Hospitals

Sen. Robert Byrd, 91, entered the hospital last month with what his office described as a minor infection.

And then he got a major infection. Acquired in the hospital. His office has said the staph infection is responding to treatment, but it has kept the frail West Virginia senator in the hospital for nearly a month. 

Reducing such infections has been a major goal of the health care quality movement. But now, the recession is forcing some hospitals to cut back on their infection control budgets, Maryn McKenna writes on her Superbug blog. Some of these infections can be mild; others are fatal. The CDC estimates that about 1.7 million people acquire some form of infection in the hospital each year; nearly 100,000 die. They also add billions of dollars to our health spending.

In a survey of 2,000 infection preventionists—conducted by the Association for Professionals in Infection Control and Epidemiology—41 percent reported cuts in funding for infection-prevention efforts in the past 18 months due partly to the struggling economy.

When was the last time you were assigned a random stranger as a roommate? Probably not since freshman year—unless, of course, you end up in a hospital. Shared rooms are common in most hospitals, a convention that evidence-based design experts warn may cause poorer health outcomes.

Many new hospitals are switching over to single-occupancy rooms, the New York Times reported this week. Studies have found single rooms lower the likelihood of infection, and allow patients to feel less stress and get more sleep. The American Institute of Architects' Guidelines for Design and Construction of Hospital and Health Care Facilities in 2006 called for the construction of single, rather than double rooms in all hospitals.

According to the sixth annual National Healthcare Quality Report (NHQR) from the Agency for Healthcare Research and Quality (AHRQ), many Americans aren't receiving the care they need. The AHRQ report collects data on health care quality from across the country and analyzes it using indictors from four important categories: effectiveness, patient safety, timeliness, and patient centeredness.

The NHQR turned up three main themes:

Health care quality is suboptimal and continues to improve at a slow pace. Out of the 45 core measures of health care quality used in the report, an average of only 59 percent of Americans were receiving the total amount of recommended care for their health needs. For example, a heart transplant patient might receive up to 95 percent of the medical services they need to achieve the best possible outcome, while in contrast, a patient on dialysis only has about a 15 percent chance of being placed on a kidney transplant waiting list.

Catheter-associated MRSA infections have dropped by half in ICUs in the last decade, JAMA reports. That's great news for the infectious disease crowd but why is combating drug-resistant staph infections of such interest to a health policy blog? Because it shows that reformers and quality initiatives can win over physicians and other skeptics, devise fairly simple interventions that work, and improve the quality of care in a way that can also save money. Some of the techniques are really quite simple once they are applied consistently, as Lindsay Tanner notes in this AP story:

The study authors say the results are likely a sign that doctors and nurses are working harder at prevention efforts. These include frequent hand-washing, instrument sterilization and other measures.

We've written repeatedly about quality and safety, checklists, infection control, the Institute for Healthcare Improvement—and about pockets of resistance to achievable change that will improve patient care (and usually save money). Today's Washington Post has a story by and about an infectious disease consultant, Dr. Manoj Jain, whose skepticism evolved into conviction. In two years, his hospital cut ICU infection rates in half and reduced costs by 21 percent per ICU discharge. Good for the health care system. Definitely good for the patients. And more satisfying for the health care team.

 
The whole column is a quick good read, but here's a good excerpt: