In the News

AHRQ funds program to reduce ICU infections, and other medical updates.

AHRQ funds program to reduce ICU infections

The Agency for Healthcare Research and Quality (AHRQ) has committed $3 million to a three-year patient safety endeavor aimed at reducing central line-associated bloodstream infections in hospital intensive care unit patients, according to a recent press release.

The contract entrusts The Health Research & Educational Trust with coordinating the program in conjunction with Johns Hopkins University, which developed it, and the Michigan Health & Hospital Association. The program, which has already been tested in 100 Michigan hospital ICUs, helped reduce the infection rate to zero in half of those ICUs within three months of implementation.

The safety program will be implemented by consortia in at least 10 states, with at least 10 hospitals participating in each state. The consortia will include members of state hospital associations, quality improvement organizations and public health agencies. AHRQ's director described the effort as an opportunity to provide health care professionals with valuable tools that support patient safety.

Each year, an estimated 250,000 cases of central line-associated bloodstream infections occur in hospitals in the U.S., and an estimated 30,000 to 62,000 patients who get the infections die as a result, according to the CDC.

Joint Commission to enforce anticoagulant safety goals

The Joint Commission has issued safety suggestions for anticoagulants and will step up their enforcement, the agency recently announced.

High profile errors related to commonly used blood thinners have harmed or even killed patients, according to a Joint Commission alert. The Joint Commission's Sentinel Event Database includes 446 medication-related sentinel events (9.3% of all events) reported from January 1997 through December 2007. Of these, 7.2% (32) involve anticoagulants; of those, twothirds (21) involve heparin.

The Joint Commission addressed these errors in its 2008 National Patient Safety Goals, and requires full implementation of the goals by Jan. 1. Commission investigators will make unannounced visits to ensure hospitals adopt strict measures to prevent blood thinner errors, and those who fail to do so could see their accreditation revoked, The Joint Commission president told the Associated Press.

The commission has highlighted several factors that contribute to anticoagulant medication errors, including lack of standardized labeling and packaging, failure to document and communicate patient instructions during hand-offs, and inappropriate dosing for pediatric patients. To reduce the risk of errors related to commonly used anticoagulants, The Joint Commission recommends that health care organizations take a series of 15 specific steps, including:

  • Assess the risks of using anticoagulants;
  • Use best practices or evidence-based guidelines regarding anticoagulants;
  • Establish standard dose limits on anticoagulants and require that a doctor confirm any exceptions;
  • Clearly label syringes and other containers used for anticoagulants; and
  • Clarify all anticoagulant dosing for pediatric patients, who are higher risk because these drugs are formulated and packaged for adults.

Groups issue guidelines to prevent hospital-acquired infections

The Joint Commission and the American Hospital Association along with three major epidemiological organizations recently released evidence-based guidelines for preventing the most common types of healthcare-associated infections (HAIs).

“The Compendium of Strategies to Prevent Healthcare- Associated Infections in Acute Care Hospitals” addresses two organism-specific HAIs: methicillin-resistant Staphylococcus aureus and Clostridium difficile, as well as four device and procedure- oriented infections: central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection and surgical site infection. For each type of HAI, the guideline authors recommend several basic prevention strategies and list special procedures for when basic steps fail to control an infection.

Most strategies outlined in the new guidelines are not new, but they represent the first professional consensus on a basic set of prevention strategies, the authors said. The compendium also includes proposed performance measurements for internal monitoring, in light of Medicare's recently adopted policy of withholding reimbursement for costs related to treating certain HAIs.

Other societies that helped develop the compendium included the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology. SHEA and IDSA will assume responsibility for updating the strategies as science evolves.

Health officials try to raise awareness of DVT

Deep vein thrombosis (DVT) is the target of new awareness campaigns announced recently by the AHRQ and the Surgeon General's office.

Acting Surgeon General Steven K. Galson, MD, issued a call to action urging clinicians and patients to reduce the incidence of deep vein thrombosis and pulmonary embolism (PE). Annually, the conditions affect an estimated 350,000 to 600,000 Americans and contribute to at least 100,000 deaths, a press release said. Risk factors, in addition to hereditary clotting disorders, include being hospitalized or confined to bed rest, having major surgery, suffering a trauma, or traveling for several hours, Dr. Galson noted.

The call to action resulted from a 2006 Surgeon General's Workshop on the disorders and its goals include:

  • increasing awareness about DVT and PE;
  • encouraging evidence-based practices for DVT; and
  • obtaining more research on the causes, prevention and treatment of DVT.

The AHRQ has released two new resources to help physicians and consumers prevent the blood clots from developing. The clinician guide, “Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement,” is a 60-page guide which details how to start, implement, and evaluate a quality improvement strategy.

The AHRQ's consumer booklet is a 12-page easy-to-read resource that helps patients and their families identify the causes and symptoms of blood clots, learn tips on how to prevent them and know what to expect during treatment. Both guides and a press release are on the AHRQ Web site.

Residents looking for jobs with lifestyle perks, loan help

A survey of final-year medical residents found that younger doctors value lifestyle over financial rewards when making career decisions and that most are looking for positions with large groups or hospitals.

Asked what they look for in a practice setting, more than 80% of respondents to the national survey, conducted by Merritt Hawkins & Associates, rated “adequate call/personal time” high on their list. Other factors considered important were a good financial package and educational loan forgiveness. Other findings from the survey included:

  • A majority (58%) of respondents rated the Internet as their most important source for learning about job opportunities. Other sources included personal networking, physician recruiters and medical journals.
  • 80% of respondents said they had been contacted by recruiters more than 25 times during their residency, while 40% reported being contacted more than 50 times.
  • 82% of respondents start their job search more than one year before completing their residency.
  • 29% of respondents owed between $100,000 and $150,000 in student loans, up from 21% in 2006, while 35% rated repayment as a major concern (vs. 12% in 2006) and 40% said payment of loans would have a great effect on their decision to accept a position.

Hospitals score low on compliance with colon cancer guideline

Pathology examination of 12 or more lymph nodes is associated with improved colon cancer survival, yet only 38% of U.S. hospitals routinely complied with the guideline in 2004 and 2005, a study reported.

In the study published in the Sept. 9 online issue of the Journal of the National Cancer Institute, researchers examined data from 1,296 hospitals included in the National Cancer Database, identifying 74,669 colon cancer patients who underwent colectomy in 1996-97 and 82,120 who underwent colectomy in 2004-05. Compliance with the American Joint Committee on Cancer guideline, which requires that at least 75% of patients have 12 or more nodes examined, increased from 15% of hospitals in 1996-97 to 38% in 2004-05. Adherence between the two time periods increased in 900 hospitals, remained the same at six hospitals, and fell in 310 hospitals.

In 2004-05, hospitals designated by the National Cancer Institute as Comprehensive Care Centers were most likely to comply with the 12-node examination recommendation (78.1% compliance), followed by other academic institutions (52.4%), Veterans Administration hospitals (53.1%) and community hospitals (33.7%).

With nearly two-thirds of hospitals failing to meet the guideline's requirements, much improvement in lymph node examination rates is needed, the authors concluded. They noted that the measure soon may be used by insurers to assess hospital and physician performance.

Inadequate sign-out processes contribute to adverse events

Faulty sign-out processes used by medical residents contributed to inefficiencies, delayed treatment and adverse patient events, according to a study published in Sept. 8 Archives of Internal Medicine.

Researchers conducted a prospective audiotape study of 12 days of sign-out of clinical information among eight internal medicine housestaff teams. Of 84 sign-out sessions, postcall interns identified 24 sign-out-related problems involving delays in diagnosis or treatment (5 patients), intensive care unit transfer (1 patient), near misses (4 patients), and 15 inefficiencies or redundancies in work. Sign-outs also omitted key information, such as a patient's clinical condition, recent scheduled events (such as tests or surgeries), tasks to complete, plan or action, or rationale for assigned tasks.

While the study was limited by its size (it was performed at one academic medical center), the results suggest an inability among some residents to accurately convey an overall patient assessment or to provide enough information to assist with overnight decisions, researchers noted. According to the authors, improvements to patient care transfer processes require a focus on higher-order synthesis and judgment. One author noted the need to establish standards for successful hand-offs and systems to ensure that all important information is transmitted to the person who is assuming responsibility for the patients during transfer of care.