Christina's Considerations

The Doctors and Richard Simmons

The Doctors have been focused on exercise this month and I thought I'd share this video clip as a reminder to all doctors to have those conversations about weight and exercise with your patients.  I, too, also hope it helps inspire a few readers to get up and exercise. 

I don't watch The Doctors (too busy working), but I do love Richard Simmons and think I'll go for a walk now!!!

A few of the 13 secrets being revealed on the show are:

•  Gym membership not in the budget? Exercise at home using items you already have, including:
  • Tights (stockings) – Work shoulders, biceps and upper back by using tights just like resistance bands.
  • Paper Plate Push Ups – The increased resistance from a paper plate can amp up any workout.  Put plates under your hands and do a push-up; slide hands closer together and do another push-up; repeat.  Or, place plates under feet and do “mountain climbers” to work triceps and chest muscles.
• Fake a butter allergy! Even the healthiest veggies can be sabotaged by too much butter. If you’re dining out and worried the chef may not honor your request to remove butter, tell the server you have an allergy and save yourself from unnecessary saturated fats.
• Text a buddy!  Instead of keeping a food diary, try the “text accountability system” and text a friend what you eat each day. A friend may be able to better help maintain perspective on your diet.
• Ditch the mundane treadmill workouts. Challenge yourself with a water resistance course – Co-host Dr. Jim Sears shows viewers how an H20 boot camp can burn up to 600 calories/hour without the joint pain some experience in a regular workout.

 

 

Telemedicine: A Public Service Announcement

If you are like me and feel we need to start educating consumers on the power of telemedicine, then please share this video.  It was created by my friends at @CTELTweets, so let them know what you think!

 

I am the patient experience!

What a great few days of learning it has been here at The Beryl Patient Experience Conference.  The video below sets the stage for how we healthcare workers are the patient experience.  Below the video are some key quotes/thoughts from the last couple of days.

• Empathy and compassion were key themes!
• Will Boomers push for combined physician and hospital bills - so they can understand better?
• Physicians weren't really trained to deal with patient fears!
• Decrease perceived wait time just by asking waiting ED patients, "How is your pain?" or "How is the wait?"
• It's not about meeting patient expectations, it is about exceeding them!
• The culture is driven by management systems and priorities... not workers or values.  What gets your leader's attention?
• Reshape expectations - as far upstream as you can!
• Healthcare is not a service industry, it is an "experience" industry.  The emotion (pain, stress, suffering) and mask of tragedy!
• A exceptional experience is magic, not a script!
• Happy employees make happy patients!
• Focus on what can't be measured - from Deming actually.
• Empathy, then the broken record.
• The strategy for engaging physicians is to:
  • engage as partners in planning the patient experience,
  • help them build their skills, and
  • develop and support physicians as coaches and team players.
• We need more courageous conversations in healthcare!
• The hospital is in the safety/security level of Maslow's Hierarchy.
• Check out the Critical Care Family Assistance Program guidelines from the American College of Chest Physicians

Patient Engagement & Their Experience: The Virtual Touch Points

My new collegues at Tower seem to like the fact that I envision and write about the application of technologies to improve the work that has to get done in hospitals.  Since my work is now focused on re-defining patient experiences across all touch points (physical and virtual), we created a paper that highlights opportunities to engage consumers and patients using technologies for an enhanced web experience.

Patient Engagement and Their Experience: The Virtual Touch Points was prepared just in time for this week's Patient Experience Conference and it ties my long-term passion for improving care for the benefit of our patients to the role of information technology.  

The paper explores the drivers for transforming the way healthcare organizations engage consumers, patients and their families and the web-based opportunities across the continuum of care from pre-admission through post treatment follow-up and across all departments.  It describes how virtual engagement can enhance patient experiences and satisfaction with provider encounters.  It also highlights the role of key technologies, such as, enterprise portals, social media, mobile applications, business intelligence and telehealth.

According to our CEO, Sue Sutton, RN, PhD, “It is important to address the needs of patients where they are in their experience and tie disparate information systems together to present a seamless interaction for patients and their family caregivers.  Providing access to self-management tools and creating opportunities to help enhance their encounters with the system contributes to more engaged and accountable patients.”

The team at Tower has helped expand my view of technology applications, which we all agree, is an important strategy to enhancing today’s patient experiences, as well as, contributing to more efficient business and care processes, better outcomes and lower costs.

Trusted Source: Certified Medical Apps and Products

Not long ago I referenced Continua in an interview about securing and optimizing iPads and don't believe I've included them in a blog post.  So, it is probably a good time to share a little more information.

Continua is a pioneer in establishing industry standards and security for interoperable connected health technologies such as smart phones, gateways and remote monitoring devices. They were established established six years ago with the mission to empower information-driven health management and facilitate the incorporation of health and wellness into the day-to-day lives of consumer.  Their 250 members represent companies from around the world; including Intel, Microsoft, IBM, GE Healthcare, and Cisco.

The risk manager in me recommends that apps be downloaded from trusted sources, so I was really pleased to learn that they are certifying medical apps, as well as, devices and services for personal health management and healthcare delivery. Their certification is granted to technologies that meet their guidelines and to date, 45 diverse products have been certified.  This includes weight scales, glucometers, and blood pressure monitors.  Their first Apple mobile solution enables developers to build custom health applications and connect with other certified personal health devices and facilitates integration with various interoperable servers to relay health information.

While there is no absolute protection, this is a good start!

 

Liking, following, linking, tagging, stumbling: social media is changing the nature of health-related interactions

Earlier this year I was invited by the eHealth Initiative to participate in a focus group for PwC Health Research Institute's newly released report entitled, “Social media likes healthcare: From marketing to social business.”  It included both consumer and industry surveys.

The report finds that social media activity by hospitals, health insurers and pharmaceutical companies is miniscule compared to the activity on community sites. While eight in 10 healthcare companies (as tracked by HRI during a sample one-week period) had a presence on various social media sites, community sites had 24 times more social media activity than corporate sites.

Highlights from the consumer survey found:

• One-third of consumers now use social media sites such as Facebook, Twitter, YouTube and online forums for health-related matters, including seeking medical information, tracking and sharing symptoms, and broadcasting how they feel about doctors, drugs, treatments, medical devices and health plans.

• When asked how information found through social media would affect their health decisions, 45% of consumers said it would affect their decision to get a second opinion; 41% said it would affect their choice of a specific doctor, hospital or medical facility; 34 % said it would affect their decision about taking a certain medication; and 32 % said it would affect their choice of a health insurance plan.

• As is the case more broadly, young adults are leading the social media healthcare charge. More than 80 % of individuals between the ages of 18 and 24 said they were likely to share health information through social media channels and nearly 90 % said they would trust information they found there. By comparison, less than half (45%) of individuals between the ages of 45 and 64 said they were likely to share health information via social media. But, keep in mind that 45% is a really big group of aging Boomers.

• Sixty-one percent of consumer respondents are likely to trust information posted by providers, and 41% are likely to share with providers via social media, compared to 37% trusting information posted by a drug company, and 28% likely to share information with a drug company.

Findings from the surveyed eHealth Initiative members include:

• Eighty-two percent said their organization’s social media efforts are managed by marketing/communications. Few organizations said their IT departments and digital teams owned social media strategies.

• One-half said they are concerned about how to integrate social media data into business strategy and processes. 

As I often advise, it is important to include a social media strategy in your hospital's plans for engaging patients and consumers.  The plan should include a balance of engagement on community and corporate sites, as well as, promote innovation for applying the technologies as solutions to clinical challenges.

Apps for Heart Attack and Stroke Prevention

The Office for the National Coordinator recently announced the winners of their "One in a Million Hearts Challenge," which invited developers to create software applications aimed at promoting heart health. The contest supports HHS' Million Hearts Initiative and the goal to prevent one million deaths from heart attacks and strokes over the next five years.

The winning apps are: 

• THUMPr,  first place, enables users to easily create personal heart health profiles and provides individualized heart health recommendations based on the Million Hearts Initiative's ABCS framework, which stands for aspirin, blood pressure, cholesterol and smoking cessation ($50,000 prize);
• mHealthCoach, second place, incorporates 11 unique data feeds, supports social media integration, peer communities, and fitness groups to educate users about heart health ($20,000 prize); and
• Wellframe, third place, focuses on patient engagement, evidence-based information and resources, targeted and actionable information and ease of usability to provide heart disease risk assessments, social comparisons, educational information and preventive care notifications ($5,000 prize).

The challenge was designed to foster innovative health IT solutions that empower patients to pursue healthy lifestyles and improve their heart health.  These new tools go a long way toward engaging patients and their families to take a more active role in their care and will, hopefully, also contribute to fewer admissions/re-admissions and a better experience with the healthcare system.

CA Nurses Can Administer Anesthetics

A state appeals court has ruled nurses who are trained as anesthetists do not need a doctor's supervision to give anesthetics to California hospital patients.  I think the impact will be primarily felt in rural communities where it is often more challenging to recruit acute and specialty staff.

I understand the concerns of physicians, but if I'm the injured or laboring patient experiencing serious pain in the rural hospital ER - that hasn't been able to recruit sufficient anesthesisa coverage, I'll take the medications from a well trained nurse who isn't being supervised during the administration process.

We have a physician specialist distribution issue and we need to find new ways to deliver the care patients need.

Also see Moderninzing Rural Health Care and Rural Healthcare: Increasing Access to Physicians and Technology.

Making Patient Experience a Priority - Infographic

Source: berylhealth.com via Nrip on Pinterest

Tools Help Foster Communication Between Patients and Clinicians

I'm a big fan of the AHRQ's tools and have a new one to share.  I realize that some people aren't impressed by some of the tools, but overall I think that they are good -- and they are free.  If for no other reason, they will help stimulate ideas among providers who that then improve upon the resources they provide.

The latest tools are part of the “Questions Are the Answer,” a new public education initiative that encourages patients and their clinicians to engage in effective two-way communication to ensure safer care and better health outcomes.  An added benefit, or as we say in Louisiana a little "lagniappe" is the contribution improved safety and outcomes has on the patient experience.

To promote safer care and the importance of Patient Safety Awareness Week (March 4–10), AHRQ offers these free multimedia tools that health care providers can use with their patients:

• A 7-minute video featuring patients and clinicians who give firsthand accounts on the importance of asking questions and sharing information—this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.
• A new brochure, titled "Be More Involved in Your Health Care: Tips for Patients," that offers helpful suggestions to follow before, during and after a medical visit.
• Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.
• An interactive “Question Builder” tool that enables patients to create, prioritize and print a personalized list of questions based on their health condition.

For more information, go to www.ahrq.gov/questions. To request free copies of the DVD, brochure and notepad, email AHRQpubs@ahrq.hhs.gov or call 800–358–9295 and include the following reference numbers: DVD (AHRQ Pub. No. 10-(12)-0094-DVD); brochure (AHRQ Pub. No. 10(11)-0094-A; notepad (AHRQ Pub. No. 10(11)-0094-1).

  

 

What I saw/learned at HIMSS12 - Highlights

It has taken me a while to catch up and recover from being at HIMSS12 last week, but I've finally had a chance to sit down and reflect on what I saw and learned during that busy week.  So below are my higlights:

• Thoughts from Biz Stone: 
  • Opportunity can be manufactured! You can create it!
  • Creativity is a renewable resource. It is infinite! Challenges are fun puzzles; not problems!

• Thoughts about the Future from the Smith and Hobbs presentation on Clinical Mobile Applications: 
  • 500 million people are expected to manage health concerns with smartphone apps by 2015 according to Research 2 Guidance 2010.
    
  • "Drive discovery about behavior, adapting to person and optimizing behavior"
  • The convergence of biology and machine
  • We need to establish risk model taxonomies for consumers, providers and manufacturers for safe & secure apps.
  • We need sensors to pick up signs that an intervention is needed in healthcare, just like our cars are doing today.

• CMS' ICD 10 and Version 5010 Implementation Timeline widget

• Guam HIE Project that demonstrate its Secure Messaging capabilities using the Nationwide Health Information Network Direct Project for coordinated care and disaster communications.

• Kaiser Permanente launched its new Mobile Optimized kp.org app giving members access to their medical records, refill prescriptiosn, appointments and messaging via mobile devices.

• Learned about iTriage's ER CheckIn smartphone app service that hospital staff of incoming patients. iTriage is the same one that made it to my list of top apps for the flu season late last year.

• The There's an App for That presentation demonstrating apps for vision, hearing, sleep, sobriety test, contractions/labor, smoking cessation, heart rate, spirometry, Airstrip, AED, allergy alert, EKG, podiatry, and more.

• The Patient Safety Company promoted their cloud environment and apps for safety and risk.  Also, help you develop your own apps. 

• Seeing MicroBloggingMD a microblogging platform used for secure hospital communications.

• Learning about Happitique which classifies apps for professionals which helps with the sorting process of the thousands of available apps and provides an enterprise mHealth solution. 

• Talking to several people about the move toward BYOD (bring-your-own-device) and the associated risks (including data security) in healthcare environments. (Stay tuned for an BYOD post to come.)

• Experiencing my first "hat interview" as tweeted by @EHRworkflow

• Learning about HealthInfo Island, Health Support Coalition, Cancer Co-Op, AIDS and HIV Support, etc  -- communities on the virtual world 2nd Life.

• And, getting an update from Zac on Louisiana's HIT/HIE activities.

But, the absolute best part of the week was finally meeting several of my blogger friends in person! Talking with them in person gave us a chance to bring our relationship full circle.  Some I just met this past year, but I've known two since first starting to blog in 2005 -- @hospitaltony and @techguy.

Convergence of HIE and Social Media

The San Diego Beacon eHealth Community is one example of how we are starting to see the convergence of health information exchange (HIE) and social media technologies.  They recently shared the details of their pilot study, which is designed to use SMS technology to improve childhood immunization rates. Highlights include:

• Purpose:  determine the impact and cost effectiveness of text messaging to improve child vaccination rates (all, on-time by age 19 months)
• Parents of childrent 9 - 13 months who speak either English or Spanish will be recruited.
• Participants receiving the intervention will receive monthly text message reminders to schedule or keep an existing appointment for their child's 15- and 18-month well-baby visits, as well as, educational messages.
• The control participants will only receive general milestone and health information during the study period.
• Some messages for both the intervention and control groups require a response (making the communications bi-directional.)

In addition, the involvement of a cell phone (mHealth) also makes this another great example of the convergence of telehealth and HIE.

A Challenge of Ethics on Facebook

Ben Dillon has posted on a truly difficult ethical situation shares the story on GeoVoices. It involves a mom who blogs on the challenges of raising a child with a genetic defect and this naturally attracts a sympathetic following.  

The mom's posts include her disappointment over being told hospital nephrologists have denied a kidney transplant for her 3 y.o. daughter, because of her genetic defect - which is also known to cause mental retardation.  We don't know the actual reason for the denial, but the family believes it is because of the child's mental retardation and this is shared in the mom's blog posts and it ultimately made it's way to traditional media, including the Washington Times.

 

The result is that the hospital's Facebook wall now includes passionate pleas to reconsider the decision. Like Ben, I believe Children's Hospital of Philadelphia (CHOP) is appropriate in their handling of the social media aspects of this truly unfortunate situation.  It should be a guide to others.

• CHOP is carefully avoiding any discussion of the patient’s case or health situation and remains respectful of the opinions and feelings of everyone engaged in the discussion.
• They appear to be leaving all visitor posts on their page - the good and the uncomfortable.
• CHOP has issued a statement acknowledging that they are listening and reiterating their policies, values and history as relates to this issue. 
• CHOP and the family have issued a joint statement on Facebook as a result of the significant public interest.
• The organization is discussing the issue with the family offline.

 Let's all say a prayer for the child and her family!

Reach Out To Consumers, Measure & Control Your Domain

Not long ago, I read an article reporting that 1 in 5 Americans are using social media for healthcare information.  It made me wonder if hospitals are calculating their market share -that is, the portion of those info seekers in your service area(s) who are accessing online information sponsored by your organization, rather than that of a competitor or sites that may have questionable trustworthyness.

Then, over the weekend I picked up on a tweet about efforts to smack down ROI.  Basically, some in social media, not necessarily in healthcare, are promoting an anti-measurement agenda.  My feeling is that we in healthcare must measure our performance.  If it is important that we measure for evidence-based medicine, outcomes, patient satisfaction, compliance with regulations, improving quality and performance, managing risks, reporting, effective and efficient use of resources and more; then it is important that we measure the performance of our social media applications.

So this takes me to actually leveraging the technologies and learning to use social media in our healthcare environments and a couple of new resources that can help us all keep up with the rapidly evolving world of social media.

While at HIMSS last week, I came across two new social media white papers.  The first is the Health IT Social Media Primer from HL7 Standards.  It answers questions like "what do I need to know?" and "what should I tweet?", presents some important "how to" details and also reviews newer social media channels like Google+ and Quora (a question & answer forum). 

The second is a new white paper from the HIMSS Social Networking Work Group, Healthcare "Friending" Social Media:  What Is It, How Is It Used, and What Should I Do?  It also reviews recent social media developments, but I found the reference to there being 787 hospitals on Foursquare, but less that 10% having claimed their listing to be most interesting.  It reminds me of the teen patient who started a Facebook page in his childrens hospital's name, so he and the other patients could connect and support each other anytime.  

I was also happy to see that the HIMSS workgroup included the example an HIO delivering virtual education for electronic health information exchange (HIE).  And, I can't be more pleased that they also referenced my work. The topical review is publically available.

So, hospitals, do me a favor and:

• do reach out to the growing number of healthcare consumers searching for healthcare information from a trusted-source.
• do measure the performance and impact of your social media activities.
• don't let others control your domain name and brand.

Health Literacy Resources for Pharmacies

The AHRQ has released resources to help hospitals address Pharmacy Health Literacy; the degree to which individuals are able to obtain, process, and understand basic health and medication information and pharmacy services needed to make appropriate health decisions. 

The tools present an opportunity for hospital pharmacies to improve their patient experiences and outcomes because:

• Only 12% of adults have proficient health literacy (e.g., can interpret the prescription label correctly).
• Medication errors are likely higher with patients with limited health literacy, as they are more likely to misinterpret the prescription label information and auxiliary labels.
• Studies document an association between low literacy and poor health outcomes.

This is important because:

• Pharmacists are responsible for making sure patients obtain the maximum positive health outcomes from their medications.
• Pharmacists care for patients with low to high education levels, low to high incomes, and multiple races of people; all of whom may have limited health literacy.
• Medication errors are likely higher with patients with limited health literacy.
• Studies document an association between low literacy and poor health outcomes.
• Pharmacists are one of the most accessible health care providers.
• Addressing literacy is an important quality improvement effort because it ties to an organization's HCAHPS scores and will ultimately impact reimbursement.

The Pharmacy Health Literacy resources include tools to address staff communications and conduct health literacy assessments using the Facilitator's Guide for Patient Focus Groups.  It also includes a Health Literacy Assessment Survey of pharmacy staff "How Health Literacy Friendly Are We?" for some self-reflection.  The staff survey covers an assessment of print materials, verbal communications and sensitivity to literacy.

Caring for the healthcare givers!

Not long ago I posted on a shocking example of un-compassionate healthcare.  An agency employee made fun of and posted a picture of the patients medical records on his Facebook pages.  Worse, he refused to see is error or accept responsibility for violating the patient's rights and privacy.

So, last week I ran into a friend of mine who is the Executive Director of Adventures in Caring Foundation, a nonprofit organization that cultivates and teaches compassion in healthcare. Their volunteers visit hospital and nursing home patients and are often undergraduate students who will pursue a healthcare career. They also teach and train staff on delivering compassionate care and having those difficult conversations.

We discussed this shocking example of un-compassionate care and wondered if it is possible that this employee isn't managing their stress -- leading to poor judgement and actions.  In other words, is this employee letting the pressures of caregiving and life wear him down to the point that he exhibits self-destructive behaviors?

I'm especially interested in the thoughts of those of you in direct care roles, or who work and support caregivers.

Californians’ Attitudes and Experiences with Death and Dying

A recent survey findings of Californians shows that patients and physicians not discussing end-of-life care.  Key findings include:

• About 80% of Californians said they would want to discuss end-of-life care with their physician if they had a serious illness.
• Only 7% said they have taken part in such a discussion, including only 13% of residents ages 65 and older.
• 82% of respondents said it is important to have their end-of-life wishes in writing, but only 23% have drafted such a plan.
• 70% of respondents said they would prefer to die at home, but only 32% have made such arrangements.
• About 66% of respondents said they would prefer a natural death if severely ill, and only 7% would want health providers to take all necessary measures to prolong their lives.
• 44% of those who recently had experienced the death of a loved one said the person's end-of-life care preferences had been followed completely by health care providers.

Dr. Gawande stated it perfectly in his New Yorker Article, "modern medicine is good at staving off death with aggressive interventions - and bad at knowing when to focus, instead, on improving the days that terminal patients have left."  

Healthcare leaders may also be interested in the ACHE policy on decisions near the end of life.

Patient Safety Toolkits from AHRQ

The Agency for Healthcare Research and Quality (AHRQ) has sets of toolkits designed to help health care institutions and clinicians provide—and consumers receive—safe, quality health care at various points in the health care process—in the hospital, in the emergency department, in the intensive care unit, in the pharmacy, and when being discharged from one setting to another.

The 17 toolkits were produced under AHRQ's Partnerships in Implementing Patient Safety (PIPS) grant program and include multidisciplinary evidence-based tools, including training materials, medication guides and checklists, that are easily adapted to other institutions and care settings. 

---

Toolkits by Setting Type

Hospital — General 
Emergency Departments 
Hospital Care Units 
Outpatient Settings 
Consumer/Patient Care

Hospital—General – These toolkits contain evidence-based resources to help inpatient facilities improve performance around some of the most common and most serious patient safety problems faced by hospitals today.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Interactive Venous Thromboembolism Safety Toolkit for Providers and Patients
• Patient Multidisciplinary Training for Medication Reconciliation
• Implementing a Program of Patient Safety in Small Rural Hospitals ;
• Preventing Venous Thromboembolisms in the Hospital
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia
• Reducing Discrepancies in Medication Histories and Orders at Handoffs
• Testing the Re-Engineered Hospital Discharge (One of my favorites- see Louise)
• Using Military Simulation to Improve Rural Obstetric Safety

Emergency Departments – These toolkits contain resources to help hospitals apply evidence-based safe practices in the Emergency Department (ED) to improve patient flow, implement a multidisciplinary simulation-based safety curriculum, and improve medication safety by implementing a formal ED pharmacist program.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Patient Flow in the Emergency Department
• A Simulation-Based Safety Curriculum in a Children's Hospital Emergency Department

Hospital Care Units – These toolkits contain resources to help hospitals apply evidence-based safe practices.

• Implementing Reduced Work Hours to Improve Patient Safety
• Improving Patient Safety Through Enhanced Provider Communication
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia

Outpatient Settings – These toolkits contain resources to help facilities address outpatient medication safety by applying evidence-based safe practices.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Safety in Clinics for Patients 55 and Older 
  Improving Warfarin Management
• Patient Multidisciplinary Training for Medication Reconciliation
• Testing the Re-Engineered Hospital Discharge

Consumer/Patient Care – These toolkits contain resources to help facilities educate consumers in medication safety and post-hospital care.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Improving Medication Safety in Clinics for Patients 55 and Older
• Improving Warfarin Management
• Testing the Re-Engineered Hospital Discharge
• Using Military Simulation to Improve Rural Obstetric Safety 

Additional toolkits may be added as they are developed and will be found at http://www.ahrq.gov/qual/pips/

 

 

HIE for Consumers

Will from Redwood MedNet sent me a powerful video from Health Information Partnership for Tennessee. The video will help consumers learn and understand more about why health information exchange is important.  In the video, I was pleased to see an old RHIO friend, Dr. Mark Frisse.

There is a surprising twist near the end, so please watch and learn! 

You can also check out their videos for administrators and providers.

Candy Stripers and Junior Volunteers

I've posted on the subject of volunteers, young people working in hospitals and those considering a career in healthcare administration, previously.  However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.

Candy Stripers at Doctors Memorial Hospital, FL

I'd love to here your thoughts or stories about the youngest of our hospital workforce!  If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com

I'm thinking I should also start researching the Pink Ladies, too!

Report on Hospital Acquired Infection in CA Released

Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH).  This means anyone can see the nosocomial infection rates of their local hospital by unit.  But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital.  Hospitals may be interested in using this data to benchmark themselves against other hospitals.

Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.

HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:

• Central-line associated bloodstream infections;
• Clostridium difficile infections;
• Methicillin-resistant Staphylococcus aureus (bloodstream)
• vancomycin-resistant Enterococcus (bloodstream)
• Surgical site infections

Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.

• Central-line insertion practices 
• Staff influenza vaccination rate 

 

 

Low Health Literacy: Impact on Costs

The American College of Physicians has a YouTube video that demonstrates the impact of low health literacy on the healthcare delivery system and costs.  Healthcare administrators and clinicians should view this video to see the challenges for themselves.  Notice the potential for medication errors alone! 

It reminds me of Louise, the discharge advocate!

 

This video hits a little close to home since LSU Shreveport seems to have been involved and a few of the accents were familiar.  However, this is an issue across the US.

Earthquake Publications for Businesses

Thousands of earthquakes occur in the United States each year; most are too small to significantly affect businesses and communities. However, large and very damaging earthquakes have occurred in the past and could happen again at anytime.  In general, many businesses (and healthcare providers) have invested in emergency management and continuity of operations planning. However, most businesses have not conducted earthquake mitigation measures to protect their assets, staff, and business operations. During an earthquake, buildings—or their components or contents—can be collapsed, toppled, broken apart, tossed around, or rendered inoperable or unusable.

Therefore, as part of addressing all-hazards emergency management, it is critical for businesses (and healthcare providers) to also incorporate actionable earthquake mitigation solutions into their planning and business decisions.  By doing so, businesses protect the organization’s assets (people, property, operations); sustain the capability to provide goods and/or services to the community; maintain cash flow; preserve competitive advantage and reputation; and provide the ability to meet legal, regulatory, financial and contractual obligations.

To help businesses (and even healthcare providers), the Federal Emergency Management Agency (FEMA) National Earthquake Hazards Reduction Program (NEHRP) has released FEMA P-811 CD:  Earthquake Publications for Businesses (QuakeSmart Toolkit). 

This QuakeSmart Toolkit (FEMA P-811CD) provides business owners, managers, and employees with basic guidance and ready-to-use tools that can be tailored to the specific needs and requirements of the user. The guidance and tools focus on the importance of earthquake mitigation and the simple things they can do to reduce the potential of earthquake damages, injuries, and financial losses at work…AND also at home and within their communities.

The toolkit walks you through the following 3-step QuakeSmart process: 

1. How to identify your risk
2. How to make a mitigation project plan
3. How to take action and implement the techniques for ensuring and enhancing business resilience from an earthquake

These resources are especially timely for California, because the 2012 Statewide Medical and Health Training and Exercise will be an earthquake scenario.  View or download the QuakeSmart Toolkit (FEMA P-811CD) or order CD copies of the QuakeSmart Toolkit from the FEMA Publications Warehouse by calling (800) 480-2520. Or fax your request to (240) 699-0525.  All orders will be shipped in January 2012.

Other FEMA materials and earthquake guidance are also available.

5 Facts You Should Know About Nurse Practitioners

From time to time I include guest posts on my blog and this is one.  I see the role of nurse practitioners in a new healthcare delivery system being significant, so I'm especially pleased to share this post with my readers.

by Brooke Stafford, Nursing Practitioner Student 

With the healthcare crisis looming, many patients are likely to be seen by nurse practitioners (NPs). 

 

These are advanced training nurses who often hold a doctorate in medicine and can do many of the common practices and functions of a traditional doctor.  To help you learn more about them, below we have included five facts regarding the nurse practitioner.

1. There’s tons of them – In the U.S. alone, there are an estimated 150,000 nurse practitioners in practice.  They can be found in hospitals, clinics, offices of their own, and other healthcare facilities.
2. On the rise – The number of students enrolled in nurse practitioner programs as well as those who have graduated have steadily risen.  For example, there were over 20,000 students enrolled in the 2004-2005 academic year, and it rose to over 35,000 just five years later in 2009-2010.
3. They can prescribe – Ordinarily someone with the title “nurse” cannot prescribe medication.  However, licensed nurse practitioners can prescribe medication in every state and in the District of Columbia.  In 21 states and the District, NPs can even practice medicine independently without physician supervision.
4. Lower costs – Because the cost for operating as a nurse practitioner is lower than a traditional physician, the cost to the patient is lessened as well.  Visits to an NP can cost about $30 to $50 dollars, or about the same as a co-pay to a doctor.  However, those without insurance can see an NP, and the wait times are far less, with many NPs offering services to walk-in patients.
5. Specialties – Just as many doctors and nurses go into specialties, so too do NPs.  A few include family medicine, pediatrics, women’s health, geriatric, neonatal, and many others.  Many nurse practitioners are also required to have an extensive education and/or certification in the area they practice in.

Brooke Stafford is a nursing practitioner student and also writes for Family Nurse Practitioner Degrees. The site helps students find the right nurse practitioner degree to fit their needs.

 

Measuring: Elmo and Healthcare

I learned something about measuring today - from Drew Brees and Elmo.  I thought of adding the video below since it includes two of my favorite things - the Saints and Sesame Street - and people - Elmo and Drew.

But, then I started thinking.  In healthcare we measure many things and some are rather objective -- like Drew's ruler.  However, it is also important that we not forget the more subjective measures and stories.  

Sometimes, those subjective measures are just as important, if not more important.  So keep this in mind as you go about your day in the hospital, clinic or other healthcare environment and set up your measures.  Remember the stories when it comes to patient experience, quality and all of those emerging technologies.