When it's your job to monitor the quality of a healthcare organization, there's a long list of items that you think about on a daily—if not hourly—basis. You're always looking for new ways to prevent the spread of infection, or how to keep patients who are susceptible to falls from getting out of bed without assistance. You're up to date on your organization's readmission and mortality rates, and you're on top of your hospital's latest HCAHPS scores.
But in the minds of our consumers, a quality healthcare experience is something completely different. A cardiac patient may be given an aspirin immediately after being admitted to your hospital. He may be shielded from a hospital acquired infection by your new infection control protocol, but if he must wait for hours in a crowded waiting room to receive care, he'll remember that experience as anything but "quality."
I know this because last week I was one of those patients. After taking ill at work, my doctor recommended that I get myself to the closest emergency department for evaluation. Five hours later, when I finally got to see a physician, they couldn't find anything wrong with me.
"I don't know what may have caused you to pass out, Ms. Larkin," the doctor said after monitoring my vitals for a couple of hours. "Granted, that was almost eight hours ago now, so there could have been something going on that we can't see now."
Gee, thanks.
I had a great nurse tending to me in the ED. He made sure that I was fed, hydrated, and comfortable. He came in often to check on me and kept me informed about when the doctor would be in to chat with me about my test results, and finally, when I'd be able to go home. But when anyone asks me about my ED experience, the first thing I tell them is how long I had to wait-and how my waiting didn't even produce a diagnosis.
I'm not telling you this because I need a place to vent about my ED experience. Nor do I want you to think that I expected to receive care immediately after walking in the door. I understand that a person with nausea and lightheadedness isn't going to be seen before the woman who comes in bleeding with a large cut on her forehead, or the man experiencing chest pains. But as more people in America seek care at emergency departments, we must figure out a way to provide better experiences for patients in our EDs. Delivering a "quality" experience in our EDs may be rare, but it's possible.
Earlier this year, my colleague Molly Rowe wrote about the challenges that EDs pose to hospitals in HealthLeaders magazine. She profiled several hospitals that recognize the importance of the ED to the rest of the hospital's operations. They've changed their processes and staffing levels to allow smooth patient throughput regardless of how many patients are waiting to be seen. They recognize that patients coming through the doors of the ED—60% of hospital admissions come from the ED—are important to the hospital's success. A "quality" experience in the ED can bring you a patient for life.
When it comes to providing high quality care, there's a lot that leaders must think about—infections, falls, and the timeliness of procedures—but we also need to keep in mind what quality means to patients. There may come a day when we've eliminated MRSA and we no longer worry about pressure ulcers, but if we can't give timely treatment to a patient in our emergency department, will we really be able to say that we offer a quality healthcare experience?
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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Looking to prevent a significant labor and cost burden on America's hospitals, CEOs from 17 hospitals and health systems sent a letter to the Centers for Medicare & Medicaid Services this week, strongly objecting to some of the required date reporting included in the 2009 proposed Inpatient Prospective Payment System rule. The 17 CEOs represent more than 100 hospitals—all members of the Premier healthcare alliance.
Some of the measures that hospitals would be required to report under the 2009 IPPS rule are those collected by the Society for Thoracic Surgeons' database, says Charles Hart, MD, CEO of Regional Health in Rapid City, SD, and chair of Premier's Quality Improvement Committee. STS is a private, proprietary database that hospitals must pay to participate in. Many hospitals already collect this data, Hart says, but for those who don't, being required to do so will mean a significant cost increase and need for additional personnel.
"There's certainly routine agreement in the medical field that it's an excellent database," Hart says, but he and the 16 other CEOs who signed the letter fear that the STS database is the first of many that CMS could require hospitals to participate in. While the CEOs are in favor of more transparency and data reporting, Hart says, they asked CMS to come up with a way to automate reporting requirements and lessen the burden on healthcare organizations.
"We'd much rather spend our time looking at the data to see how we can improve instead of spending our time collecting this information," Hart says.
Premier also sent a separate letter to the National Quality Forum (NQF) opposing the use of any quality measures that depend on proprietary methodologies or tools as contrary to the public interest and evidence-based quality improvement.
"Private-sector innovation can contribute valuable methodologies that enhance quality measures, and that innovation should be encouraged," says Blair Childs, Premier healthcare alliance senior vice president of public affairs. "However, measures subject to public reporting, and those used as a basis of reimbursement, must be fully transparent to providers and the general public. Monopolistic suppliers of quality measures that are required in public programs are unacceptable."
New Ulm, MN, will participate in an experiment on whether it's possible to eliminate heart attacks throughout an entire community.
The experiment is one of two Allina Hospitals and Clinics plans to announce in a five-year, $100 million health initiative it has named the Center for Healthcare Innovation. The other experiment is aimed at discovering if Allina can affect the health of those who live in the Minneapolis neighborhoods where Allina is based. Both New Ulm and the south Minneapolis neighborhoods will become living laboratories on how to prevent disease and do a better job of treating it when it does occur, said Allina officials.
Patients with advanced cancer often don't know how long they have to live or how chemotherapy will affect their lives, according to a study. In many cases doctors don't give patients such information, and other times patients misunderstand their doctors and perhaps hear what they want to hear, the study found. As a result, patients may ask for aggressive, painful therapies that have no hope of helping them.
As criminals capitalize on the growing use of the Internet by consumers searching for inexpensive drugs, counterfeit medicines are on the rise worldwide. Seizures of bogus prescription medicines jumped 24% in 2007, and illicit versions of 403 different prescription drugs were confiscated in 99 countries, according to the Pharmaceutical Security Institute.
Hospitals that receive high marks for coronary-bypass outcomes still may not be doing all they can to avoid preventable deaths from the procedure, according to a study. Researchers reviewed 347 deaths from coronary-bypass surgery at nine Ontario hospitals and found that 32% of them likely resulted from lapses in established procedures and other preventable shortcomings. The findings indicate that relying solely on hospital report cards misses a critical opportunity to improve quality of care.