November 2008
Monthly Health News
Hospital executives cite poor patient flow as a problem and tout IT as a solution
In a survey of 200 healthcare executives, 89% said their facilities are experiencing poor patient flow and require a productivity boost to manage patient demand. The reasons for the poor patient flow were:
- Poor communication (67%)
- Ineffective scheduling of activities and resources (36%)
- Lack of beds (36%)
- Lack of staff to help facilitate patient flow (34%), and
- Poor centralized knowledge about the location and status of each patient (32%).
Given the possible array of approaches to alleviate the problems, 67% of hospital executives are planning to invest in information technology (IT), specifically patient-tracking technology; 43% intend to expand their facilities; 35% plan to hire more nursing staff, and 3% expect to hire more administrative staff.
10/9/2008 Healthcare IT News
HeathcareITNewPtFlow
The Leapfrog Group forms consortium to study computer-based provider order entry best practices
The Leapfrog Group is a voluntary program that mobilizes employers to prod the healthcare industry to adopt technology and practices that support big leaps in safety, quality, and customer value. The group has long been an advocate of computer-based provider order entry (CPOE), and is now forming an Executive Consortium, which will include vendors, to develop best practices for implementing CPOE as well as a core set of decision-support rules.
10/15/2008 Health Data Management,
HealthDataMgmtLeapfrogCPOE
Smart hospitals require strong information technology infrastructure
Hospitals building for the future are focusing on integrating information technology for optimizing people, workflow, processes, and technology in a more safe, efficient, and cost-effective manner. Construction experts advise that streamlining workflow must include systems, communications, and infrastructures focused on servicing several stakeholders simultaneously, such as patients and their families, physicians and other clinicians, various hospital departments, employees, and the community.
In addition to benefiting from clinical systems, patients in newer, “smart” hospitals have flatscreen panels at their bedsides that enable them to
- see their itinerary of tests and procedures
- announce and record staff visits
- view, evaluate, and document retention of patient education materials
Thorough planning and requirements identification is important because it is more difficult, complicated, and expensive to integrate systems after construction is complete.
10/8/2008 Medical Construction & Design
http://www.mcdmag.com/SeptOct2008/FdMCD0908_28-30-Digital%20Hospital.pdf
RAND Corporation report asserts that creating unique patient identification number for every U.S. citizen would reduce errors and augment efficiency
According to a report by the RAND Corporation, creating a unique patient identification number for every person in the United States would facilitate a reduction in medical errors, simplify the use of electronic medical records, increase overall efficiency, and help protect patient privacy. Even though such an identification system could cost as much as $11 billion, the effort is expected to return even more in benefits from electronic medical records, such as lessening the occurrence of expensive errors and increasing efficiency.
10/20/2008 RAND Corporation
States lead the way on healthcare information technology adoption
Speaking at the American Health Information Management Association Annual Conference, Lori Evans, deputy director of the New York Department of Health, reported that 70% of states are adopting various health information technology (HIT) initiatives to fill a void of inaction by the federal government. For example, New York is funding up to $200 million to help providers adopt HIT and build interoperable health information exchanges, which would communicate with the Centers for Disease Control and Prevention (CDC) and other stakeholders.
Other notable examples are Minnesota, which has mandated interoperable electronic health records by 2015; California, which has an executive order requiring e-prescribing by 2010, and Rhode Island, which recently enacted a law to establish and fund a statewide health information exchange. Despite advances made by various states, thousands of silos of health information remain across the nation and there is no consensus on how to communicate among them.
10/15/2008 Health Data Management
HeatlhDataManagementStateHIE
Miscounts of surgical instruments and sponges occur in 13% of surgeries – new barcoding and RFID can help
A study in the Annals of Surgery in which researchers observed 148 surgeries found that one in eight surgeries involved an intraoperative discrepancy in the count of surgical sponges and instruments, which creates a risk for incidents of retained sponges and instruments (RSI). The Centers for Medicare & Medicaid Services (CMS) considers RSI a “never event,” for which they will deny reimbursement (see next article).
The researchers found that a total of 29 discrepancies involving sponges (45%), instruments (34%), or needles (21%) were observed in 19 (about 13%) of the 148 surgeries. Most discrepancies indicated a misplaced item (59%) as opposed to a miscount (3%) or error in documentation (38%). Each discrepancy took an average of 13 minutes to resolve. Counting activities after personnel changes were significantly more likely to involve a discrepancy than those for which the original team was present.
Bar-coded surgical sponges have been implemented in hospitals at a cost of $9 per surgical case for the sponges and the bar-coding device. Sponges also can be equipped with radio-frequency identification tags that count sponges when they are placed in the appropriate receptacle, and sponges can be located in patients or elsewhere in the operating room using special wands.
8/2008 Annals of Surgery. 248(2):337-341
AnnalsofSurgerySurgeryMiscounts (subscription required)
Government decision to curtail reimbursement for “never events” may cause a spike in medical malpractice claims
On October 1, 2008 the Centers for Medicare & Medicaid Services (CMS) instituted a policy to cease reimbursement for 10 hospital-acquired conditions, called “never events,” because they are preventable and should never occur (for instance, hospital-acquired infections, injuries, objects left in surgery, pressure ulcers, and so forth). These 10 conditions already account for one out of six malpractice claims.
Risk management experts predict that the increased awareness of non-reimbursable conditions may cause an increase in the frequency of related hospital professional liability claims as well as other hospital-acquired conditions not currently addressed by CMS regulations. On the bright side, as healthcare facilities identify and shore up internal practices and processes designed to deter the incidence of the never events, it is likely that such care-related diligence will spill over into prevention of occurrence of other harm-related conditions, resulting in a reduction in medical malpractice claims.
9/29/2008 National Underwriter Property & Casualty Risk & Benefits
NationalUnderwritersCMSNeverLiability
“E-logbook” needed to monitor meth chemical purchases
President Bush signed into law the Methamphetamine Production Prevention Act of 2008. This law requires retail sellers of listed chemicals to use an electronic logbook or a bound paper book to obtain required information for sales of listed chemicals. In addition, sellers and purchasers of these chemicals must verify the accuracy of information recorded in these books. Certain chemicals that are required to produce methamphetamine are readily available in household products or over-the-counter cold and allergy medicines. Current law restricts the amount of these products that can be purchased at one time by a single person.
The new law arose out of a concern that some meth producers are able to skirt restrictions by purchasing meth precursor ingredient products by visiting multiple pharmacies and buying small quantities at each pharmacy. The new electronic logbook allows law enforcement officials to track those individuals who frequent multiple pharmacies making small purchases.
10/06/2008 Modern Healthcare
ModernHealthcareElogbook
Economy-related stress affects Americans’ health
According to data released by the American Psychological Association’s 2008 Stress in America survey, the declining state of the nation’s economy is taking a physical and emotional toll on people nationwide. The population group that seems to be most impacted are women. Women of the Boomer generation (aged 44 to 62) and Matures (aged 63+) were most likely to report the economy as a significant stressor. Female Boomers report increases in stress associated with their job stability and health problems affecting their families. Reported stress-related symptoms are fatigue, irritability or anger, lying awake at night with worry, decreased motivation, depression, and tension headaches.
Almost half of Americans (47%) reported overeating or eating unhealthy foods to manage stress. Women were more likely than men to report unhealthy behaviors to manage stress, such as eating poorly (56 versus 40%), shopping (25 versus 11%), and napping (43 versus 32%). Almost one-fifth of Americans (18%) reported drinking alcohol to manage their stress, and 16% reported smoking. According to the director of the New Haven-based Yale Stress Center at Yale University School of Medicine, chronic stress can weaken the immune system, raise blood pressure, disturb sleep, and lead to unhealthy habits.
10/07/2008 American Psychological Association
http://www.apa.org/releases/women-stress1008.html
Researchers identify new antibiotic target and new antibiotic mechanism that may lead to new broad-spectrum antibacterial agents
Researchers from Rutgers University and the Helmholtz Center for Infection Research in Braunschweig, Germany have identified a new antibiotic target and a new antibiotic mechanism that may set the stage for the development of broad-spectrum antibacterial agents effective against bacterial pathogens resistant to current antibiotics. The results could spearhead new treatments for tuberculosis (TB) that involve shorter courses of therapy and are effective against drug-resistant TB.
The researchers showed how three antibiotics—myxopyronin, corallopyronin, and ripostatin—block the action of bacterial RNA polymerase (RNAP). RNAP is the enzyme that transcribes genetic information from DNA into RNA, which in turn directs the assembly of proteins, the building blocks of all biological systems. Blocking bacterial RNAP kills bacterial cells. The goal is to shrink the antibiotic treatment time from the current six months down to two weeks. The research findings are reported in the journal Cell, published October 17.
10/16/2008 Rutgers
http://news.rutgers.edu/medrel/news-releases/2008/10/rutgers-researchers-20081008
and the journal Cell
CellAntibotics
New experimental surgery provides less invasive option for weight loss procedure
A new surgery that has been used for two to three years in Europe and Mexico provides an alternative to current bariatic surgeries. Transoral gastroplasty (TOGA) involves stapling a patient’s stomach from the inside out. To perform the procedure a stapler attached to a tube is pushed through the mouth and down the patient’s esophagus. The procedure reduces the size of the stomach, making the patient feel full after eating smaller meals.
Patients who have had the procedure in other countries have lost approximately 40% of their excess fat in one year. A small number of US hospitals are now performing the procedure as part of the clinical trials required for approval from the Food and Drug Administration (FDA). The advantages of the procedure is that is far less risky than traditional invasive surgery. Reported complications are risks for hernia and leaks in the digestive tract from the stapling.
10/21/2008 New York Times
NewYorkTimesStomachStapling
Off course: As the use of golf carts for transportation grows, golf cart-related injuries rise
Although the majority of golf carts are used on golf courses, a growing number are being used for residential use. Because of their small size, low maintenance, and ease of use more people are zipping around in golf carts and their risk of injury is accelerating. Researchers found that 48,225 people, or roughly 1,000 people a month, sustained injuries from golf carts between 2002 and 2005. The two age groups with the highest number of golf cart accidents were people aged 10 -19 and those over 80.
Males had higher accident rates than females. The most common injuries were leg abrasions, bone fractures, and head injuries. In a related study, the most common injury was related to falling out of the cart. The researchers recommend safety instruction for children and teens as well as the use of seat belts on carts.
6/2008 Journal of Trauma-Injury Infection & Critical Care. 64(6):1562-1566
JournalofTraumaInjury Infection,andCritical CareGolfCart, June 2008 [subscription required]).
Good alternatives to sweets for breakfast are apples, bananas, or oatmeal with raisins or bananas to provide a sweet taste
Most children’s cereals are consumed by adults and many are over 50% sugar
Did you know that there is as much sugar in a serving of 11 popular cereals as there is in a glazed doughnut? Of the top 27 cereals, 23 marketed to children are rated as Good or Fair for nutrition. An estimated 58% of "children’s" cereals are consumed by those over 18 years old. Two cereals—Kellogg's Honey Smacks and Post Golden Crisp—are more than 50% sugar (by weight) and nine are at least 40% sugar.
There were four cereals that were rated very good. Cheerios, Kix, Honey Nut Cheerios, and Life have relatively lower sugar and higher dietary fiber. Cheerios ranked the highest for a healthy cereal because it has only 1 gram of sugar and a healthful 3 grams of fiber per serving. Although Kellogg's Rice Krispies has only 4 grams of sugar per serving, it received a Fair rating, because it is higher in sodium and has zero dietary fiber. Kellogg's Frosted Mini-Wheats Bite Size earned a healthful cereal score of Good; it has 12 grams of sugar per serving but is also very low in sodium and has a hefty 6 grams of fiber.
11/2008 Consumer Reports Health.org
ConsumerReportsCereals (nutritional ratings are available to subscribers)
Wishing you the best of health,
Kathleen Kimmel, RN
