Healthcare-Associated Infection Reports

By John Govednik, MS; Maryanne McGuckin, Dr. ScED, FSHEA; Jessica Bunson, MS, MT (ASCP), CIC; David Hyman, MD, JD; and Bernard S. Black, JD

Healthcare-associated infections (HAIs) are one of the top-10 leading causes of death in the United States (Klevens et al., 2007). When in the hospital for treatment, a patient risks being among the 5% who become infected by bacteria or viruses from other patients or from the hospital environment (The World Health Organization, 2009). These bacteria and viruses are spread in various ways, including unwashed hands of personnel or visitors, inadequate sterile techniques, and patient care practices.

Integrating Biomedical Devices Across the Enterprise? Go with the Flow

By Mike Freeman, BSBA

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.

Brain Science Provides New Approach to Patient Safety Training

By B. Price Kerfoot, MD, EdM

No matter how rigorous and well-formulated patient safety training may be, attendees cannot escape the normal physiological process of forgetting that can wipe out much of what they learn even within 30 days. This “forgetting curve” is a daunting consideration for health quality leaders who must assure their staff members continually meet Joint Commission and other healthcare quality standards long after a training course is completed.

Don’t (Always) Give Blood

By Rohinton J. Morris, MD; and Charles Yarnall, CCP

Every Friday morning at Abington Memorial Hospital in suburban Philadelphia, cardiac surgeons, anesthesiologists, medical technologists, and critical care nurses gather to discuss new protocols. Later the same day, they go on rounds together, gathering at open-heart surgery patients’ bedsides to share knowledge and look for ways to improve outcomes for these critically ill patients.

Editor’s Notebook

Public Reporting: What Do Consumers Really Need?

By Susan Carr

The authors of our cover story, “Healthcare-Acquired Infections—How Effective is Public Reporting?” report that 32 states plus the District of Columbia are currently required to report rates of hospital-acquired infections (HAIs) in their states. Govednick, McGuckin, and their co-authors review the background for reporting HAI rates and evaluate different methods of reporting the data.

Health IT & Quality

Our Tower of Babel

By Barry P. Chaiken, MD, FHIMSS

The Bible describes why humans speak so many languages:

The narrative of the city of Babel is recorded in Genesis 11:1-9. Everyone on earth spoke the same language. As people migrated from the East, they settled in the land of Shinar. People there sought to make bricks and build a city and a tower with its top in the sky, to make a name for themselves, so that they not be scattered over the world…

Healthcare Analytics

Analytics Drive Transparency Efforts

By Graham Hughes, MD; and Krisa Tailor

A variety of initiatives are dragging U.S. healthcare kicking and screaming from a system where performance data is a closely guarded secret to one where transparency is the norm.

ISMP

Develop Partnerships with Technology and Device Vendors to Improve Staff Training

By The Institute for Safe Medication Practices

When new medication-related technology or a device is implemented in an organization, staff training is critical to optimize its use, employ all its safety features, and prevent misuse that might lead to medication errors. For teaching staff how to use the technology or device, could there be a better partner than the vendor of the product?

Social Technologies

Meeting the Challenges of Population Health

By Christina Thielst, FACHE

Social technologies offer powerful tools that can be applied in healthcare settings to improve the quality of care and patient safety, especially as the U.S. healthcare delivery system transforms to accommodate changes brought about by the Affordable Care Act and aging baby boomers.

Staffing

New Nurse Turnover and Patient Safety: What’s the Problem?

By Karlene M. Kerfoot, PhD, RN, NEA-BC, FAAN

Ineffective staffing programs are often the invisible factors that cause the best intentioned patient safety programs to collapse. Positive patient care outcomes depend on a “point of excellence” where the clinician and the patient interact synergistically every time. Variability between clinicians because of nurse turnover blocks the chances of achieving excellence, which is particularly harmful when it involves the new nurse.