Home News Briefs High hospital occupancy, advance directives, more

High hospital occupancy, advance directives, more

July 2007

Published in the July 2007 issue of Today’s Hospitalist.

High hospital occupancy linked to adverse events

A new study has found that a large, urban teaching hospital that runs at more than 100% occupancy for much of the year had a higher rate of adverse events, compared to three hospitals with lower occupancy rates.

The study was a retrospective chart review of patients at four teaching hospitals “two urban and two suburban “in 2000 and 2001. In the busiest hospital, researchers concluded that a 10% increase in hospital occupancy boosted the risk of adverse events by 15%.

The most common problems were adverse drug events (20.1%) and wound infection rates (12.5%). The study, published in the May issue of Medical Care, concluded that hospitals operating at or near capacity should re-engineer care processes to respond to higher occupancy rates. Suggestions included maintaining an on-call pool of nurses.

Researchers also said that most safety interventions are designed for hospitals with "average activity levels" and that safety processes need to be tested under at-capacity conditions.

Medicare ending payment for hospital-acquired conditions?

The Centers for Medicare and Medicaid Services (CMS) has proposed ending payment for six hospital-acquired conditions that the agency says are preventable.

Those conditions include pressure ulcers, catheter-related urinary tract infections, and staph aureus septicemia, as well as three conditions that the National Quality Forum designates as "never events": air embolism, blood incompatibility and object left behind after surgery.

If adopted, the CMS rule would take effect in October 2008. While the proposal has been applauded by consumer and employer groups, the American Hospital Association (AHA) has asked that several conditions “pressure ulcers and the two types of infections “be taken off the list, saying that those conditions aren’t always preventable or can be hard to diagnose on admission. The AHA claims that hospitals would need new billing codes to be able to report that those conditions were present upon admission, and that coding systems wouldn’t be updated in time for the proposed rule to take effect.

The CMS will issue its final rule next month. The agency is also asking for comments on seven other conditions it wants to add to the no-payment list in 2009. Those include ventilator-associated pneumonia, vascular catheter-associated infections, C. diff-associated disease, methicillin-resistant Staph aureus, and surgical-site infections, as well as falls and wrong-site surgery.

Advance directive now available in more than 20 languages

The American Hospital Association is partnering with national aging and hospice groups to distribute one-half million copies of an advance directive over the next year. Copies are being sent to hospitals, hospices and community organizations.

The living will, which is known as the "Five Wishes," is available in more than 20 languages. The advance directive meets legal requirements in 40 states and is used as a model to prepare living wills in the remaining 10.

The Five Wishes directive asks patients the following questions:

“¢ Who will make decisions for you if you can’t make them yourself?
“¢ What kind of medical treatment do you want or don’t want?
“¢ How comfortable would you like to be?
“¢ How do you want people to treat you?
“¢ What do you want your loved ones to know?

The directive is available online at or by calling 888-594-7437.

Quick facts: mental health and substance abuse

● In 2004, 7.6 million out of 32 million hospital stays “almost one in four “for patients 18 and older involved mental illness or substance abuse.
● About 20% of those hospital stays were for patients 80 years old and older, primarily for dementia.
● Patients diagnosed with both a mental illness and substance abuse accounted for 1 million hospital stays.
● The most frequent admitting mental health diagnosis for women was mood disorders, while the most common diagnosis for men was substance abuse.
● 240,000 women hospitalized for childbirth or pregnancy also had mental health or substance abuse problems.
Source: Agency for Healthcare Research and Quality