The first day of public hearings on New Jersey legislative leaders' version of the state budget was dominated by representatives of hospitals and other healthcare providers. Dozens of advocates appeared before the Assembly Budget Committee in a hearing that lasted nearly five hours. While many thanked lawmakers for scaling back some of the budget cuts that had been initially proposed, they also pleaded for more funding.
Physicians are working together to form larger groups or becoming employees of hospitals as they try to deal with what many see as a financial squeeze from tighter reimbursement policies by insurers and government health programs. Some physicians are giving up private practice to join corporate America, or they're adding new services to boost fee income.
Weeks after a critical audit of Gov. Rod Blagojevich's healthcare department, Illinois auditors have found a series of fiscal management issues inside the agency. The Auditor's office cited 15 serious concerns in its annual review of the Department of Healthcare and Family Services, ranging from untimely healthcare payments to long delays in producing financial statements to paying claims from the wrong fund. The new audit came about a month after a special audit requested by lawmakers found a series of issues with how the department makes Medicaid payments.
As medical tourism continues to grow, the American Medical Assocaciation is providing guidance to patients about traveling abroad for care and to employers about covering such procedures.
The AMA approved the guidelines at its annual policymaking meeting in Chicago, and representatives said about 150,000 Americans in 2006 received some form of medical care overseas. About half were for "medically necessary procedures," according to AMA representatives.
Hospitals and doctors who make medical mistakes will no longer be able to bill the state of Massachusetts or its largest private health insurer for costs related to fixing the error, according to policies outlined separately by the state government and Blue Cross and Blue Shield of Massachusetts. The state and Blue Cross policies apply to 28 types of surgical, medication, and other errors, and the policy changes by the state are part of a national effort to reduce healthcare errors. Analysts said the move to restrict reimbursements represents the boldest attempt by any state to use payments to reduce life-threatening errors that are considered preventable.
A government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions: The report found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care, yet fewer than one in five of the nation's doctors has started using such records. The survey also found that electronic records were used in less than 9% of small offices with one to three doctors, where nearly half of the country's doctors practice medicine.
A series of three eight-hour discussions focusing on healthcare reform showed that 88% of the participants put a high priority on all Kansas residents having some health insurance coverage. The forums also turned up strong support for preventive healthcare, for funding those costs through taxes, and for making sure everyone has a health professional who would oversee the person's healthcare. Each of the three discussions included about 30 people who were asked to consider different approaches to healthcare reform.
In 2009, SSM Health Care plans to open SSM St. Clare Health Center, a full-service acute-care center and state-of-the-art replacement for the 65-year-old SSM St. Joseph Hospital in Kirkwood, MO. The $236 million hospital is scheduled to open on March 30. SSM officials sought to streamline the healthcare delivery process through a facility that maximizes patient and practitioner efficiency. They started by scrutinizing processes like outpatient admissions and emergency department procedures and soliciting opinions from staff, physicians and patients.
The Joint Commission announced its 2009 National Patient Safety Goals (NPSG) and Elements of Performance (EP) yesterday. The biggest changes came in the form of new infection control requirements.
"I think more and more attention is going to be on infection control beyond 2009 because it's on the public's radar screen," says Leigh Chapman, RN, BSN, infection control coordinator at St. Joseph Medical Center in Towson, MD "They're coming to our hospital and expecting not to get an infection, so I think more measures like this will be coming out."
Crucial to understanding the 2009 NPSGs is a new method of numbering the goals, for which the Joint Commission has created a crosswalk available on its Web site. The Joint Commission says it created the new method for numbering the NPSGs and relating EPs to more easily sort electronic editions of the NPSGs, as well as to better allow for future goals.
In addition, what were formerly referred to as implementation expectations (IEs) are now referred to as elements of performance (EPs). All of the new organizational changes appear to make the NPSGs look more like the standards in the Joint Commission's Comprehensive Accreditation Manual for Hospitals (CAMH), which is also expected to be renumbered in the near future.
There are six brand new requirements, three of which pertain to healthcare-associated infections. These requirements have a one-year phase-in period during which hospitals, critical access hospitals, and ambulatory facilities will be expected to meet quarterly deadlines. New requirements include:
NPSG.01.03.01: Elimination of transfusion errors that are related to misidentification of patients
NPSG.07.03.01: (one-year phase-in period, with full implementation by January 1, 2010): Prevention of healthcare-associated infections resulting from multiple drug-resistant organisms (MDRO) using evidence-based practices
NPSG.07.04.01: (one year phase in period): Prevention of central line-associated bloodstream infections using evidence-based practices
NPSG.07.05.01: (one year phase in period): Prevention of surgical site infections using best practices
NPSG.08.03.01: When a patient leaves a facility, the patient and his or her family receives a complete list of the patient's medications with an explanation of that list
NPSG.08.04.01: In settings in which medications are prescribed minimally or for a short time, modified medication reconciliation processes are carried out
In addition to the new requirements, some of the NPSGs already in place have been modified:
NPSG.01.01.01 (formerly Goal 1A): An EP for this goal about patient education has been added to include language about needing active patient and family involvement in the identification process. If the patient is unable to be involved in the process, the hospital will name a caregiver who will be responsible for being part of the identification process.
NPSG.03.05.01 (formerly Goal 3E): In addition to the removal of the phase-in language, new language has been added to the goal about anticoagulation therapy, specifying that it only applies when the expectation is a patient's coagulation lab values remain outside normal values. It does not apply to routine situations in which short-term anticoagulation will take place. Further, some EPs have been modified to become more specific about patient education and improvement of anticoagulation practices.NPSG.08.01.01 (formerly Goal 8A): For this medication reconciliation goal, what was formerly IE 2, concerning comparing the list of medications ordered for a patient while in the hospital with the patient's medication list at admission, and reconciling discrepancies, has been separated into two EPs. Also, there is an addition concerning the importance of medication reconciliation during a patient handoff.
NPSG.08.02.01 (formerly Goal 8B): Providing a list of a patient's medications to the patient's primary care provider has been reinstated in this Goal, and if this cannot possibly be done, providing that list to the patient and his or her family will suffice. It is acceptable to send the list to the next provider of care or referring provider, and this must be documented.
NPSG.13.01.01 (formerly Goal 13A): Added to this goal on actively involving patients in their care are two new EPs concerning educating the patient about hand hygiene and respiratory hygiene measures, and contact precautions used in the facility, and when and how this should be done. Also, surgical patients should be educated about the methods the facility employs to prevent adverse events during surgery.
NPSG16.01.01 (formerly Goal 16A): In addition to the removal of the phase-in language, this goal, which concerns recognizing and responding to change in a patient's condition, has been modified. EP 7 has been updated to say that just having a team in place (e.g., a rapid response team) is not enough to be in compliance with the goal.
Extensive changes have been made to the Universal Protocol (UP), most of which are used to make the existing UP more specific:
UP.01.01.01 (formerly requirement 1A): The biggest change here involves incorporating a checklist when the patient moves from the pre-procedure setting. In addition to the existing relevant documentation and correct diagnostic and radiology results, The Joint Commission has required a signed consent form and any blood products that will be used be confirmed as a part of the checklist.
UP.01.02.01 (formerly requirement 1B): EP1, concerning marking the site, now applies to all procedures that involve incision or percutaneous puncture. Also, this goal specifies that the surgeon or person performing the operative procedure marks the site with his or her initials. Additionally, there is added language about the way in which spinal procedures should be marked and that facilities must have an alternative process in place to identify the surgical site for patients who refuse the site marking and for certain procedures that are difficult to mark.
UP.01.03.01 (formerly requirement 1C): This goal on performing the time out now includes language about the need for separate time outs to take place when more than one procedure is being performed. Also, the time out now should include an accurate procedure consent form, address if antibiotics or fluids will be needed, and mention any safety precautions that should be taken based on a patient's history or medication use. Lastly, all steps of the UP and time out must be documented, not just the time out.
Although the goals relating to infection prevention incorporate the biggest changes to the NPSGs, there is a general consensus that most facilities are already doing at least some of the requirements.
"This does not seem too much of a stretch from what is typical for IC programs across the country," says Claude (Bud) Pate, REHS, vice president for content and development at The Greeley Company in Marblehead, MA. Most hospitals are already doing surveillance on the populations of patients at risk for surgical site infections and central line-associated blood stream infections, he says.
The Centers for Disease Control and Prevention has reported that healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year in American hospitals. Of those healthcare-associated infections, 32% were urinary tract infections, 22% were surgical site infections, 15% were lung infections (pneumonia), and 14% were bloodstream infections.
Molly McDaniel, PharmD, medication safety officer at Sanford USD Medical Center in Sioux Falls, SD says that the Joint Commission's changes to the medication reconciliation goal are a step in the right direction. Limiting the requirements for areas where patients are only admitted for a short period of time eases a burden for caregivers, she says.
"This helps shift the focus onto the patient while not being bogged down with tons of documentation," McDaniel says. "Also, I appreciate the focus The Joint Commission has placed on discharge. Discharge can be a very complicated and confusing time for patients and their new medication list is one of the many pieces of information they need to understand."
The Joint Commission has made a larger effort in this release of the NPSGs to emphasize the importance of educating the patient and his or her family, a move lauded by Lisa Khanna, RN, BSN, patient safety officer at Cooley Dickinson Hospital in Northampton, MA.
"The goals seem to be moving in a more patient-centered direction," Khanna says." It seems that The Joint Commission has taken the feedback it has gotten and fine-tuned some existing goals to make the expectations of implementation clearer, and reasons for the goals more meaningful."
Scores of employees of the Anne Arundel County (MD) Department of Health and Fort Meade descended on the county’s two hospitals to test their preparedness for facing a flu pandemic. Anne Arundel and Baltimore Washington medical centers practiced assessing a surge in patients to the emergency department, amid their own mock shortages in staff. In addition, the Department of Health and the Office of Emergency Management tackled their own challenges of having staff reduced by influenza and directing their remaining resources. The joint effort is the first time the groups have come together in a realistic exercise.
