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Patient Safety Pays

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For hospitals, investing in prevention now comes with ROI later.

Charlotte Pope feels good about what she does. As a registered nurse and certified wound specialist at HCA-owned Conroe (TX) Regional Medical Center, she's in charge of making sure patients in the 38-bed intensive care unit at the hospital don't develop skin problems while they are helpless and incapacitated because of surgery or illness.

Chief among those problems are pressure ulcers, which don't develop on ambulatory patients because they can move when circulation is impeded. Patients in Pope's ICU can't. The hospital spent $73,950 last year for special boots to aid circulation. It spent $9,000 per patient bed to outfit beds with pressure-sensitive pads that move and vibrate to aid circulation. And Conroe recently spent $100,000 on transferring devices so nurses and techs don't pull and scrape delicate skin that could cause sores.

Conroe's expenditures are helpful to patients, but moreover, keeping patients from getting sicker while they are in the hospital is now not only a quality issue but is also a bottom-line priority for many hospitals. And hospitals are spending like never before on methods to keep patients from catching medicine-resistant bugs or from developing infections and pressure ulcers. Partially, that's because many commercial insurers have decided to stop paying for treatment for maladies patients develop in the hospital on the basis that the hospital should have prevented them in the first place. Medicare, for its part, is also increasing the pressure, refusing to pay for eight hospital-associated conditions starting in October 2008.

If they aren't already, people like Pope are drawing more attention from many hospital senior executives because of the potential for lost revenue if she and her staff don't do their job well. Conroe, a 280-staffed-bed community hospital, recognized the problem years ago, to its credit. In 2002, it developed a dedicated nursing service department for wound/ostomy/continent patients. Long before such challenges were a big revenue issue, the department invested thousands of dollars in the prevention of pressure ulcers, one of the eight hospital-acquired problems for which Medicare has said it will no longer pay for treatment. Conroe has developed a skin risk scale that is updated every day to gauge an immobile patient's susceptibility to infection.

"We calculate the score every day, and according to that score, we have some skin protection protocols in place," Pope says.

Conroe's program addresses just one problem with hospital-acquired maladies, says Jonathan Perlin, MD, HCA's chief medical officer and president of the clinical services group for the Nashville-based for-profit chain of 168 hospitals and 115 outpatient centers.

Perlin has led what could only be categorized as a personal crusade against the spread of methicillin-resistant staphylococcus aureus, or MRSA, a bacterium that causes a difficult-to-treat infection in patients. MRSA cannot be completely eradicated in hospitals, and patients with weakened immune systems, wounds or invasive devices are extremely susceptible. But certain protocols can nearly eliminate the threat.

"We can't buy enough gowns, gloves and masks for this not to be a great investment," he says. "The real payoff is in terms of providing the best care to patients."

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