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JCAHO Affiliate
Publishes Infection Control Books NDEP Publishes Two Evidence-Based Guides WHO
Cites HHS as ‘Key Partner’ in
New Patient Safety Effort U.S.
Adults Wait Longer to See Doctors, Int’l
Survey Reports EHRs to Have Positive Financial Impact, Survey
Says Report Proposes $3-6 Incentives Per Patient
for EHR Adoption NEJM Study Finds Lack of Sleep Can Lead to
Medical Errors Wyatt, NBCH Partner to Evaluate Health Plans JCAHO-Sponsored Patient Safety Film to Debut
Nov. 9 JCAHO Affiliate Publishes Infection Control Books The Joint Commission Resources, an affiliate of the Joint Commission
on Accreditation of Healthcare Organizations has published two new books
on infection control. The first
book, “Meeting JCAHO’s Infection Control Requirements:
A Priority Focus Area,” illustrates the challenges of infection
control in all types of health care organizations and describes the Joint
Commission’s 2005 infection control standards plus the priority
focus area on infection control and the National Patient Safety Goal
on reducing the risk of health care-associated infections. “Infection Control Issues in the Environment of Care” addresses
infection control issues from the environment of care professional’s
perspective. This book explores infection control issues involving personnel,
equipment, utilities, building, construction, and performance measurement
and improvement. It also provides strategies, tools, and practical tips
to improve infection control strategies. To order these publications, call 877-223-6866, 9 a.m. to 9 p.m. Eastern
time, weekdays, or visit Infomart on the JCR website at www.jcrinc.com. NDEP
Publishes Two Evidence-Based Guides The National Diabetes Education Program has published two evidence-based
guides for health care to help providers and patients with diabetes and
pre-diabetes. “Guiding Principles for Diabetes Care” helps
providers identify people with pre-diabetes and undiagnosed diabetes
and provide patient-centered care. “4 Steps to Control Your Diabetes for Life,” helps
providers educate patients in vital self-care principles and to be
active partners in their own care. Information for children and high-risk minority populations also is
available, including materials in Spanish, Asian and Pacific Islander
languages. For more
info, http://www.ndep.nih.gov WHO
Cites HHS as ‘Key Partner’ in New Patient Safety Effort The World
Health Organization announced it has launched the World Alliance for
Patient Safety, a partnership between WHO, ministers of health and
senior officials, academics and patients’ groups have come together
from all corners of the globe to advance the patient safety goal of “First
do no harm” 1 and reduce the adverse health and social consequences
of health care. WHO said the alliance marks the first time that a coalition of partners
has joined efforts to act globally to improve patient safety. “Improved health care is perhaps humanity’s greatest achievement
of the last 100 years,” said WHO Director-General Lee Jong-wook. “Improving
patient safety in clinics and hospitals is in many cases the best way
there is to protect the advances we have made.” A number of countries have already initiated patient safety plans and
legislation. In particular, two partners of the Alliance - the Department
of Health of the United Kingdom and the Department of Health and Human
Services of the United States of America - are committing resources and
expertise to start reversing the escalating incidence of preventable
adverse effects in health care. The creation of the World Alliance comes two years after the 55th World
Health Assembly Resolution on Patient Safety in 2002. For more info, www.who.int. U.S.
Adults Wait Longer to See Doctors, Int’l Survey Reports An international
survey of patients’ experiences with doctors
in five nations found that U.S. and Canadian adults are the least likely
to see a doctor the same day when sick and most likely to wait multiple
days for care. The use of emergency rooms for non-emergencies was most frequent in
countries with lowest rates of same-day access to doctors, and patients
in all five nations report lab test errors and delays in receiving results.
U.S. patients are most likely to have high out-of-pocket health care
costs and to forego care because of costs, compared to the other four
countries, Australia , Canada , New Zealand , and the United Kingdom
. In “Primary Care and Health System Performance: Adult Experiences
in Five Countries,” the Commonwealth Fund surveys patients in five
countries, and the results were published in a Health Affairs Web
exclusive. The survey found shortfalls in all countries but also country
variations in delivering accessible, safe, high-quality and patient-centered
care. “Health care leaders in all five countries should be concerned
about missed opportunities, errors, and gaps in primary health care,
which is the core of any health system,” Commonwealth Fund President
Karen Davis said of the report. “The good news is that these deficits can be improved through
targeted policy interventions, which some countries have already undertaken
by investing in electronic medical records and prescribing systems, and
redesigned primary care practices,” Davis said. The article, authored by Commonwealth Fund Vice President Cathy Schoen
and colleagues at the Fund and Harris Interactive, is based on the 2004
Commonwealth Fund International Health Policy Survey, conducted by Harris
researchers between March and May 2004. For more
info, www.healthaffairs.org. EHRs to Have Positive
Financial Impact, Survey Says The majority
of executives at major health organizations believe that Electronic
Health Records (EHRs) – widely considered a critical
step to reducing medical errors and lowering administrative and medical
costs – will also have a positive financial effect on their organizations
over time. More than 70% of the respondents to a Capgemini survey
held that view and a vast majority—88%—indicated that their
organizations have either already begun to take concrete steps to address
the adoption of EHRs or expect to do so within the next six months. The survey,
fielded by health care consulting firm Capgemini in early October,
drew responses from executives at 84 hospitals, health insurers, physicians,
health technology vendors and other types of health organizations,
representing a cross section of the health care industry. “The fact that many health care organizations are beginning to
seriously discuss EHR implementation and develop their own financial
analysis of adopting clinical information technology is very encouraging,” said
Lewis Redd, national leader for Capgemini’s health practice. “We
find it particularly interesting that nearly a third of the respondents
think their organizations are actually in the process of implementing
EHRs.” Capital
costs are cited by the majority of respondents, or 58%, as the greatest
obstacle to implementation, with physician resistance to adoption and
lack of office technology mentioned by 46% as another major hurdle. Other reasons
cited for slowing progress on implementation of EHRs include: For more
info, www.us.capgemini.com/health. Report Proposes $3-6
Incentives Per Patient for EHR Adoption A public-private
collaborative has released “Financial, Legal
and Organizational Approaches to Achieving Electronic Connectivity in
Healthcare,” a report which proposes a level of financial incentives
necessary to significantly increase the adoption of electronic health
records (EHR) by doctors. Undertaken by Connecting for Health’s
Working Group on Financial, Organization and Legal Sustainability of
Health Information Exchange, the report proposes incentives at a rough
level of $3-$6 per patient visit or $0.50 -$1.00 per patient per month. The report notes that small and medium sized practices, while likely
to benefit more than larger ones from interoperability, will require
greater attention and assistance due to their lack of resources, and
suggests that financial and other types of support should be provided
to local and regional electronic health record efforts and information
sharing collaboratives. “Electronic health records have the potential to help reduce
medical errors, lower costs and empower patients,” said Carol Diamond,
MD, managing director at the Markle Foundation and chair of Connecting
for Health. “However, without the widespread adoption of electronic
health records by small and medium physician practices - that represent
more than half of the practices in this country - and the requirements
for achieving the level of interconnectivity necessary to allow for the
effective exchange of health related information, the benefits of information
technology cannot be fully realized. We hope this report sparks a full
and frank debate over the issue and that it can be a first step toward
realizing the potential of electronic health records.” The report concludes that the current business case for the adoption
of health information technology ( HIT ) systems is not sufficient and
that financial incentives are necessary to encourage health care providers
to adopt IT systems that allow for interconnectivity to improve the quality
of care. The report also finds that initial financial incentives for
small and medium sized practices will need to cover most of the costs
of adopting electronic health records, but that over time, these incentives
will transition to performance-based incentives. The range of incentives
is estimated to be $12,000 - $24,000 per full time physician per year.
The analysis also shows that the business case for the incremental adoption
of applications of HIT is sound, as long as the applications are interoperable,
and suggests that e-prescribing and on-line tools for chronic disease
management are good starting points. The report concludes that most management and legal issues related
to the establishment of a secure, confidential health information infrastructure
can be addressed in the context of existing law and through the use of
contracts. For more
info, www.connectingforhealth.org. NEJM Study Finds
Lack of Sleep Can Lead to Medical Errors Brigham
and Women’s Hospital (BWH), in two of the nation’s
first comprehensive studies of sleep and medical intern performance,
has found evidence that eliminating extended work shifts of 24 hours
or more, implementing shift limits of 16 hours or less and reducing work
weeks to less than 80 hours, decreases the number of medical errors performed
by this group of physicians. In the
two studies, senior researcher Charles A. Czeisler, PhD, MD, chief
of BWH’s
Sleep Medicine Division and colleagues, gathered evidence evaluating
the effect of eliminating extended works shifts. BWH is unveiling its
plan to enhance patient safety through regulating shifts for its post-graduate
year-one (PGY-1) interns, including: Both studies were published in the Oct. 28, 2004 issue of the New
England Journal of Medicine (NEJM), at http://content.nejm.org. “While sleep experts advocate eight hours of sleep per 24 hour
period, it has historically been difficult to achieve in medicine as
patient care is an around the clock effort. These are the first studies
to demonstrate clinically that reducing work shifts and tackling sleep
deprivation will help increase attentiveness and reduce medical errors,” Czeisler
said. In the
first study in the NEJM, lead researcher Steven W. Lockley, PhD, Czeisler
and colleagues studied 20 interns during two three-week rotations in
both a medical intensive care unit (MICU) and a coronary care unit
(CCU). Through daily sleep and work logs and continuous eye movement
monitoring through electrooculography (EOG), researchers found that
interns on the intervention schedule worked 19.5 hours per week less,
slept 5.8 hours per week more and slept more in the 24 hours preceding
each working hour. In addition, these interns had less than half the
rate of attentional failures – as defined by slow rolling eye
movements – while
working during on-call nights. In the
second study, lead researcher Christopher P. Landrigan, MD, MPH of
BWH and Children’s Hospital Boston, Czeisler and colleagues
conducted a randomized study in which the rates of serious medical errors
made by PGY-1s in a MICU and CCU were observed when working a traditional
shift with extended work shifts – 24 hours or more – and
an interventional schedule that eliminated extended work shifts. The
researchers found that during a total of 2,203 patient-days involving
634 admissions, interns made 35.9% more serious medical errors during
the traditional schedule than during the intervention schedule. These errors
did not translate into increased serious complications leading to deaths
or prolonged stays in the ICU, the study reported. This may be due
to the fact that BWH has implemented many patient safety improvements
including enhanced computerized physician order entry and an electronic
pharmacy. For more
info, www.brighamandwomens.org. Wyatt, NBCH Partner
to Evaluate Health Plans Watson Wyatt
Worldwide, a human capital consulting firm, and the National Business
Coalition on Health (NBCH), a non-profit organization of employer-based
health coalitions, announced that Watson Wyatt and NBCH will conduct
annual evaluations of health plans for their employer clients and coalitions
using the NBCH’s eValue8 Request for Information tool. The results
of these national health plan surveys will be available to both Watson
Wyatt clients and NBCH for its member coalitions to use in their assessment
and management of health plans. Each evaluation will include hundreds of benchmarks on critical issues
such as plan administration, provider performance, pharmacy benefit management,
disease management, patient safety, and member and provider communication.
The benchmarks will help employers improve service and make the most
of their health care spending. Using a
standard request for information (RFI), the eValue8 tool gathers comprehensive
data on health care quality and performance from all types of health
plans and providers including health maintenance organizations and preferred
provider organizations. For more information about eValue8 Request for Information,
please visit www.nbch.org and www.watsonwyatt.com. JCAHO-Sponsored Patient Safety Film to Debut
Nov. 9 Partnership
for Patient Safety (p4ps) announced that the newest in its acclaimed
series of video-based patient safety learning tools will premiere at
A Prescription for Patient Safety and Medical Liability: New Solutions
to an Old Dilemma, a symposium sponsored by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) and Joint Commission
Resources. The conference will be held at the Hilton Alexandria Mark
Center , Alexandria , VA , November 8-9, 2004. First,
Do No Harm® Part 3: Healing Lives, Changing Cultures was
developed by Chicago-based p4ps and Captains of Industry, a film-making
and communications company located in Boston . Drawn from actual medical
malpractice claims files, the First, Do No Harm® series follows the
fate of Ariana Romanov, a healthy, pregnant woman who step by step falls
between the cracks of the health care system, with tragic results. Part 1, produced in 2000 -- just months after the Institute of Medicine
highlighted medical error as a serious public health epidemic -- depicts
the trajectory of failure in care experienced by Romanov, her husband
and her medical care providers, as small mistake built on small mistake.
Part 2, which debuted in 2002, examined initial reactions as all of the
people involved struggled to cope with tragedy. Both films have been
widely used by patient safety leaders and educators across the globe. First,
Do No Harm® Part
3: Healing Lives, Changing Cultures debuts on November 9, 2004 at 7:30
AM , Hilton Alexandria Mark Center Hotel, Plaza Ballroom B and C. About Partnership for Patient Safety (p4ps) For more
information about the JCAHO/JCR conference, A Prescription for Patient
Safety and Medical Liability: New Solutions to an Old Dilemma, Alexandria
, VA , November 8-9, 2004 , see www.jcrinc.com/education.asp?durki=6996&site=5&return=6118. For more
information about the Joint Commission on Accreditation of Healthcare
Organizations, contact Charlene Hill at (630) 792-5175 or via email
at chill@jcaho.org. For more
information on Captains of Industry, contact Ted Page at (617) 236-7577,
ext. 202, or via email at ted@captainsofindustry.com. For more
information about Partnership for Patient Safety, contact Mitchell
Dvorak, at (312) 274-9695 or via email at mdvorak@p4ps.org.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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