Published in the June 2010 issue of Today’s Hospitalist
A NEW STUDY FOUND that less than 40% of heart failure patients seeking outpatient follow-up receive that follow-up within a week, a factor that affects their readmission rates.
The study, published in the May 5 Journal of the American Medical Association, looked at more than 30,000 Medicare patients hospitalized for heart failure between January 2003 and December 2006. Patients stayed a median of four days, and more than 21% of them were readmitted within 30 days.
Researchers found that patients who received earlier follow-up after discharge ran the least risk of being readmitted within 30 days. Because early outpatient follow-up is critical to prevent patients from bouncing back, authors recommended that hospitals improve transitional care by helping patients arrange early follow-up and providing safety-net services for patients who lack or have less than optimal outpatient care.
How strong is your inpatient team?
SURVEY RESULTS SHOW that inpatient physicians, nurses and medical subspecialists in medical units often have diverging views not only on how well they function in team settings, but what they expect from teams.
The results, published in the April 2010 issue of Quality and Safety in Health Care, found that doctors were much more likely to rate the quality of teamwork as high or very high, but that only a minority of nurses gave similar ratings.
Inpatient physicians participating in the survey rated the lack of a single paging system as the largest barrier to effective teamwork. Nurses, however, reported that a major barrier to effective team communication was identifying patients’ physicians and their roles.
Nurses also reported that their collaboration with doctors was poor. When it came to effective collaboration, nurses rated subspecialists lower than they did primary inpatient physicians.
Nurses also reported frustration over explaining procedures and tests to patients, a role they said was more appropriate for physicians.
Teaching skills for more effective discharges
RESEARCHERS SAY that a curriculum LINK TO http://www.ncbi.nlm.nih.gov/pubmed/20443072?dopt=AbstractPlus they developed for third-year medical students and implemented at six Denver hospitals helped improve students’ skills for hospital discharge.
The transitions in care curriculum was used during students’ inpatient clerkship. The curriculum consisted of interactive sessions, learning exercises, and a follow-up visit with patients at home, hospice, or a skilled nursing facility.
According to a study posted online in May by the Journal of General Internal Medicine, students taking part in post-discharge visits found medication discrepancies in 43% of those visits. The two most significant reasons for those discrepancies were patients’ lack of understanding about the medication and intentional noncompliance.
Students gave high ratings to the curriculum for its usefulness in teaching transitional care, and they reported increased confidence in their discharge skills.
What reform may mean for quality improvement
According to the report, hospitals will be penalized for excess AMI, heart failure and pneumonia readmissions beginning October 2012. Value-based purchasing, which will be pegged to hospitals’ reported performance on quality measures, will begin in 2013.
Also in 2013, hospitals that do well on value-based purchasing will receive a 1% payment bonus, an amount that will jump to 2% in 2017. But in 2015, hospitals with the worst rates of hospital-acquired infections will lose 1% of their Medicare payments. That penalty could add up to $1.5 billion industry-wide over 10 years.
The report estimated that a 300-bed community hospital with annual net Medicare revenue of $50 million that’s in the bottom quartile on quality measures could lose as much as $1.35 million a year in revenue. The impact on revenue could be compounded if patients choose which hospitals to use, based on these data.
CPOE: Children’s hospital finds significant mortality benefit
WHILE COMPUTER-PHYSICIAN ORDER ENTRY (CPOE) has been enthusiastically endorsed as a way to improve inpatient quality, a study now claims to be the first to associate the use of CPOE with mortality reductions.
The cohort study looked at nonobstetric inpatients admitted to a quartenary-care pediatric academic center between January 2001 and April 2009. (The hospital implemented a commercial, locally modified CPOE system in November 2007.) Researchers found that the mean monthly adjusted mortality rate decreased 20% from expected estimates.
That rate reduction translated to 18 fewer deaths over an 18-month period, authors said. Researchers noted that the rate reduction could be associated with other interventions concurrent with CPOE implementation, including standardized order sets hardwired into the hospital’s electronic medical record and the elimination of redundant pharmacy transcription.
The study was published online in May in Pediatrics.
Frequency of PPI therapy linked to risk of C diff
THE MORE FREQUENTLY PATIENTS TAKE PPIs in the hospital, the more likely they are to develop C diff. A study in the May 10 Archives of Internal Medicine that examined more than 100,000 discharges found that the risk of C diff jumped from 0.3% for patients not receiving acid suppression therapy to 0.6% for patients receiving H2RA therapy.
For patients receiving daily PPI therapy, the risk of C diff rose to 0.9%, and for patients receiving more frequent therapy, C diff risk rose to 1.4%.
According to that risk profile, authors noted that one additional patient would develop nosocomial C diff for every 533 patients treated daily.
That is significant, researchers said, because of the magnitude of patients receiving PPI therapy. Currently, 60% of patients are prescribed acid suppression “although previous studies suggest that as many as two-thirds of those prescriptions are not necessarily indicated.