Dozen of healthcare clinics are now operating in schools around Greater Cincinnati and Northern Kentucky. The Health Foundation of Greater Cincinnati funds the centers, and this month it will start taking applications to add six new centers at local schools over the next three years. So far, the program has been open only to schools that serve students in grades K-8. The next round of applications will be open to high schools. A study sponsored by the foundation found the centers improve students' health.
The national commission that accredits hospitals is investigating how administrators at Sacramento's Mercy General handled a power failure that may have left some surgery patients and their doctors in the dark during a massive storm in January. The Joint Commission made an unannounced visit to the hospital in early February to conduct an "on-site survey" related to the hospital's actions during the storm, which left an estimated 370,000 customers in the Sacramento region without power. The commission can remove accreditation if it finds a hospital violated established standards of care.
Continuing a race among Portland hospitals to add services for people with cancer, the Oregon Health & Science University Cancer Institute has hired a "Patient Navigator" to help patients do everything from finding support groups to paying bills. The American Cancer Society is covering part of the salaries for the new staff member who will try to help patients connect with services they need to ease their treatment.
By demonstrating compliance with national standards for healthcare quality and safety, Slidell Memorial Hospital has achieved full accreditation from the Joint Commission. The hospital received the Joint Commission's Gold Seal of Approval following an unannounced, on-site evaluation. Joint Commission standards address Slidell Memorial's level of performance in key areas such as patient rights, patient treatment and infection control. The standards focus not simply on the hospital's ability to provide safe, high-quality care, but on its actual performance as well.
I could start with a corny line about the power of the pen, but I'll spare you that for now. Instead, I'm going to share a story that gives me hope that medicine is an industry that not only can change--but is hungry for it.
Earlier this month, the Society of Hospital Medicine launched a letter writing campaign to express its discontent with a ruling made in December 2007 by the Office for Human Research Protections. The ruling stopped a Johns Hopkins University study that examined the use of checklists in intensive care units as a way to curb hospital infections. Days after the letter writing campaign began, the OHRP issued a statement that said it would no longer stand in the way of Michigan hospitals using the checklist, or any other quality improvement efforts that pose minimal risks to patients.
If you're a regular reader of this column, you know that I've written about the benefits of the "checklist study" before. Modeled after lists used in the cockpit of airplanes, the list is made up of common sense actions that when taken together can virtually eliminate a patient's chance of acquiring an infection. It's an easy way to remind caregivers of the small, but important steps they should take when treating patients--steps that are often overlooked when pressure mounts.
Hospitalists--who now number more than 20,000 in the United States--are intimately involved with quality improvement efforts, says Russell Holman, MD, president of SHM's board of directors. That's why more than 160 members of his organization were inspired to send letters to the OHRP and members of Congress, urging the reversal of the "checklist study" shutdown.
"We see ourselves as inpatient leaders of quality improvement, patient safety, and service," he says. "More and more inpatient care is falling under the umbrella of hospital medicine, so we're intimately concerned with the systems of care and how to best deliver quality and safety to the patients that we serve."
The checklist struck a chord with members of SHM, Holman says, because of the intricacies of medicine and the human condition. We all know that Americans are getting sicker each year--with many having multiple conditions that must be considered when they seek treatment. Therefore, doctors juggle multiple thoughts, and it's often the simple, common sense things that get put on the back burner.
"There are too many things to remember and too much complexity for us to not use a tool like a checklist," Holman says. "We should expend our intellectual power on things that are less straightforward and more unique to the individual patient."
Perhaps the most interesting thing about SHM's letter writing campaign is that it debunks the myth that physicians are reluctant to change--and therefore will derail quality improvement efforts that disrupt the status quo. In just a matter of days, more than 160 physicians decided that yes, they would advocate for change in our industry, potentially opening themselves up to scrutiny by nurses, caregivers, and patients. For those 160 physicians, it will be all worth it if we can provide Americans with safer healthcare.
Was it the 160 letters that changed the OHRP's mind? Holman says he's not sure what other influences the OHRP may have had, but he'd like to think SHM's efforts played a part in it.
"We hope it was a contributing factor to the reversal and the recognition that quality improvement work done in a hospital is very different than original research methodologies," he says.
A recent study by the Journal of the American Medical Association suggested that hospital-borne infections are the country's fourth-largest killer. Each year, close to 2 million Americans acquire an infection while in a hospital, according to the Center for Disease Control and Prevention. Of those, almost 100,000 die.