Hospital emergency rooms can be unpleasant destinations. When the wait times seem to stretch forever, it just makes things worse. Now, one northern New Jersey hospital is trying to lure patients from competing hospitals by bragging about its low average wait times in the emergency room. Bayonne Medical Center on Tuesday unveiled two billboards in Jersey City that are updated with the emergency-room wait times several times a day. "When people face a medical emergency they want to know they're going to get high-quality care and they're going to be seen in a timely manner," Bayonne CEO Dan Kane said on Tuesday, when the wait time stood at 32 minutes. "They're going to wait far less than they would in any other area emergency department." Wrong, said officials at nearby hospitals. They said their service was just as fast, and scoffed at the notion that patients would choose a hospital based on numbers flashed on billboards.
Hospitals are under intense pressure to reduce their cost of operations as they prepare for a healthcare environment that will soon require them to provide higher quality care at lower costs. Easier said than done since half of the nation’s hospitals are already operating in the red.
To reach cost reduction targets, hospitals are focusing on improving efficiency. This is a tricky task, because efficiency can be evaluated differently depending on who’s defining it. The definition will likely differ across the organization, or the community, or payers. We suffer somewhat from that fact that we have no definition of “true” efficiency. The Agency for Healthcare Research and Quality states it well: “There is insufficient evidence to say with certainty what and how many healthcare service inputs will yield the greatest efficiency and with what risks and benefits. For example, a variety of imaging approaches can be used to make a diagnosis, each with varying risks, benefits, and acceptability to patient and provider.”
It’s important that we ensure resources are dedicated to improving safety and quality and are not spent wastefully. Most efficiency initiatives focus on two resource areas: labor-related subjects such as “productivity” and supply chain issues such as “inventory turns.” In some instances, efforts to improve efficiency span both areas.
When addressing labor efficiency, the knee-jerk assumption is that this approach should first involve a staffing evaluation. Not true. Medical literature fully supports the benefits of appropriate nursing care and patients suffer when nursing care is diminished. At VHA, we’ve convened several educational forums over the past few years on “the business case for nursing” and we’ve learned that one key to efficient healthcare is using nursing staff effectively in adequately supported care environments. Hospitals that can identify and eliminate inefficiencies in nursing care create better places to work and improve experiences for patients. Addressing “stuff” before “staff,” meaning a focus on supply chain efficiency first, has been used successfully as an approach to “waste management.”
Here are seven ideas that hospitals can leverage to increase efficiency while reducing costs and better managing patient care:
1.Evaluate: Survey your clinical staff: what are the top 10 supplies they hunt for? Learn from them and build solutions based on what they already know. Make sure all staff are familiar with where supplies are. One study indicated that it took temporary nurses nearly twice as long to find supplies as regular staff nurses, at least initially, which reduced time available to do other tasks.
2. Redesign: Redesign nursing unit layouts to improve access to frequently used supplies and to prevent nurses from stockpiling what they need (and later discarding) unused supplies.
3.Ask: Survey your exchange cart staff: what products are out of place most often? Do any work arounds exist, such as hoarding or product relocation?
4.Purge: Get rid of antiquated capital equipment. Antiquated equipment breaks often and challenges staff to cope with unnecessary delays, create workarounds to make the equipment work, or takes extra time to complete processes.
5.Shadow: The director of materials management can shadow a nurse for a few hours. Walking a mile (many nurses walk four miles each day) in the nurse’s shoes can build perspective for the daily constraints that must be overcome and enable materials leaders to develop new processes that make the most of both nursing time and resources.
6.Organize: Arrange supply and medication rooms so they are the same or similar on every nursing unit. Supply techs become more efficient with the standardized layout during stocking activities, and staff (especially those who float, travelers, or are reassigned to different units), don’t have to guess where a product is located.
7.Track: Unused but discarded supplies can be costly. Operating rooms have learned the lessons about this reality, and this mindset can be spread to medical–surgical units. But we can’t improve what we can’t measure, so being able to quantify what is unused is crucial, and is a key first step to developing process changes that can send dollars straight to the bottom line.
Lillee Gelinas, MSN, RN, FAAN, is chief nursing officer at VHA Inc.
Healthcare workers would lose their licenses permanently upon conviction of a sex crime or forcible felonies under legislation the House overwhelmingly passed Monday. The bill would require healthcare workers, including doctors, with charges pending to have chaperones with them if they keep treating patients before their trials. They would need to notify all of their patients in writing about any pending criminal allegations. The measure now moves to the Senate. Sponsoring Rep. Will Burns, D-Chicago and 4th Ward alderman-elect, expects it to pass easily. Burns hailed the series for pointing out the problems with current regulations and doctors and advocates of victims of sexual assault for being able to "get this done." No person whose name is on a sex offender registry would be eligible to get a medical license under the bill.
Over strong objections from the hospital industry, the government has published data about things that can go wrong in hospitals—falls, objects left behind during surgeries, bloodstream or urinary infections associated with catheters, incompatible blood infusions, serious bed sores and more. The information is the first hospital-specific patient safety data to be released nationally by Medicare. Published last week, it comes from a review of hospital bills submitted for elderly and disabled patients between October 2008 and June 2010. All of Chicago's top medical centers appear on the list of hospitals with safety issues, to one extent or another. For instance, the University of Illinois at Chicago Medical Center, the University of Chicago Medical Center and Rush University Medical Center all reported higher-than-average numbers of hospital-acquired bloodstream infections associated with catheters. Officials at each medical center questioned the government's method of counting infections while acknowledging mistakes in data they submitted to Medicare.
David Aldridge of Los Angeles had a kidney transplant in 2006, but he will soon need another. Like many people living with HIV, he suffers from kidney damage, either from the virus or from the life-saving medications that keep it at bay. Until recently, such patients did not receive transplants at all because doctors worried that their health was too compromised. Now they can get transplants, but organ-donor waiting lists are long. And for Mr. Aldridge, 45, and other HIV patients, a potential source of kidneys and livers is off limits, because it is illegal to transplant organs from donors who test positive for the virus—even to others who test positive. But federal health officials and other experts are calling for repeal of the provision that bans such transplants, a 23-year-old amendment to the National Organ Transplant Act.
A failure in the sterilization process at a Birmingham pharmacy appears to have caused the infection that sickened 19 people in Alabama hospitals, nine of whom died, the state health department said. Investigators found exact matches of the bacteria on a water faucet, a container and a device used to mix intravenous nutritious supplements at Meds IV, State Health Officer Don Williamson said. But there are still questions about how the contamination occurred. The Alabama Department of Public Health and the federal Centers for Disease Control and Prevention have been investigating the outbreak of Serratia marcescens in five hospitals around Birmingham and one in Prattville. It is linked to bags of TPN, total parenteral nutrition -- a supplement given intravenously to patients too sick to eat -- mixed by Meds IV and sent to those hospitals in January, February and March. Williamson said that samples of the bacteria were taken from Meds IV's compounding room, grown out and run through a genetic fingerprinting process.