AUGUST 7, 2012

Welcome to the Patient Safety Update eNewsletter
This issue sponsored by The Quality Colloquium

Final IPPS Rule Has Three New Value-Based Purchasing Measures, Finalizes Readmissions Factors
CMS has issued its final rule for hospital inpatient prospective payment and in doing so included three new outcome measures: 1) a central line blood stream infection measure, 2) a patient safety indicator measure, and 3) a Medicare spending per beneficiary measure. This rule also finalizes the payment adjustment methodology for heart attack, heart failure and pneumonia readmission which CMS estimates will save them approximately $280 million. (Inside Health Policy, August 1, 2012)

Study Highlights Methodist Hospital's Success in Improving Patient Safety
The intraluminal protection device (IPD), an IV connector, significantly outperformed two widely used negative-pressure IV connectors in a Methodist Extended Care Hospital (MECH) study. Results published in the Summer 2012 issue of Journal of the Association for Vascular Access (JAVA) demonstrated a decidedly lower rate of central line-associated bloodstream infections (CLABSIs) for cases employing the IPD. These results, consistent with other such studies, represent important patient safety and financial news for hospitals and clinicians. The CDC estimates 250,000 CLABSIs occur annually resulting in a 12% to 25% mortality rate from these infections or as many as 62,500 unnecessary deaths per year. Financially, CLABSIs cost up to $56,000 to treat and CMS has stopped reimbursing hospitals for hospital-acquired CLABSIs. (Newswise, July 31, 2012)

Safety Plan Cuts Infections in Colon Surgery
Surgical site infections (SSIs) for colorectal patients were reduced by 1/3 (from 27.3% to 17.2%) according to a study reported online in the Journal of the American College of Surgeons. Infection reductions like this improve health and financial performance. "Assuming the average SSI costs $6,000 to $10,000, we estimate that the comprehensive unit-based safety program (CUSP) intervention resulted in $168,000 to $280,000 in cost savings at our institution in 1 year," the authors of the study noted. They went on to say, "In addition, assuming a nationwide incidence of 1.7 million SSIs per year, widespread application of the CUSP intervention can reduce the number of SSIs by 170,000 per year, saving $102 million to $170 million annually." (MedPage Today, August 1, 2012)

FDA Balances Costs, Patient Safety in the Biologics and Personalized Medicine Revolution
"Biologics" are a new class of treatments made from living organisms intended to treat not the consequence of a disease but rather to block the diseases in their early development. Biologics represent serious patient safety and expense concerns. The Hatch-Waxman Act of 1984 established the structure to bring generics to market after a patent exclusivity period. Consumer groups are pushing for biologics to be subject to similar regulations resulting in biologics known as "biosimilars." The Affordable Care Act (ACA) clears the way for the FDA to create a "biosimilar pathway" with a 12 year patent exclusivity period. The problem is patient safety. "Because biologics are created using DNA technology, rather than a uniform chemical reaction with a predictable outcome as are traditional drugs, their risks are significant and often unpredictable. How can the government ensure that biosimilars are as safe and as effective as the original innovator drug?" The question at hand is "scientific equivalency" or ensuring the quality of biosimilars. (Forbes, July 23, 2012)

6 States Trace Path of Worker Accused of Infecting Patients with Hepatitis C
David Kwiatkowski, a medical technician, was arrested at a Massachusetts hospital. He is charged with fraudulently obtaining (stealing) fentanyl, a powerful anesthetic, from Exeter Hospital's cardiac catheterization lab and returning dirty syringes to treatment areas where they were used on patients. He is accused of infecting more than 30 patients with hepatitis C. He has worked in recent years at hospitals in Arizona, Georgia, Michigan, Maryland, and New York and most recently at Hays Medical Center in Hays, Kansas. (boston.com, July 23, 2012)

Proventix Records the 10 Millionth Hand Wash
Proventix Systems, Inc has recorded more than 10 million hand washing events in an initiative by hospitals across the country to improve patient safety through hand washing. Princeton Baptist Medical Center in Birmingham, Alabama, showed a 22 percent reduction in healthcare-associated infections (HAIs) with use of the nGage system. The hospital expanded the system to the Medical Intensive Care Unit and infection markers were reduced by 35.1 percent when compared to the same months in the previous year. These reductions resulted in a decrease of 239 patient days and a reduction in net losses of $200,079. (MarketWatch, July 24, 2102)

Care Up in the Air
Rural hospitals recognize the benefit of helicopter transport for many trauma patients but concern is growing regarding the safety of these costly services. A recent report indicates that adult trauma patients have better odds for survival if transported by ground. New rules governing helicopters in EMS (HEMS) are expected which could improve the safety of these services. These rules, proposed in 2010, resulted from nine helicopter accidents in 2008; six of those accidents produced 24 deaths. (Modernhealthcare.com, July 21, 2012)

Court Rules Nurse Anesthetists Don't Need Physician Supervision
A Colorado decision to allow nurse anesthetists to administer anesthesia to patients with the supervision of a physicians has been upheld by a Colorado appeals court. In a related case the California Supreme Court refused to block a similar ruling. These cases resulted from decisions by the governors to opt out of rules requiring CRNA to be supervised by a physician. The Colorado Society of Anesthesiologists and the Colorado Medical Society sued and will likely appeal to the Supreme Court. The decision raises complex liability concerns for all parties. A Colorado doctrine holds that an operating surgeon is liable for the actions of all those in the operating room making the supervision of a nurse anesthetist an important issue. (amednews.com, August 6, 2012)

China Launches WHO Patient Safety Curriculum Guide
China has adopted the World Health Organization's (WHO) Patient Safety Curriculum Guide. The Guide is intended to address the fact that an estimated one in ten hospital patients suffers serious injury or death resulting from inadequate care. The Guide addresses various medical fields including dentistry, nursing and pharmacy. Wang Zhong, a doctor from Peking Union Medical College Hospital, says the key is for doctors to take patient's needs into account. "A patient should be treated as an individual rather than as a subject carrying diseases. Doctors should not only look into the illness a patient has suffered physically, but more importantly what the patient feels. Only after knowing what the patient really needs can the doctors set up a personalized treatment plan and relieve a patient's pain." See the resource section below for a link to the WHO's guide. (CRI English.com, July 19, 2012)

WHO - Patient Safety Curriculum Guide

The World Health Organization has developed a patient safety curriculum guide. The PDF version can be found here.

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The Political Economy of Quality Improvement in the U.S. Today

Marc J. Roberts, PhD
Harvard School of Public Health, Cambridge, MA