Financial Incentives to Reduce Hospital-Acquired Infections Under Alternative Payment Arrangements

OBJECTIVEThe financial incentives for hospitals to improve care may be weaker if higher insurer payments for adverse conditions offset a portion of hospital costs. The purpose of this study was to simulate incentives for reducing hospital-acquired infections under various payment configurations by Medicare, Medicaid, and private payers.DESIGNMatched case-control study.SETTINGA large, urban hospital system with 1 community hospital and 2 tertiary-care hospitals.PATIENTSAll patients discharged in 2013 and 2014.METHODSUsing electronic hospital records, we identified hospital-acquired bloodstream infections (BSIs) and urinary tract infections (UTIs) with a validated algorithm. We assessed excess hospital costs, length of stay, and payments due to infection, and we compared them to those of uninfected patients matched by propensity for infection.RESULTSIn most scenarios, hospitals recovered only a portion of excess HAI costs through increased payments. Patients with UTIs incurred incremental costs of $6,238 (P<.01), while payments increased $1,901 (P<.05) at public diagnosis-related group (DRG) rates. For BSIs, incremental costs were $15,367 (P<.01), while payments increased $7,895 (P<.01). If private payers reimbursed a 200% markup over Medicare DRG rates, hospitals recovered 55% of costs from BSI and UTI among private-pay patients and 54% for BSI and 33% for UTI, respectively, across all patients. Under per-diem payment for private patients with no markup, hospitals recovered 71% of excess costs of BSI and 88% for UTI. At 150% markup and per-diem payments, hospitals profited.CONCLUSIONSHospital incentives for investing in patient safety vary by payer and payment configuration. Higher payments provide resources to improve patient safety, but current payment structures may also reduce the willingness of hospitals to invest in patient safety.Infect Control Hosp Epidemiol 2018;39:509–515

Download Full-text

Healthcare-Acquired Catheter-Associated Urinary Tract Infections in a Community Hospital Setting: How Do We Improve Patient Safety, Reduce Hospital Acquired Infection Rates, and Lower Costs?

American Journal of Infection Control ◽

10.1016/j.ajic.2007.04.172 ◽

2007 ◽

Vol 35 (5) ◽

pp. E147

Author(s):

T.B. Dozier

Keyword(s):

Patient Safety ◽

Urinary Tract ◽

Community Hospital ◽

Improve Patient Safety ◽

Hospital Setting ◽

Infection Rates ◽

Hospital Acquired Infection ◽

Tract Infections ◽

Hospital Acquired ◽

Improve Patient

Download Full-text

Hospital Acquired Infections: Preventable Cause of Mortality in Spinal Cord Injury Patients

Journal of Laboratory Physicians ◽

10.4103/0974-2727.129089 ◽

2014 ◽

Vol 6 (01) ◽

pp. 036-039 ◽

Cited By ~ 2

Author(s):

Sanjeev Lalwani ◽

Parul Punia ◽

Purva Mathur ◽

Vivek Trikha ◽

Gurudutta Satyarthee ◽

...

Keyword(s):

Spinal Cord ◽

Cause Of Death ◽

Spinal Cord Injuries ◽

Tertiary Care ◽

Epidemiological Data ◽

Trauma Patients ◽

Hospital Acquired Infections ◽

Cord Injury ◽

Tract Infections ◽

Hospital Acquired

ABSTRACT Background: There is an alarming rate of morbidity and mortality observed in the trauma victims who suffer spinal cord injuries (SCI). Such patients are admitted immediately and stay for longer periods of time and thus are at risk of acquiring nosocomial infections. Aims: The aim of this study is to analyze the primary cause of mortality in SCI patients. Design: Retrospective study. Materials and Methods: We conducted a retrospective 4 year analysis of the postmortem data of 341 patients who died after sustaining SCI at a tertiary care apex trauma center of India. Epidemiological data of patients including the type of trauma, duration of hospital stay, cause of death and microbiological data were recorded. Results: On autopsy, out of 341 patients, the main cause of death in the SCI patients was ascertained to be infection/septicemia in 180 (52.7%) patients, the rest 161 (47.2%) died due to severe primary injury. Respiratory tract infections (36.4%) were predominant followed by urinary tract infections (32.2%), blood stream infections (22.2%), wound infections (7.1%) and meningitis reported in only 5 (2.1%) cases. Acinetobacter sp (40%) was the predominant organism isolated, followed by Pseudomonas sp (16.3%), Klebsiella sp (15.1%), Candida sp (7.8%), Escherichia coli (6.9%), Staphylococcus aureus (6.9%), Proteus sp (3.3%), Enterobacter sp and Burkholderia sp (two cases each) and Stenotrophomonas sp (one case). A high level of multidrug resistance was observed. Conclusions: Hospital acquired infections (HAI) are leading cause of loss of young lives in trauma patients; hence efforts should be made to prevent HAIs.

Download Full-text

HOSPITAL INFECTION IN SURGICAL DEPARTMENTS AT HUE UNIVERSITY HOSPITAL IN 2015

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.5.6 ◽

2016 ◽

pp. 39-43

Author(s):

Dinh Binh Tran ◽

Dinh Tan Tran

Keyword(s):

Surgical Site Infection ◽

Surgical Intervention ◽

University Hospital ◽

Hospital Infections ◽

Site Infection ◽

Cross Sectional ◽

Surgical Interventions ◽

Hospital Acquired Infections ◽

Tract Infections ◽

Hospital Acquired

Objective: To study nosocomial infections and identify the main agents causing hospital infections at Hue University Hospital. Subjects and Methods: A cross-sectional descriptive study of 385 patients with surgical interventions. Results: The prevalence of hospital infections was 5.2%, surgical site infection was the most common (60%), followed by skin and soft tissue infections (35%), urinary tract infections (5%). Surgical site infection (11.6%) in dirty surgery. There were 3 bacterial pathogens isolated, including Staphylococcus aureus (50%), Pseudomonas aeruginosa and Enterococcusspp (25%). Conclusion: Surgical site infection was high in hospital-acquired infections. Key words: hospital infections, surgical intervention, surgical site infection, bacteria

Download Full-text

Global Trigger Tool methodology to detect adverse events: pilot study at Academic Hospital of Udine

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.522 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Scarpis ◽

S Degan ◽

D De Corti ◽

F Mellace ◽

R Cocconi ◽

...

Keyword(s):

Patient Safety ◽

Adverse Events ◽

Academic Hospital ◽

Trigger Tool ◽

Hospital Acquired Infections ◽

Frequent Type ◽

Global Trigger Tool ◽

Clinical Records ◽

Hospital Acquired ◽

Over Time

Abstract Introduction Identification and measurement of adverse events (AEs) is crucial for patient safety in order to monitor them over time and to implement quality improvement programs, testing if they are effective. Global Trigger Tool (GTT) has been proposed as a low-cost method, being also the most effective to detect AEs. This study aims to describe the number of triggers, the rate and level of AEs identified by GTT and the most frequent type of AE. Methods The Italian version of the GTT was used. Ten paper-based clinical records (CRs) randomly selected every 2 weeks were reviewed from January to April 2019 by three independent reviewers (two nurses, one doctor) at the Academic Hospital of Udine. The AEs rates calculated are: AEs per 1,000 patient-days, AEs per 100 admissions, percentage of admissions with an AE. AEs were classified by harm levels according to National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Results CRs reviewed were 80. Mean age of the patients was 69.3±16.4, women were 37.5%. Mean hospitalisation was 16.8±15.3. Nine were the cases of re-hospitalisation within 30 days (11.3%). The total number of trigger was 156. AEs were 31, with at least one AE on 27.5% of admissions, 38.8 AEs per 100 admissions and 23 AEs per 1,000 patient-days. AEs with harm level E, F and H were respectively 5 (16.1%), 24 (77.4%) and 2 (6.5%). The most frequent type of AE were hospital acquired infections with 15 cases (48.4%). Conclusions The most frequent type of AE was the hospital acquired infections. Rates and levels of AEs were higher than other international studies, probably because of the limited number of CRs reviewed. Key messages Global Trigger Tool is an effective method to detect adverse patient safety events in order to monitor them over time. The most frequent type of adverse events was the hospital acquired infections.

Download Full-text

Correlation between Antibiotic Consumption and Hand Hygiene Compliance Among Anesthesia and Intensive Care Healthcare Professionals

The Open Anesthesia Journal ◽

10.2174/2589645802014010042 ◽

2020 ◽

Vol 14 (1) ◽

pp. 42-48

Author(s):

Emanuela Santoro ◽

Marco Fiore ◽

Sebastiano Leone ◽

Armando Masucci ◽

Roberta Manente ◽

...

Keyword(s):

Intensive Care ◽

Hand Hygiene ◽

Healthcare Professionals ◽

Tertiary Care ◽

Antibiotic Consumption ◽

Alcoholic Solution ◽

Hand Washing ◽

Hospital Acquired Infections ◽

Consumption Data ◽

Hospital Acquired

Aims: The aim of this study was to investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals working in the Department of Anesthesia and Intensive Care of a tertiary care University Hospital. Background: Two centuries have passed since the discovery of Semmelweis that the “puerperal fever” was due to an infection transmitted by the hands. Currently the hand hygiene is still not well performed, rather it is often replaced by the improper use of gloves. Microbial transmission is estimated to occur in one-fifth of all contact cases. Objective: To investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals. Furthermore, to correlate the consumption data of the hydroalcoholic solution and the amount of antibiotics used for the treatment of hospital-acquired infections. Method: The study was conducted over six months period (from January to June 2018); during this period, 20 monitoring sessions were performed. The following indicators were evaluated: a) Non-adherence to hand hygiene with concomitant use of gloves; b) Adhesion to alcoholic friction of hands; c) Hand-washing adhesion. Instead, the consumption data, provided by the hospital ward itself, were used for the evaluation of d) The antibiotics used in the treatment of hospital-acquired infections; e) The hydro-alcoholic solution used by the healthcare professionals for hand hygiene. Results: The frequency of non-adherence to hand hygiene was very high at the beginning of the study, subsequently it decreased to about a half percent to that at the initial stage. The adhesion to alcoholic friction of hands increased during the study period. Otherwise, the hand-washing adhesion slightly reduced, especially in March probably due to the recruitment of new inadequately trained nursing staff. The trend of antibiotic consumption was similar to handwashing. The consumption of hydro-alcoholic solution was very low, however over time, it increased considerably until the end of the study. Conclusion: In light of the findings from this work, it is necessary to make the hospital staff increasingly aware of the correct practice of hand hygiene and to organize training and informative sessions to promote the health of the individual and the community.

Download Full-text

Faculty Clinical Quality Goals Drive Improvement in University HealthSystem Consortium Outcome Measures

The American Surgeon ◽

10.1177/000313481207800712 ◽

2012 ◽

Vol 78 (7) ◽

pp. 749-754 ◽

Cited By ~ 1

Author(s):

Kevin E. Behrns ◽

Darwin Ang ◽

Huazi Liu ◽

Steven J. Hughes ◽

Holly Creel ◽

...

Keyword(s):

Patient Safety ◽

Improve Patient Safety ◽

Clinical Score ◽

Outcome Data ◽

Faculty Members ◽

Clinical Quality ◽

Patient Safety Indicators ◽

Before And After ◽

The University ◽

Hospital Acquired

Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions (HACs) are routinely reported by the University HealthSystem Consortium (UHC) to measure quality at academic health centers. We hypothesized that a clinical quality measurable goal assigned to individual faculty members would decrease UHC measures of mortality, LOS, PSIs, and HACs. For academic year (AY) 2010–2011, faculty members received a clinical quality goal related to mortality, LOS, PSIs, and HACs. The quality metric constituted 25 per cent of each faculty member's annual evaluation clinical score, which is tied to compensation. The outcomes were compared before and after goal assignment. Outcome data on 6212 patients from AY 2009–2010 were compared with 6094 patients from AY 2010–2011. The mortality index (0.89 vs 0.93; P = 0.73) was not markedly different. However, the LOS index decreased from 1.01 to 0.97 ( P = 0.011), and department-wide PSIs decreased significantly from 285 to 162 ( P = 0.011). Likewise, HACs decreased from 54 to 18 ( P = 0.0013). Seven (17.9%) of 39 faculty had quality grades that were average or below. Quality goals assigned to individual faculty members are associated with decreased average LOS index, PSIs, and HACs. Focused, relevant quality assignments that are tied to compensation improve patient safety and outcomes.

Download Full-text

Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2020-000627 ◽

2020 ◽

pp. bmjstel-2020-000627

Author(s):

Lisa Aufegger ◽

Emma Soane ◽

Ara Darzi ◽

Colin Bicknell

Keyword(s):

Decision Making ◽

Patient Safety ◽

Real World ◽

Shared Leadership ◽

Improve Patient Safety ◽

Tertiary Care ◽

Management Training ◽

Healthcare Management ◽

Self Report ◽

Good Opportunity

IntroductionSimulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM.MethodUsing a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation’s degree of realism, content, relevance, as well as areas for improvement.ResultsParticipants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes.ConclusionsOur simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.

Download Full-text

Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010368 ◽

2020 ◽

Vol 29 (9) ◽

pp. 717-726 ◽

Cited By ~ 3

Author(s):

Colleen M Pater ◽

Tina K Sosa ◽

Jacquelyn Boyer ◽

Rhonda Cable ◽

Melinda Egan ◽

...

Keyword(s):

Patient Safety ◽

Improve Patient Safety ◽

Tertiary Care ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Tertiary Care Centre ◽

Patient Acuity ◽

Nursing Satisfaction ◽

Paediatric Hospital ◽

Hospital Units

Background10The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; and optimise workflow. We used quality improvement (QI) methods to safely decrease non-actionable alarm notifications to bedside providers.MethodsIn a paediatric tertiary care centre, we convened a multidisciplinary team to address alarm notifications in our acute care cardiology unit. Alarm notification was defined as any alert to bedside providers for each patient-triggered monitor alarm. Our aim was to decrease alarm notifications per monitored bed per day by 60%. Plan-Do-Study-Act testing cycles included updating notification technology, establishing alarm logic and modifying bedside workflow processes, including silencing the volume on all bedside monitors. Our secondary outcome measure was nursing satisfaction. Balancing safety measures included floor to intensive care unit transfers and patient acuity level.ResultsAt baseline, there was an average of 71 initial alarm notifications per monitored bed per day. Over a 3.5-year improvement period (2014–2017), the rate decreased by 68% to 22 initial alarm notifications per monitored bed per day. The proportion of initial to total alarm notifications remained stable, decreasing slightly from 51% to 40%. There was a significant improvement in subjective nursing satisfaction. At baseline, 32% of nurses agreed they were able to respond to alarms appropriately and quickly. Following interventions, agreement increased to 76% (p<0.001). We sustained these improvements over a year without a change in monitored balancing measures.ConclusionWe successfully reduced alarm notifications while preserving patient safety over a 4-year period in a complex paediatric patient population using technological advances and QI methodology. Continued efforts are needed to further optimise monitor use across paediatric hospital units.

Download Full-text