 67% increase in palliative-care services at hospitals of 50 or more beds. The highest concentration for hospital-based palliative care is in the Northeast regions, with the lowest percentage in the South region.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

The proportion of U.S. hospitals projected to offer palliative-care programs by 2014, according to the most recent survey of the industry by the Center to Advance Palliative Care.⁷ The report estimates a 67% increase in palliative-care services at hospitals of 50 or more beds. The highest concentration for hospital-based palliative care is in the Northeast regions, with the lowest percentage in the South region.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

The proportion of U.S. hospitals projected to offer palliative-care programs by 2014, according to the most recent survey of the industry by the Center to Advance Palliative Care.⁷ The report estimates a 67% increase in palliative-care services at hospitals of 50 or more beds. The highest concentration for hospital-based palliative care is in the Northeast regions, with the lowest percentage in the South region.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

Antibiotic resistance to hospital-acquired infections (HAIs) is rising at faster rates than predicted in 2008 by the Centers for Disease Control and Prevention (CDC), according to an analysis of privately gathered data reported in a recent commentary in Antimicrobial Agents and Chemotherapy, concluding that resistance is “at crisis levels.”³

Antibiotic-resistant microbes infect more than 2 million Americans each year and kill more than 100,000.

“We must act to find new weapons in the global battle against deadly superbugs,” particularly three common HAIs: acinetobacter, E. coli, and klebsiella, said co-author Brad Spellberg, MD, infectious-disease specialist at Harbor-UCLA Medical Center in Los Angeles.

A recent fact sheet from the Alliance for Aging Research notes that older patients, who represent 45% of HAIs annually, carry a higher burden of illness and less favorable outcomes than younger patients.⁴

Meanwhile, a study of the ICUs at 43 Hospital Corporation of America hospitals, published in the New England Journal of Medicine, provides support for treating all ICU patients with universal precautions for methicillin-resistant Staphylococcus aureus (MRSA).⁵ Washing all ICU patients with antibiotic soap and administering nasal antibiotics reduced all types of bloodstream infections by 44% and proved more effective than the common practice of screening patients for MRSA first, then treating those testing positive.

Another recent resource for HAIs is the “Eliminating Catheter-Associated Urinary Tract Infections” guide from the American Hospital Association’s Hospitals in Pursuit of Excellence unit.⁶ The booklet recommends an evidence-based, three-step action plan derived from AHA’s On the CUSP: Stop CAUTI project, and is available free on the AHA website. It has an accompanying webinar, which outlines the business case for eliminating catheter-associated urinary tract infections (CAUTIs) and the importance of hospital culture in achieving sustainability.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

Antibiotic resistance to hospital-acquired infections (HAIs) is rising at faster rates than predicted in 2008 by the Centers for Disease Control and Prevention (CDC), according to an analysis of privately gathered data reported in a recent commentary in Antimicrobial Agents and Chemotherapy, concluding that resistance is “at crisis levels.”³

Antibiotic-resistant microbes infect more than 2 million Americans each year and kill more than 100,000.

“We must act to find new weapons in the global battle against deadly superbugs,” particularly three common HAIs: acinetobacter, E. coli, and klebsiella, said co-author Brad Spellberg, MD, infectious-disease specialist at Harbor-UCLA Medical Center in Los Angeles.

A recent fact sheet from the Alliance for Aging Research notes that older patients, who represent 45% of HAIs annually, carry a higher burden of illness and less favorable outcomes than younger patients.⁴

Meanwhile, a study of the ICUs at 43 Hospital Corporation of America hospitals, published in the New England Journal of Medicine, provides support for treating all ICU patients with universal precautions for methicillin-resistant Staphylococcus aureus (MRSA).⁵ Washing all ICU patients with antibiotic soap and administering nasal antibiotics reduced all types of bloodstream infections by 44% and proved more effective than the common practice of screening patients for MRSA first, then treating those testing positive.

Another recent resource for HAIs is the “Eliminating Catheter-Associated Urinary Tract Infections” guide from the American Hospital Association’s Hospitals in Pursuit of Excellence unit.⁶ The booklet recommends an evidence-based, three-step action plan derived from AHA’s On the CUSP: Stop CAUTI project, and is available free on the AHA website. It has an accompanying webinar, which outlines the business case for eliminating catheter-associated urinary tract infections (CAUTIs) and the importance of hospital culture in achieving sustainability.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

Antibiotic resistance to hospital-acquired infections (HAIs) is rising at faster rates than predicted in 2008 by the Centers for Disease Control and Prevention (CDC), according to an analysis of privately gathered data reported in a recent commentary in Antimicrobial Agents and Chemotherapy, concluding that resistance is “at crisis levels.”³

Antibiotic-resistant microbes infect more than 2 million Americans each year and kill more than 100,000.

“We must act to find new weapons in the global battle against deadly superbugs,” particularly three common HAIs: acinetobacter, E. coli, and klebsiella, said co-author Brad Spellberg, MD, infectious-disease specialist at Harbor-UCLA Medical Center in Los Angeles.

A recent fact sheet from the Alliance for Aging Research notes that older patients, who represent 45% of HAIs annually, carry a higher burden of illness and less favorable outcomes than younger patients.⁴

Meanwhile, a study of the ICUs at 43 Hospital Corporation of America hospitals, published in the New England Journal of Medicine, provides support for treating all ICU patients with universal precautions for methicillin-resistant Staphylococcus aureus (MRSA).⁵ Washing all ICU patients with antibiotic soap and administering nasal antibiotics reduced all types of bloodstream infections by 44% and proved more effective than the common practice of screening patients for MRSA first, then treating those testing positive.

Another recent resource for HAIs is the “Eliminating Catheter-Associated Urinary Tract Infections” guide from the American Hospital Association’s Hospitals in Pursuit of Excellence unit.⁶ The booklet recommends an evidence-based, three-step action plan derived from AHA’s On the CUSP: Stop CAUTI project, and is available free on the AHA website. It has an accompanying webinar, which outlines the business case for eliminating catheter-associated urinary tract infections (CAUTIs) and the importance of hospital culture in achieving sustainability.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

In July, four U.S. hospitals were recognized for their leadership and innovation in quality improvement (QI) and safety—as defined by the Institute of Medicine (IOM)—through the American Hospital Association’s McKesson Quest for Quality Prize.² Beth Israel Deaconess Medical Center (BIDMC) in Boston was awarded the overall prize for its sustainable approach and hospitalwide commitment to pursuing IOM’s quality aims for safe, effective, efficient, timely, patient-centered, and equitable health care.

The award, presented since 2002, is supported by healthcare-services company McKesson Corp., based in San Francisco.

Key to BIDMC’s success is the clear message of its top leadership’s commitment to quality and a strong partnership with the medical community, says Kenneth Sands, MD, MPH, BIDMC’s senior vice president for healthcare quality. “That includes an official vote by the hospital’s board to adopt IOM’s definition of quality. And everyone here participates in the quality process,” he says.

Each year, the hospital holds a quality symposium featuring QI projects solicited from across the organization. This year’s poster contest recognized three winners, one from the finance department, one from an ICU, and a third from the hospital cafeteria (it tracked the percentage of days that fresh fish is offered as a healthy menu choice).

“To see these three winners standing together on the podium sends a powerful message,” Dr. Sands says. “These are not quality-improvement experts, but front-line staff.”

Another quality initiative involves a hospitalist leader trying to promote “conversation readiness” for a hospital staff’s ability to respond to patients’ expressed desires to complete advance directives, then make sure these documents get captured in the medical record.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

In July, four U.S. hospitals were recognized for their leadership and innovation in quality improvement (QI) and safety—as defined by the Institute of Medicine (IOM)—through the American Hospital Association’s McKesson Quest for Quality Prize.² Beth Israel Deaconess Medical Center (BIDMC) in Boston was awarded the overall prize for its sustainable approach and hospitalwide commitment to pursuing IOM’s quality aims for safe, effective, efficient, timely, patient-centered, and equitable health care.

The award, presented since 2002, is supported by healthcare-services company McKesson Corp., based in San Francisco.

Key to BIDMC’s success is the clear message of its top leadership’s commitment to quality and a strong partnership with the medical community, says Kenneth Sands, MD, MPH, BIDMC’s senior vice president for healthcare quality. “That includes an official vote by the hospital’s board to adopt IOM’s definition of quality. And everyone here participates in the quality process,” he says.

Each year, the hospital holds a quality symposium featuring QI projects solicited from across the organization. This year’s poster contest recognized three winners, one from the finance department, one from an ICU, and a third from the hospital cafeteria (it tracked the percentage of days that fresh fish is offered as a healthy menu choice).

“To see these three winners standing together on the podium sends a powerful message,” Dr. Sands says. “These are not quality-improvement experts, but front-line staff.”

Another quality initiative involves a hospitalist leader trying to promote “conversation readiness” for a hospital staff’s ability to respond to patients’ expressed desires to complete advance directives, then make sure these documents get captured in the medical record.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.

In July, four U.S. hospitals were recognized for their leadership and innovation in quality improvement (QI) and safety—as defined by the Institute of Medicine (IOM)—through the American Hospital Association’s McKesson Quest for Quality Prize.² Beth Israel Deaconess Medical Center (BIDMC) in Boston was awarded the overall prize for its sustainable approach and hospitalwide commitment to pursuing IOM’s quality aims for safe, effective, efficient, timely, patient-centered, and equitable health care.

The award, presented since 2002, is supported by healthcare-services company McKesson Corp., based in San Francisco.

Key to BIDMC’s success is the clear message of its top leadership’s commitment to quality and a strong partnership with the medical community, says Kenneth Sands, MD, MPH, BIDMC’s senior vice president for healthcare quality. “That includes an official vote by the hospital’s board to adopt IOM’s definition of quality. And everyone here participates in the quality process,” he says.

Each year, the hospital holds a quality symposium featuring QI projects solicited from across the organization. This year’s poster contest recognized three winners, one from the finance department, one from an ICU, and a third from the hospital cafeteria (it tracked the percentage of days that fresh fish is offered as a healthy menu choice).

“To see these three winners standing together on the podium sends a powerful message,” Dr. Sands says. “These are not quality-improvement experts, but front-line staff.”

Another quality initiative involves a hospitalist leader trying to promote “conversation readiness” for a hospital staff’s ability to respond to patients’ expressed desires to complete advance directives, then make sure these documents get captured in the medical record.

---

Larry Beresford is a freelance writer in San Francisco.

References

1. Harrison J, Quinn K, Mourad M. Is anyone home? The association between being reached for a post-discharge telephone call and 30-day hospital readmission. Harrison J, Quinn K, Mourad M. Any questions? The relationship between responses to post-discharge call questions and 30-day hospital readmissions [abstracts]. Journal of Hospital Medicine, 2013, 8 Suppl 1.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine website. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed Sept. 9, 2013.
3. Shlaes DM, Sahm D, Opiela C, Spellberg B. Commentary: the FDA reboot of antibiotic development. Antimicrob Agents Chemother. 29 Jul 2013 [Epub ahead of print].
4. Alliance for Aging Research. HAIs growing problem, group says. Alliance for Aging Research website. Available at: http://www.agingresearch.org/content/article/detail/33504. Accessed Sept. 9, 2013.
5. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255-2265.
6. Hospitals in Pursuit of Excellence. Eliminating catheter-associated urinary tract infections. Hospitals in Pursuit of Excellence website. Available at: http://www.hpoe.org/Reports-HPOE/eliminating_catheter_associated_urinary_tract_infection.pdf. Accessed Sept. 9, 2013.
7. Center to Advance Palliative Care. Growth of palliative care in U.S. hospitals 2013 snapshot. Center to Advance Palliative Care website. Available at: http://www.capc.org/capc-growth-analysis-snapshot-2013.pdf. Accessed Sept. 9, 2013.