There are two kinds of things we especially like to report here at Hospitals & Health Networks. One is about hospital folks who have taken it upon themselves to improve the process and quality of care. The second is when those improvements are so practical other hospitals might want to adopt them. Here are three examples that have come to my attention recently.
• In a study conducted at 43 of its hospitals, HCA reduced MRSA and other bloodstream infections by 44 percent by bathing all intensive care unit patients with microbial soap and swabbing under their noses with a chemical ointment. Universal decolonization — putting each and every ICU patient through those procedures — proved more effective than two other prevention strategies: screening all ICU patients and isolating MRSA carriers; or screening, isolating and decolonizing MRSA carriers. The study was published in the New England Journal of Medicine.
• Researchers at the Children’s Hospital at Montefiore reduced the average wait time for kids to see a primary care physician from 11 weeks to two weeks by implementing modest changes such as scheduling nurse practitioners and physician assistants for noncritical follow-up appointments. Prior to that, physicians often were allotted a certain number of new appointments but ended up using them for follow-up appointments. The strategy also called for developing contingency plans to handle periods of high demand. Regular team meetings and monthly meetings with the hospital’s director of pediatric ambulatory sub-specialty keep the physicians and staff from falling back into old habits. Other positive results: A significant increase in new patients’ visits and a reduction in the time it takes to get a follow-up appointment from eight to two weeks. The study was published in Pediatrics.
• Researchers at Intermountain Medical Center in Salt Lake City developed a real-time electronic screening tool to speed up diagnosis and treatment of patients with pneumonia. The tool monitors patient data, analyzing more than 40 variables, including vital signs, lab results, chest X-ray reports, nurse examination findings and the patient’s primary symptom, to determine the probability of a patient having pneumonia. The data is calculated and then displayed on computer screens in the emergency department. If it measures a 40 percent or greater likelihood that a patient has pneumonia, the physician is alerted and the data reviewed to determine if the patient indeed has the infection. Doctors have used the tool since May 2011 in four EDs. It will continue to be developed and improved.
“Our goal is to have the tool standardize what we do to ensure that we are all doing the same things consistently for all patients,” said Caroline Vines, M.D., an emergency medicine physician and co-investigator. “The best thing about the tool is that it’s easy to use and reminds you to order the appropriate tests and proper antibiotics for the patient.” The report was published in JAMA Internal Medicine.