Noise is an Issue for Hospitals

Hospitals are noisy places. Monitor beeps, staff conversations, medication alarms, and other noises contribute to a constant cacophony of sounds that a patient hears through day and night. Hospitals have previously worked on reducing noise, but the push now comes with added urgency due to new Medicaid policies that allows adjusted or reduced reimbursement rates based on criteria that includes patient ratings on quality of care. According to the Wall Street Journal, “the latest data from [Medicaid] for the year ended in June 2012 shows that only 60% of patients said the area outside their room was quiet at night, representing the lowest satisfaction score among 27 questions about the hospital experience.”

A “State of Patient Experience” report released in April by the Beryl Institute, a nonprofit that helps hospitals improve patient satisfaction, showed that hospital administrators ranked noise reduction as their top priority for the second time since the last report in 2011. While they share a common goal, different hospitals have different methods of working towards it.

Some hospitals are utilizing stoplight like devices that turn yellow and red with elevating noise levels. Other hospitals are expanding the number of private rooms, or providing patients with “quiet kits” that include earplugs, headphones for TVs, and other devices. Doctors and nurses are seeing change as well; some hospitals are switching to wireless headsets instead of loudspeaker pages or walkie –talkies instead of beepers. A lot of hospitals are looking at installing white noise machines to counteract exterior noise, although one study suggested that they have no effect on patient perception of noise levels.

The barrage of noises may not only be a problem for patients. In April, NAHAM News reported a warning from the Joint Commission regarding alarm fatigue, when a doctor of nurse tunes out potentially important patient alarms due to noise overload. That article can be read here.  

OIG Report Shows that CMS can Save on Lab Tests

A new report released this week by HHS’s Office of the Inspector General (OIG) found that Medicare could have saved $910 million in lab test fees in 2011. Medicare is the largest payer of lab services in the nation, according to CQ, but the program paid 18 to 30 percent more than other insurers. The program could have saved almost $1 billion if fees had matched the lowest rate charged to private companies in each geographic area.

OIG officials looked at 2010 claims data for the most frequently ordered and most expensive lab tests under Medicare. They compared Medicare rates for 20 tests representing 56 percent of Medicare costs for lab tests, with the maximum payments for the same tests allowed under each of 50 state Medicaid programs and the Federal Employees Health Benefits Program. They found at least one of the other programs paid a lower rate 94% of the time.

One explanation for the discrepancy is that most private insurance programs use Medicare rates as a starting point before applying their own discounts. State Medicaid programs are also banned from paying more than the Federal Medicare program. Medicare beneficiaries do not pay co-payments or deductibles for lab tests, a factor that decreases costs for private insurers. The report suggested that CMS officials should weigh whether future enrollees should begin to pay deductibles to lower costs.

As a remedy, the OIG suggested that Congress act to alter the fee schedule, since the Centers for Medicare and Medicaid Services (CMS) has a limited capacity to do so.

You can view the full report via the OIG website here. 

EHR Study Reveals Customer Satisfaction

Satisfaction with electronic health records (EHR) systems varies widely, and issues do not always lie with the systems themselves. With only a couple of exceptions, a new report from health information technology market research firm KLAS states that “the greatest frustration that we encountered was about vendor relations, rather than the software itself.” The report, entitled “Ambulatory EMR Usability 2013, More Nurture than Nature”, covers interviews with 163 providers from practices with more than 25 physicians.

According to ModernHealthcare, the study ranked nine vendors in a composite score based on physician responses to questions about how well the typical physician can efficiently and effectively perform on six common EHR tasks or functions. Those tasks were: e-prescribing, medication reconciliation, physician documentation, problem lists, viewing patient information and supporting mobile devices. 

Among the providers, Athenahealth customers rated their experiences the best. The company scored best on getting providers to usability at first use, or “go-live,” and second best in the handholding department—that is, guiding clients who purchased their systems on how to use them.

Runners up include Epic Systems Corp. in second, GE Healthcare and Greenway Medical Technologies tied for third, Allscripts’ in fourth, and McKesson Corp. in fifth.

The Joint Commission celebrates National Time Out Day

NAHAM has long been looking into patient identity integrity issues and advocating for greater consistency in hospital procedure. To that end, a recognized best practice for hospital care is taking Time Outs for Safety. These can be useful at the check in desk to ensure proper patient identification, at the bedside before giving medication, or even in the operating room before making an incision.

In that spirit, the Joint Commission is teaming up with the Association of periOperative nurses to observe National Time Out Day on June 12^th, 2013. The Joint Commission sent out a letter urging healthcare practitioners to recognize National Time Out Day. While their specific focus is on wrong-procedure or wrong-person surgery, the idea of National Time Out Day is something that can be adapted for patient safety by any healthcare professional.

Read more about National Time Out Day on the Joint Commission website here.

Using Soap with all ICU Patients found to Reduce MRSA

A new study, released late last month, tested three different strategies for preventing methicillin-resistant Staphylococcus aureus, or MRSA. Researchers from the University of California, Irvine, Harvard Pilgrim Health Care Institute, Hospital Corporation of America (HCA), and the Centers for Disease Control and Prevention (CDC), all participated in the study. They compared providing routine care to all patients, providing germ-killing soap and ointment only to patients with MRSA, and using germ-killing soap and ointment on all ICU patients.

The study found that with routine care, neither the presence or MRSA or other bloodstream infections were significantly reduced. Method two, bathing and treating only patients who were found to carry MRSA, reduced infections by 23 percent. The best treatment, however, was universal bathing and treatment of all ICU patients, which reduced infections by 44 percent.

A total of 74 adult ICUs and 74,256 patients were part of the study, making it the largest study on this topic, CDC officials said. The study, and a synopsis, can be found on the CDC website here.

How to Choose a Hospital

For most citizens who do not work in the healthcare field, choosing a hospital can be quite difficult. Most have the ability to shop around and decide which hospital they want to go to for non-emergency situations. Despite that, according to the Atlantic, few patients are able or willing to invest the time and effort that would be required to find the best hospital. Even if they did, which healthcare parameters should they track? The factors used in decisions vary from patient to patient, and they can consider factors ranging from procedure success rates to hospital food. Even with research, some of these questions are not so straightforward.

In the case of a specific procedure, for example, patients may be tempted to pick the hospital with the 99 percent success rate over the hospital with the 95 percent success rate, due to a perceived better quality of care. The 95 percent hospital, however, might perform the procedure on the sickest patients in most dire need of the surgery, while the 99 percent hospital may only perform the procedure on relatively young and healthy patients, many of whom do not need it as much.

Patient satisfaction is another factor patients may look at when choosing a hospital. The Centers for Medicare and Medicaid Services and the National Committee on Quality Assurance require participating organizations to publicly report their patient satisfaction data, so rates are easily obtained. This data can also be misleading though, as patients may rate a hospital experience poorly because they had to wait, when in all reality they received excellent care. Alternatively, patients may rate their hospital experience highly because there was ample parking, even though their care was sub-par. These factors may not be the best to determine where to undergo a procedure.

At the end of the day, the Atlantic suggests two key questions in choosing a hospital. First, do the people who work at the hospital, particularly nurses and physicians, seem generally happy and proud of the work they do?  Secondly, if health professionals were going to be hospitalized, which institution would they choose? These questions are good ones to keep in mind for both patients and hospital staff.

Electronic Health Records Prove Useful in a Disaster

The recent disastrous tornadoes in Oklahoma caused people all over the state, and all over the country, to jump into action. Over 40 people were killed in two separate events, and even more required medical attention. In an emergency, everyone expects the hospital to jump into action to help the wounded, but what happens when the hospital is destroyed? That is where electronic health records come into play. In Moore, OK, the site of most severe tornadoes,  the hospital was leveled. Three hundred people including staff, patients, and other community members that were in there at the time waited out the storm in the cafeteria, chapel, and in various stairwells. Luckily, all survived according to AARP.

With Moore Medical Center destroyed, patients had to be moved to other hospitals in the Norman Regional Health System. Within an hour, 30 patients had already been transferred to other hospitals that were able to seamlessly continue treatment prescribed in the patients electronic health records.

If the hospital had been using paper records, the process of finding a patient file to determine a patient’s medical history, medications, current treatment plans, etc. would have been a lot harder. The director of health information technology at the Norman Health System explained that the paper records would have most likely have been destroyed by either the tornado or the rain that followed.

Instead, transitions were easy and patients were taken care of with minimal inconvenience. In this case, the lessons learned by using electronic health records can be applied to any disaster that requires medical attention. The electronic records definitely improved patient care following a disaster, and may have even saved lives.