Health IT & Quality

We Know What to Do

By Barry P. Chaiken, MD, FHIMSS

Almost eight years ago Richard Hillestad and his colleagues from the Rand Corporation predicted that electronic medical record systems (EMRs) would generate cumulative efficiency and safety savings of $142 to $371 billion during a 15-year period, an average of $81 billion annually (Hillestad et al., 2005). These savings were based upon assumptions of a low-end 1.5% productivity improvement from information technology (experience of the retail industry) to a high-end 4% productivity improvement (half of telecom industry experience).

Medical Home

Information, Communication, and Teamwork for Care Collaboration

By Thomas McCarrick, MD

Hospitals now face penalties if too many discharged patients are readmitted within 30 days. This Medicare stipulation in the Affordable Care Act comes in response to expert analysis that indicates lack of discharge planning and poor follow-up care can lead to unnecessary admissions and higher healthcare costs.

Editor’s Notebook

Nurses and Social Media

By Susan Carr

Working on an article for this issue (pg. 32), I conducted a brief survey of 12 nurse executives, which included a question about social media. Their responses confirmed my sense that most healthcare professionals are interested but tentative in their use of social media.

News

HENs Help Hospitals Spread What They Already Know

By Susan Carr

With this issue, Patient Safety & Quality Healthcare (PSQH) reaches its fifth anniversary, which prompts me to take a moment and think about how much the world has changed and stayed the same in the past five years. When we published the first issue, in July 2004, the patient safety community was discussing how much progress—if any—had been made since the IOM published To Err Is Human five years earlier, and now we are assessing progress made over the past 10 years.

EMPSF

Drug Shortages and Emergency Care: Your Action Is Needed

By James J. Augustine, MD, FACEP

An unprecedented, unexpected, and unplanned shortage of emergency medications has resulted in a quickly expanding set of problems for emergency departments (EDs) and emergency medical services (EMS) systems. The causes of this shortage are poorly understood, but the manufacturers and federal agencies that oversee drug supply and manufacturing practices—Federal Drug Administration (FDA) and Drug Enforcement Administration (DEA)—have been at odds for the past few years over safe manufacturing and quality processes. In certain circumstances, problems in the supply chain for raw materials for drugs cause shortages; for example, some raw materials come from overseas sources and may be subject to factors such as wars, weather, and problems with supply. Medication shortages are affecting many specialties, including oncology and anesthesia, but the emergency care system is particularly at risk for patient safety issues.

Health IT & Quality

‘Show Me the Money’ Revisited

By Barry P. Chaiken, MD, FHIMSS

In the immortal words of Ronald Reagan, “There you go again.” Something that can be explained simply is twisted to look infinitely complicated with plots and subplots that would make J.K Rowling proud. The recent controversy over the use of electronic medical records (EMRs) to increase reimbursements to providers suggests intrigue, fraud, and bad intent. In contrast, if you learn how the money flows, you will better understand the true reasons for the outcomes seen in organizations using EMRs.

The Leadership Value Equation: Quality Care at Reasonable Cost

By Barbara Rebold, RN, MS, CPHQ; Alide Chase, MSN; and Jed Weissberg, MD

Effective quality programs require leadership engagement. External pressures such as healthcare reform, pay-for-performance reimbursement, value-based government purchasing, public reporting of outcomes, Sarbanes-Oxley Act corporate responsibility requirements, state laws regarding corporate oversight, the Joint Commission leadership standards, the Institute for Healthcare Improvement’s campaign for “Getting Boards on Board,” and the American Hospital Association’s governance principles have brought the value equation between the quality and financial aspects of healthcare into sharp focus.

Rapid Change with Clinical Performance Groups: Define, Design, Implement

By Barbara LaBranche, RN, BSN, MBA; and Michael Parris, MBA, MSIE, SSBB

An analysis of current practice indicated few of our facilities had policies regarding elective deliveries at less than 39 weeks, and those that did were not following them consistently. It became clear to the CPG this was an area that could be positively impacted in a short period of time.

Quality in Healthcare: A Five-Dimensional View

By Daniel L. Cohen, MD, FRCPCH, FAAP

Readers may be familiar with John Godfrey Saxe’s poetic version of the Asian Indian legend concerning the six blind men who each tries to describe an elephant by reaching out and touching the part closest to where he is standing. One touches the trunk, another a leg, one the tusk, and so on; and each describes the pachyderm by what his sense of touch has revealed, and of course none of them accurately describes the elephant.

Better Care for Patients with Atrial Fibrillation: A Three-Part Approach

By Doron Schneider, MD, FACP

Some 2.6 million Americans have atrial fibrillation, a leading cause of hospitalization in the United States. Each year, 300,000 new cases of this form of cardiac arrhythmia are diagnosed, often due to the chest pain, palpitations, syncope, and exacerbation of heart failure associated with the condition. It is a condition that requires careful management: atrial fibrillation causes 20% of all strokes, and these are more likely to be the most severe, life-altering strokes.