Childbirth is the leading reason for hospitalization in the United States and one of the top reasons for outpatient visits, yet much maternity care consists of high-tech procedures that lack scientific evidence of benefit for most women, according to a report. U.S. hospital charges for maternal and newborn care jumped from $79 billion in 2005 to $86 billion in 2006, and reducing expensive techniques such as C-sections, as well as increasing low-cost approaches such as childbirth assistants, would improve mothers' and babies' health while cutting costs, the authors say.
Mike Herrera's pain was growing as he walked into the emergency department of Dallas-based Parkland Memorial Hospital on a recent evening. But it wasn't until he collapsed in an exam room 19 hours after he was admitted that the staff seemed to spring into action, his family says. Herrera's death follows years of warnings about excessive wait times in the emergency department of the hospital, which serves the indigent and others without health insurance. A 2004 study on the hospital said wait times in Parkland's ER were so excessive that more than one in 10 patients left the hospital before seeing a doctor.
Connecticut healthcare regulators are imposing an $8,000 fine on Yale-New Haven Hospital for infractions inspectors found during unannounced visits. The Connecticut Department of Public Health said nurses and other caregivers failed to check patients for bed sores, administered wrong dosages of medicine, and held a patient against her will, among other violations. Yale-New Haven Hospital has signed an agreement with the state to correct the problems.
In a new state-by-state ranking of palliative care, only Vermont, Montana, and New Hampshire get an A, while Oklahoma, Alabama, and Mississippi get an F. The rest of the states are somewhere in between, although Southern states did not fare well in general. The rankings were conducted by the National Palliative Care Research Center. "We gave letter grades based on the percentage of hospitals that had palliative care programs, appropriately set up to meet the needs of seriously ill patients," said R. Sean Morrison, MD, a professor of geriatrics and palliative care at Mount Sinai School of Medicine in New York.
JCAHO. Until The Joint Commission changed its name early last year, that acronym was enough to strike fear in the hearts of hospital employees at all levels. When a JCAHO surveyor arrives, everyone from executives to front line managers scrambles to make sure that supplies are stored in the right places and medications are delivered properly. Survey time at a hospital is serious business.
Now another acronym has made its way to the accreditation scene, and it remains to be seen if this one will have the sheer power that JCAHO held for so long. The Centers for Medicare and Medicaid Services announced last week that it has granted DNV Healthcare, Inc. deeming authority for U.S. hospitals. DNV is the first organization to receive deeming status in more than 30 years.
JCAHO hasn't been the only deeming authority over the past 30 years, but it may seem that way. In fact, I'm sure there are a lot of healthcare workers out there would be hard-pressed to tell you the names of the other accreditation organizations out there. The Joint Commission is the accreditation authority, and any hospital that wishes to be seen as one that provides quality care works to meet its standards.
So why after 30 years has CMS decided to grant another organization deeming authority? Surely it has something to do with CMS' increased focus on quality and patient safety. By creating a growing list of "never events," and an emphasis on transparency, CMS has made it clear that it wants hospitals to not only improve on certain key outcomes, but also make the quality of hospitals something that consumers take into consideration when they're selecting a hospital. DNV's accreditation process combines CMS Conditions of Participation with ISO-9001, a collection of standards for quality management systems. DNV's process is called the National Integrated Accreditation for Healthcare organizations and was designed to streamline the accreditation process, identifying ways to make continual improvements.
It sounds good, but will hospitals really abandon The Joint Commission for another agency? I think it's possible. The Joint Commission's accreditation process isn't perfect—just ask anyone on the hospital staff who is involved with accreditation. They'll tell you that the JC's standards change too frequently, and that JC staff members, though good at pointing out needed improvements, often aren't helpful to hospitals that are implementing changes or process improvements.
DNV, too, will have its challenges. It won't be an easy road convincing hospitals to move away from what they've always known—The Joint Commission—and work through a new and different accreditation process. But there's hope for them already. Before CMS' announcement last week, 27 hospitals had already received accreditation from DNV in addition to that of the Joint Commission.
Will DNV ever strike fear in the hearts of hospital executives as JCAHO once did? That remains to be seen. But with an increased focus on quality and patient safety from both CMS and accreditation agencies, you can bet that your hospital's accreditation process will get tougher each year.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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An increase in cases of the bacteria "super bug" known as C. diff in recent years is being attributed in part to the overuse of antibiotics. Hospitals have taken measures to curb the increase, but C. diff is said to afflict as many as 500,000 Americans each year, and cause more than 15,000 deaths.