Suzanne Bopp

Zero preventable harm is the goal of every healthcare organization, and a new online application from the Joint Commission Center for Transforming Healthcare can help groups reach that goal. Oro 2.0 can assist hospital leaders with determining their organization’s status across multiple components of high reliability that will let them achieve zero preventable harm.

Hospitalists are integral to this process, says Coleen Smith, RN, BSN, MBA, CPHQ, director of high reliability initiatives for the Joint Commission. “Hospitalists are a crucial piece of improving the quality of an organization. Physicians routinely getting involved in high reliability and leading those activities are how we want high-reliability hospitals to look,” says Smith.

The Oro 2.0 application has two major elements. The first is an assessment tool for senior hospital leadership that covers 14 different performance areas, covering components such as safety culture and leadership. After an assessment is complete, the application issues a report that identifies strengths and opportunities for improvement and directs the user to specific resources, which are the application’s second element: a library of published materials about specific areas of high reliability offering more than 125 references and tools. These materials will help organizations educate themselves about the 14 components included in Oro 2.0’s high-reliability model.

This is an idea long overdue in healthcare, which lags behind other industries, according to Smith. “We know high-reliability industries like nuclear power and commercial aviation do very complex daily work but have far fewer bad things happening,” she adds. “Healthcare is nowhere near that state of reliability, but it needs to get there.”

Participation by hospitalists is required to make such a change, Smith says. She hopes they will access Oro 2.0’s resource library to understand the solutions the Joint Commission is proposing. “Then they can go to the senior leadership of their hospital and ask them to consider committing to zero patient harm,” she says. “They can support their senior leadership in this work and be vocal about their interest in pursuing high reliability and zero patient harm.”

Visit our website for more information on hospitalists and healthcare safety.

Zero preventable harm is the goal of every healthcare organization, and a new online application from the Joint Commission Center for Transforming Healthcare can help groups reach that goal. Oro 2.0 can assist hospital leaders with determining their organization’s status across multiple components of high reliability that will let them achieve zero preventable harm.

Hospitalists are integral to this process, says Coleen Smith, RN, BSN, MBA, CPHQ, director of high reliability initiatives for the Joint Commission. “Hospitalists are a crucial piece of improving the quality of an organization. Physicians routinely getting involved in high reliability and leading those activities are how we want high-reliability hospitals to look,” says Smith.

The Oro 2.0 application has two major elements. The first is an assessment tool for senior hospital leadership that covers 14 different performance areas, covering components such as safety culture and leadership. After an assessment is complete, the application issues a report that identifies strengths and opportunities for improvement and directs the user to specific resources, which are the application’s second element: a library of published materials about specific areas of high reliability offering more than 125 references and tools. These materials will help organizations educate themselves about the 14 components included in Oro 2.0’s high-reliability model.

This is an idea long overdue in healthcare, which lags behind other industries, according to Smith. “We know high-reliability industries like nuclear power and commercial aviation do very complex daily work but have far fewer bad things happening,” she adds. “Healthcare is nowhere near that state of reliability, but it needs to get there.”

Participation by hospitalists is required to make such a change, Smith says. She hopes they will access Oro 2.0’s resource library to understand the solutions the Joint Commission is proposing. “Then they can go to the senior leadership of their hospital and ask them to consider committing to zero patient harm,” she says. “They can support their senior leadership in this work and be vocal about their interest in pursuing high reliability and zero patient harm.”

Visit our website for more information on hospitalists and healthcare safety.

Zero preventable harm is the goal of every healthcare organization, and a new online application from the Joint Commission Center for Transforming Healthcare can help groups reach that goal. Oro 2.0 can assist hospital leaders with determining their organization’s status across multiple components of high reliability that will let them achieve zero preventable harm.

Hospitalists are integral to this process, says Coleen Smith, RN, BSN, MBA, CPHQ, director of high reliability initiatives for the Joint Commission. “Hospitalists are a crucial piece of improving the quality of an organization. Physicians routinely getting involved in high reliability and leading those activities are how we want high-reliability hospitals to look,” says Smith.

The Oro 2.0 application has two major elements. The first is an assessment tool for senior hospital leadership that covers 14 different performance areas, covering components such as safety culture and leadership. After an assessment is complete, the application issues a report that identifies strengths and opportunities for improvement and directs the user to specific resources, which are the application’s second element: a library of published materials about specific areas of high reliability offering more than 125 references and tools. These materials will help organizations educate themselves about the 14 components included in Oro 2.0’s high-reliability model.

This is an idea long overdue in healthcare, which lags behind other industries, according to Smith. “We know high-reliability industries like nuclear power and commercial aviation do very complex daily work but have far fewer bad things happening,” she adds. “Healthcare is nowhere near that state of reliability, but it needs to get there.”

Participation by hospitalists is required to make such a change, Smith says. She hopes they will access Oro 2.0’s resource library to understand the solutions the Joint Commission is proposing. “Then they can go to the senior leadership of their hospital and ask them to consider committing to zero patient harm,” she says. “They can support their senior leadership in this work and be vocal about their interest in pursuing high reliability and zero patient harm.”

Visit our website for more information on hospitalists and healthcare safety.

The Joint Commission has launched a new online resource for patients and hospitalists to help change mindsets and start conversations about proper antibiotic usage.

The SpeakUp: Antibiotics campaign is a package of free materials, including an infographic illustrating which illnesses may require an antibiotic, a list of questions for patients to ask when prescribed an antibiotic, a podcast, and a video reminding patients that antibiotics are not needed for colds or the flu.

“The new SpeakUp campaign provides a variety of resources to help patients and caregivers understand that how they use antibiotics today can affect how well the drugs work for them tomorrow,” says Lisa Waldowski, MS, APRN, CIC, infection control specialist at The Joint Commission.

The primary audience for these materials is the consumer, but hospitalists and healthcare workers are the crucial secondary audience. “This is a partnership; the knowledge needs to go both ways,” Waldowski says. “Sometimes there’s an expectation that when you see a physician, you are somehow shortchanged if you don’t leave with a prescription for an antibiotic.

There’s an education that needs to go on in the mindset of the physician, [in terms of] looking at whether this situation warrants an antibiotic and educating the patient if it does not. It takes time to have that conversation.”

The campaign can also provide a starting point for hospitalists to make changes in the workplace. “The information needs to be digested by everyone individually, but collectively in the organization where you work, this can lead to an antibiotic stewardship program, a coordinated intervention,” she says. She recommends a multidisciplinary approach. “Sometimes successful programs are led by a physician, and they have a strong pharmacy component, working together and supporting one another to use antibiotics appropriately.”

Visit our website for more information on antibiotic overuse.

The Joint Commission has launched a new online resource for patients and hospitalists to help change mindsets and start conversations about proper antibiotic usage.

The SpeakUp: Antibiotics campaign is a package of free materials, including an infographic illustrating which illnesses may require an antibiotic, a list of questions for patients to ask when prescribed an antibiotic, a podcast, and a video reminding patients that antibiotics are not needed for colds or the flu.

“The new SpeakUp campaign provides a variety of resources to help patients and caregivers understand that how they use antibiotics today can affect how well the drugs work for them tomorrow,” says Lisa Waldowski, MS, APRN, CIC, infection control specialist at The Joint Commission.

The primary audience for these materials is the consumer, but hospitalists and healthcare workers are the crucial secondary audience. “This is a partnership; the knowledge needs to go both ways,” Waldowski says. “Sometimes there’s an expectation that when you see a physician, you are somehow shortchanged if you don’t leave with a prescription for an antibiotic.

There’s an education that needs to go on in the mindset of the physician, [in terms of] looking at whether this situation warrants an antibiotic and educating the patient if it does not. It takes time to have that conversation.”

The campaign can also provide a starting point for hospitalists to make changes in the workplace. “The information needs to be digested by everyone individually, but collectively in the organization where you work, this can lead to an antibiotic stewardship program, a coordinated intervention,” she says. She recommends a multidisciplinary approach. “Sometimes successful programs are led by a physician, and they have a strong pharmacy component, working together and supporting one another to use antibiotics appropriately.”

Visit our website for more information on antibiotic overuse.

The Joint Commission has launched a new online resource for patients and hospitalists to help change mindsets and start conversations about proper antibiotic usage.

The SpeakUp: Antibiotics campaign is a package of free materials, including an infographic illustrating which illnesses may require an antibiotic, a list of questions for patients to ask when prescribed an antibiotic, a podcast, and a video reminding patients that antibiotics are not needed for colds or the flu.

“The new SpeakUp campaign provides a variety of resources to help patients and caregivers understand that how they use antibiotics today can affect how well the drugs work for them tomorrow,” says Lisa Waldowski, MS, APRN, CIC, infection control specialist at The Joint Commission.

The primary audience for these materials is the consumer, but hospitalists and healthcare workers are the crucial secondary audience. “This is a partnership; the knowledge needs to go both ways,” Waldowski says. “Sometimes there’s an expectation that when you see a physician, you are somehow shortchanged if you don’t leave with a prescription for an antibiotic.

There’s an education that needs to go on in the mindset of the physician, [in terms of] looking at whether this situation warrants an antibiotic and educating the patient if it does not. It takes time to have that conversation.”

The campaign can also provide a starting point for hospitalists to make changes in the workplace. “The information needs to be digested by everyone individually, but collectively in the organization where you work, this can lead to an antibiotic stewardship program, a coordinated intervention,” she says. She recommends a multidisciplinary approach. “Sometimes successful programs are led by a physician, and they have a strong pharmacy component, working together and supporting one another to use antibiotics appropriately.”

Visit our website for more information on antibiotic overuse.

Every year, hundreds of thousands of hospitalized patients fall. Now, hospitalists can get help in dramatically reducing those numbers. According to Erin DuPree, MD, FACOG, vice president and chief medical officer at The Joint Commission's Center for Transforming Healthcare, 30% to 50% of inpatients sustain an injury in a fall, incurring hospital costs of roughly $14,000 and adding, on average, 6.3 days to a hospital stay. It's an ongoing challenge.

"Hospitals have been working on preventing falls forever," Dr. DuPree says. "It's complex, and we needed to look at this in a data-driven way."

The center has done just that, and the result is a new web application called the Preventing Falls Targeted Solutions Tool. Anyone at a Joint Commission–accredited organization can gain complimentary access to the app, which guides users through a systematic, data-driven, Lean Six Sigma approach to reducing falls.

"It guides them through data collection and analyzes the data," Dr. DuPree adds. "Then the tool identifies your top contributing factors to falls and the solutions for those factors. We know every hospital has different contributing factors that matter; this is very local and dependent on the data that's entered."

Seven healthcare institutions in Missouri, Texas, Minnesota, California, North Carolina, and New Hampshire assisted the Joint Commission in developing the tool. Altogether, the pilot institutions reduced their rate of falls by an average of 35% and decreased their rate of patients injured in a fall by an average of 62%.

Hospitalists have a crucial role to play in bringing this process to their own workplace. "It's an opportunity for them to assert their leadership in their clinical role by collaborating with other disciplines on a big patient-safety issue," Dr. DuPree says.

It's also an opportunity for hospitalists to learn about quality improvement, she adds. "If they want to learn something about Lean Six Sigma," she says, "they can do a pilot project on their unit. I hope hospitalists gain access to the tool and start a falls project or work with their team to see what things in the tool could be of value to them."

Visit our website for more information on hospitalists and preventing inpatient falls.

Every year, hundreds of thousands of hospitalized patients fall. Now, hospitalists can get help in dramatically reducing those numbers. According to Erin DuPree, MD, FACOG, vice president and chief medical officer at The Joint Commission's Center for Transforming Healthcare, 30% to 50% of inpatients sustain an injury in a fall, incurring hospital costs of roughly $14,000 and adding, on average, 6.3 days to a hospital stay. It's an ongoing challenge.

"Hospitals have been working on preventing falls forever," Dr. DuPree says. "It's complex, and we needed to look at this in a data-driven way."

The center has done just that, and the result is a new web application called the Preventing Falls Targeted Solutions Tool. Anyone at a Joint Commission–accredited organization can gain complimentary access to the app, which guides users through a systematic, data-driven, Lean Six Sigma approach to reducing falls.

"It guides them through data collection and analyzes the data," Dr. DuPree adds. "Then the tool identifies your top contributing factors to falls and the solutions for those factors. We know every hospital has different contributing factors that matter; this is very local and dependent on the data that's entered."

Seven healthcare institutions in Missouri, Texas, Minnesota, California, North Carolina, and New Hampshire assisted the Joint Commission in developing the tool. Altogether, the pilot institutions reduced their rate of falls by an average of 35% and decreased their rate of patients injured in a fall by an average of 62%.

Hospitalists have a crucial role to play in bringing this process to their own workplace. "It's an opportunity for them to assert their leadership in their clinical role by collaborating with other disciplines on a big patient-safety issue," Dr. DuPree says.

It's also an opportunity for hospitalists to learn about quality improvement, she adds. "If they want to learn something about Lean Six Sigma," she says, "they can do a pilot project on their unit. I hope hospitalists gain access to the tool and start a falls project or work with their team to see what things in the tool could be of value to them."

Visit our website for more information on hospitalists and preventing inpatient falls.

Every year, hundreds of thousands of hospitalized patients fall. Now, hospitalists can get help in dramatically reducing those numbers. According to Erin DuPree, MD, FACOG, vice president and chief medical officer at The Joint Commission's Center for Transforming Healthcare, 30% to 50% of inpatients sustain an injury in a fall, incurring hospital costs of roughly $14,000 and adding, on average, 6.3 days to a hospital stay. It's an ongoing challenge.

"Hospitals have been working on preventing falls forever," Dr. DuPree says. "It's complex, and we needed to look at this in a data-driven way."

The center has done just that, and the result is a new web application called the Preventing Falls Targeted Solutions Tool. Anyone at a Joint Commission–accredited organization can gain complimentary access to the app, which guides users through a systematic, data-driven, Lean Six Sigma approach to reducing falls.

"It guides them through data collection and analyzes the data," Dr. DuPree adds. "Then the tool identifies your top contributing factors to falls and the solutions for those factors. We know every hospital has different contributing factors that matter; this is very local and dependent on the data that's entered."

Seven healthcare institutions in Missouri, Texas, Minnesota, California, North Carolina, and New Hampshire assisted the Joint Commission in developing the tool. Altogether, the pilot institutions reduced their rate of falls by an average of 35% and decreased their rate of patients injured in a fall by an average of 62%.

Hospitalists have a crucial role to play in bringing this process to their own workplace. "It's an opportunity for them to assert their leadership in their clinical role by collaborating with other disciplines on a big patient-safety issue," Dr. DuPree says.

It's also an opportunity for hospitalists to learn about quality improvement, she adds. "If they want to learn something about Lean Six Sigma," she says, "they can do a pilot project on their unit. I hope hospitalists gain access to the tool and start a falls project or work with their team to see what things in the tool could be of value to them."

Visit our website for more information on hospitalists and preventing inpatient falls.

Memory loss is prevalent among adult hospitalized patients and can complicate hospitalists' job of teaching them about their conditions and home care, recent research suggests. But just what is behind patients’ memory impairment is not clear.

In a recent study published in the Journal of Hospital Medicine, researchers assessed the memory and in-hospital sleep habits of older adult patients to determine whether the two are linked.

"Since the hospital is considered a 'teachable moment,' and hospitalized patients have to learn about their care but also face sleep loss due to a disruptive environment and their own illness, we thought it would be interesting to see if there was an association," says study co-author Vineet M. Arora, MD, MAPP, a hospitalist and associate professor of medicine at the University of Chicago.

Nearly half of hospitalized patients in the study showed poor memory, based on their recall of word lists and medical vignettes. The results led Dr. Arora to conclude that hospitalists need to rethink the idea of hospitalization as a teachable moment and try reinforcing techniques when teaching patients.

"When trying to teach something that hospitalized patients need to remember, consider adopting strategies that use reminders or tools that people can take home, such as written instructions or video," Dr. Arora says. She also suggests hospitalists consider involving a patient's caregiver during the teaching, to have someone who can serve as a backup for the patient later.

The study also found that patients averaged 5.4 hours of in-hospital sleep per night and below-normal sleep efficiency, with 44% of patients' sleep-quality scores measured in the insomniac range. But they saw no statistically significant association between sleep loss and memory impairment in this study, Dr. Arora says.

"Our study was observational; it may be that everyone was too sleep deprived," she adds. "We may not have enough variation in sleep to detect difference in memory."

In future studies, having some well-rested subjects might make it possible to detect the association between sleep loss and memory impairment, Dr. Arora notes.

"If we did an intervention and tried to improve sleep in half our patients," she says, "then it would be worth seeing if memory was improved because we would have two groups: one that had better sleep and one that had worse sleep." TH

Visit our website for more information on inpatients and memory loss.

Memory loss is prevalent among adult hospitalized patients and can complicate hospitalists' job of teaching them about their conditions and home care, recent research suggests. But just what is behind patients’ memory impairment is not clear.

In a recent study published in the Journal of Hospital Medicine, researchers assessed the memory and in-hospital sleep habits of older adult patients to determine whether the two are linked.

"Since the hospital is considered a 'teachable moment,' and hospitalized patients have to learn about their care but also face sleep loss due to a disruptive environment and their own illness, we thought it would be interesting to see if there was an association," says study co-author Vineet M. Arora, MD, MAPP, a hospitalist and associate professor of medicine at the University of Chicago.

Nearly half of hospitalized patients in the study showed poor memory, based on their recall of word lists and medical vignettes. The results led Dr. Arora to conclude that hospitalists need to rethink the idea of hospitalization as a teachable moment and try reinforcing techniques when teaching patients.

"When trying to teach something that hospitalized patients need to remember, consider adopting strategies that use reminders or tools that people can take home, such as written instructions or video," Dr. Arora says. She also suggests hospitalists consider involving a patient's caregiver during the teaching, to have someone who can serve as a backup for the patient later.

The study also found that patients averaged 5.4 hours of in-hospital sleep per night and below-normal sleep efficiency, with 44% of patients' sleep-quality scores measured in the insomniac range. But they saw no statistically significant association between sleep loss and memory impairment in this study, Dr. Arora says.

"Our study was observational; it may be that everyone was too sleep deprived," she adds. "We may not have enough variation in sleep to detect difference in memory."

In future studies, having some well-rested subjects might make it possible to detect the association between sleep loss and memory impairment, Dr. Arora notes.

"If we did an intervention and tried to improve sleep in half our patients," she says, "then it would be worth seeing if memory was improved because we would have two groups: one that had better sleep and one that had worse sleep." TH

Visit our website for more information on inpatients and memory loss.

Memory loss is prevalent among adult hospitalized patients and can complicate hospitalists' job of teaching them about their conditions and home care, recent research suggests. But just what is behind patients’ memory impairment is not clear.

In a recent study published in the Journal of Hospital Medicine, researchers assessed the memory and in-hospital sleep habits of older adult patients to determine whether the two are linked.

"Since the hospital is considered a 'teachable moment,' and hospitalized patients have to learn about their care but also face sleep loss due to a disruptive environment and their own illness, we thought it would be interesting to see if there was an association," says study co-author Vineet M. Arora, MD, MAPP, a hospitalist and associate professor of medicine at the University of Chicago.

Nearly half of hospitalized patients in the study showed poor memory, based on their recall of word lists and medical vignettes. The results led Dr. Arora to conclude that hospitalists need to rethink the idea of hospitalization as a teachable moment and try reinforcing techniques when teaching patients.

"When trying to teach something that hospitalized patients need to remember, consider adopting strategies that use reminders or tools that people can take home, such as written instructions or video," Dr. Arora says. She also suggests hospitalists consider involving a patient's caregiver during the teaching, to have someone who can serve as a backup for the patient later.

The study also found that patients averaged 5.4 hours of in-hospital sleep per night and below-normal sleep efficiency, with 44% of patients' sleep-quality scores measured in the insomniac range. But they saw no statistically significant association between sleep loss and memory impairment in this study, Dr. Arora says.

"Our study was observational; it may be that everyone was too sleep deprived," she adds. "We may not have enough variation in sleep to detect difference in memory."

In future studies, having some well-rested subjects might make it possible to detect the association between sleep loss and memory impairment, Dr. Arora notes.

"If we did an intervention and tried to improve sleep in half our patients," she says, "then it would be worth seeing if memory was improved because we would have two groups: one that had better sleep and one that had worse sleep." TH

Visit our website for more information on inpatients and memory loss.

Hospitalists are ideally positioned to help create new approaches to hospital quality and safety, but they must acquire the skills necessary to make sustained, systematic changes, says David W. Baker, MD, MPH, The Joint Commission's executive vice president of healthcare quality evaluation.

“Hospitalists know the system inside and out, and they have great ideas on how to improve care," Dr. Baker says. In a recent article he coauthored in JAMA, Dr. Baker describes the issue as crucial.

"We as physicians need to do a better job improving quality and safety, otherwise we're going to lose what autonomy we still have," he says. Tolerating quality and safety problems as an inevitable part of giving care will bring about increasing external forces regulating physicians, he adds.

Instead, physicians should embrace the goal of zero harm.

"It's not some overly idealistic, unattainable goal," Dr. Baker says. He points to Memorial Hermann, a health system in Houston. "Hospitals in their system are achieving zero harm on measures such as central line infections month after month."

To make such changes, hospitalists must understand modern principles of QI—including the tools of Lean Six Sigma—principles that The Joint Commission has fully adopted.

"Right now, hospitals do individual projects, but we need to think about systems of care and how we can develop interventions that are sustainable and achieve high reliability," Dr. Baker says. "For many physicians, that requires a different skill set."

Developing these systems means cutting out unnecessary steps and therefore saving money so they can achieve cost neutrality. "The critical thing is understanding the principles of change management so these things really become part of the culture of an organization," he says. "That's what hospitalists really need to learn to be able to do these projects so they’re truly sustainable." TH

Visit our website for more information on hospitalists’ role in quality improvement.

Hospitalists are ideally positioned to help create new approaches to hospital quality and safety, but they must acquire the skills necessary to make sustained, systematic changes, says David W. Baker, MD, MPH, The Joint Commission's executive vice president of healthcare quality evaluation.

“Hospitalists know the system inside and out, and they have great ideas on how to improve care," Dr. Baker says. In a recent article he coauthored in JAMA, Dr. Baker describes the issue as crucial.

"We as physicians need to do a better job improving quality and safety, otherwise we're going to lose what autonomy we still have," he says. Tolerating quality and safety problems as an inevitable part of giving care will bring about increasing external forces regulating physicians, he adds.

Instead, physicians should embrace the goal of zero harm.

"It's not some overly idealistic, unattainable goal," Dr. Baker says. He points to Memorial Hermann, a health system in Houston. "Hospitals in their system are achieving zero harm on measures such as central line infections month after month."

To make such changes, hospitalists must understand modern principles of QI—including the tools of Lean Six Sigma—principles that The Joint Commission has fully adopted.

"Right now, hospitals do individual projects, but we need to think about systems of care and how we can develop interventions that are sustainable and achieve high reliability," Dr. Baker says. "For many physicians, that requires a different skill set."

Developing these systems means cutting out unnecessary steps and therefore saving money so they can achieve cost neutrality. "The critical thing is understanding the principles of change management so these things really become part of the culture of an organization," he says. "That's what hospitalists really need to learn to be able to do these projects so they’re truly sustainable." TH

Visit our website for more information on hospitalists’ role in quality improvement.

Hospitalists are ideally positioned to help create new approaches to hospital quality and safety, but they must acquire the skills necessary to make sustained, systematic changes, says David W. Baker, MD, MPH, The Joint Commission's executive vice president of healthcare quality evaluation.

“Hospitalists know the system inside and out, and they have great ideas on how to improve care," Dr. Baker says. In a recent article he coauthored in JAMA, Dr. Baker describes the issue as crucial.

"We as physicians need to do a better job improving quality and safety, otherwise we're going to lose what autonomy we still have," he says. Tolerating quality and safety problems as an inevitable part of giving care will bring about increasing external forces regulating physicians, he adds.

Instead, physicians should embrace the goal of zero harm.

"It's not some overly idealistic, unattainable goal," Dr. Baker says. He points to Memorial Hermann, a health system in Houston. "Hospitals in their system are achieving zero harm on measures such as central line infections month after month."

To make such changes, hospitalists must understand modern principles of QI—including the tools of Lean Six Sigma—principles that The Joint Commission has fully adopted.

"Right now, hospitals do individual projects, but we need to think about systems of care and how we can develop interventions that are sustainable and achieve high reliability," Dr. Baker says. "For many physicians, that requires a different skill set."

Developing these systems means cutting out unnecessary steps and therefore saving money so they can achieve cost neutrality. "The critical thing is understanding the principles of change management so these things really become part of the culture of an organization," he says. "That's what hospitalists really need to learn to be able to do these projects so they’re truly sustainable." TH

Visit our website for more information on hospitalists’ role in quality improvement.

Hospitalists may soon see changes in precaution protocols for some hospital visitors, thanks to a revised set of guidelines published by the Society for Healthcare Epidemiology of America (SHEA). The guidelines include recommendations for visitors to patients hospitalized with infectious diseases.

"Up until now, visitors have been wearing contact precautions just like healthcare providers—gowns, gloves, masks, sometimes respirators," says lead author L. Silvia Munoz-Price, MD, PhD, enterprise epidemiologist at the Institute for Health and Society of the Medical College of Wisconsin based in Milwaukee. "We looked at the evidence for these policies. Using our judgment, a literature review, and a survey of our membership, we came up with new guidelines."

Among SHEA's recommendations are two major changes:

• Visitors of patients diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) don't need gowns and gloves if those pathogens are endemic in the region and the institution;
• For cases involving Clostridium difficile infection and extensively drug-resistant gram-negative organisms, contact isolation precautions are still recommended; and
• Visitors of patients under airborne isolation precautions do not need N95 respirators. Healthcare workers still need the protective masks, but because the masks only function when fitted properly to an individual, the masks loaned to visitors are probably ineffective.

"We've been asking visitors to wear N95, even though we know most likely it’s doing nothing," Dr. Munoz-Price says. "Now we're saying, stop doing that."

If visitors have had enough exposure to the patient at home, they can wear surgical masks or maybe no precautions at all, she adds. If visitors have not seen the patient for weeks, visitation may have to be restricted.

Dr. Munoz-Price notes that hospitalists should be aware of these revised guidelines and know that they apply only to visitors.

"Even though family members are not wearing contact precaution gear, that doesn't mean that hospitalists shouldn't," Dr. Munoz-Price says. "It's extremely important that hospitalists be compliant with their protocols and not be influenced by what we're doing with visitors." TH

Suzanne Bopp is a freelance writer in New Jersey.

Visit our website for more information on managing patients with infectious diseases.

Hospitalists may soon see changes in precaution protocols for some hospital visitors, thanks to a revised set of guidelines published by the Society for Healthcare Epidemiology of America (SHEA). The guidelines include recommendations for visitors to patients hospitalized with infectious diseases.

"Up until now, visitors have been wearing contact precautions just like healthcare providers—gowns, gloves, masks, sometimes respirators," says lead author L. Silvia Munoz-Price, MD, PhD, enterprise epidemiologist at the Institute for Health and Society of the Medical College of Wisconsin based in Milwaukee. "We looked at the evidence for these policies. Using our judgment, a literature review, and a survey of our membership, we came up with new guidelines."

Among SHEA's recommendations are two major changes:

• Visitors of patients diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) don't need gowns and gloves if those pathogens are endemic in the region and the institution;
• For cases involving Clostridium difficile infection and extensively drug-resistant gram-negative organisms, contact isolation precautions are still recommended; and
• Visitors of patients under airborne isolation precautions do not need N95 respirators. Healthcare workers still need the protective masks, but because the masks only function when fitted properly to an individual, the masks loaned to visitors are probably ineffective.

"We've been asking visitors to wear N95, even though we know most likely it’s doing nothing," Dr. Munoz-Price says. "Now we're saying, stop doing that."

If visitors have had enough exposure to the patient at home, they can wear surgical masks or maybe no precautions at all, she adds. If visitors have not seen the patient for weeks, visitation may have to be restricted.

Dr. Munoz-Price notes that hospitalists should be aware of these revised guidelines and know that they apply only to visitors.

"Even though family members are not wearing contact precaution gear, that doesn't mean that hospitalists shouldn't," Dr. Munoz-Price says. "It's extremely important that hospitalists be compliant with their protocols and not be influenced by what we're doing with visitors." TH

Suzanne Bopp is a freelance writer in New Jersey.

Visit our website for more information on managing patients with infectious diseases.

Hospitalists may soon see changes in precaution protocols for some hospital visitors, thanks to a revised set of guidelines published by the Society for Healthcare Epidemiology of America (SHEA). The guidelines include recommendations for visitors to patients hospitalized with infectious diseases.

"Up until now, visitors have been wearing contact precautions just like healthcare providers—gowns, gloves, masks, sometimes respirators," says lead author L. Silvia Munoz-Price, MD, PhD, enterprise epidemiologist at the Institute for Health and Society of the Medical College of Wisconsin based in Milwaukee. "We looked at the evidence for these policies. Using our judgment, a literature review, and a survey of our membership, we came up with new guidelines."

Among SHEA's recommendations are two major changes:

• Visitors of patients diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) don't need gowns and gloves if those pathogens are endemic in the region and the institution;
• For cases involving Clostridium difficile infection and extensively drug-resistant gram-negative organisms, contact isolation precautions are still recommended; and
• Visitors of patients under airborne isolation precautions do not need N95 respirators. Healthcare workers still need the protective masks, but because the masks only function when fitted properly to an individual, the masks loaned to visitors are probably ineffective.

"We've been asking visitors to wear N95, even though we know most likely it’s doing nothing," Dr. Munoz-Price says. "Now we're saying, stop doing that."

If visitors have had enough exposure to the patient at home, they can wear surgical masks or maybe no precautions at all, she adds. If visitors have not seen the patient for weeks, visitation may have to be restricted.

Dr. Munoz-Price notes that hospitalists should be aware of these revised guidelines and know that they apply only to visitors.

"Even though family members are not wearing contact precaution gear, that doesn't mean that hospitalists shouldn't," Dr. Munoz-Price says. "It's extremely important that hospitalists be compliant with their protocols and not be influenced by what we're doing with visitors." TH

Suzanne Bopp is a freelance writer in New Jersey.

Visit our website for more information on managing patients with infectious diseases.

The process of determining outpatient and inpatient status for hospitalized Medicare beneficiaries needs reform, according to a recent article in the Journal of Hospital Medicine.

These status determinations, made by Recovery Audit Contractors (RACs), are a growing concern for hospitals as increasing numbers of Medicare patients are hospitalized as outpatients under observation status and are not covered by Medicare Part A hospital insurance and subject to uncapped out-of-pocket charges under Medicare Part B.

The paper’s lead author, Ann M. Sheehy, MD, MS, FHM, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison and member of SHM’s Public Policy Committee, has testified before Congress on the issues of patient observation status and Medicare’s RAC program.

“The increase in RAC audits has prompted the growth, or at least been one of the factors in the growth, of observation care across the country,” Dr. Sheehy says.

The recent study by Dr. Sheehy and colleagues focused on Medicare Part A complex reviews at three academic hospitals between 2010 and 2013. All 8,110 RAC audits that occurred during the time period, from the more than 100,000 Medicare encounters at those institutions, all challenged billing status, never the care delivered. To manage these audits, each institution needed 5.1 full-time employees. “It’s very costly for hospitals and the government to manage this process,” Dr. Sheehy says.

The report also found that the mean duration for appeals of RAC decisions was 555 days. “It’s pretty easy to say that’s a failure of due process,” Dr. Sheehy says. “It’s hard for a hospital to have payments tied up for two or three years and still have enough money to take care of patients.”

Likewise, the RAC reporting was not transparent, Dr. Sheehy notes. Most successful hospital appeals were won during the discussion period, but because that is not part of the formal appeal period, the RACs didn’t report those numbers, meaning that most favorable decisions for hospitals did not appear in federal appeals reports. “We feel that any report of RAC accuracy is meaningless without reporting what happens in discussion, where most overturns are occurring,” Dr. Sheehy says.

“It is a process that’s flawed at this point,” Dr. Sheehy adds. “We hope this paper will contribute in some way to RAC reform, and that will help providers.”

Visit our website for more information on avoiding Medicare audits.

The process of determining outpatient and inpatient status for hospitalized Medicare beneficiaries needs reform, according to a recent article in the Journal of Hospital Medicine.

These status determinations, made by Recovery Audit Contractors (RACs), are a growing concern for hospitals as increasing numbers of Medicare patients are hospitalized as outpatients under observation status and are not covered by Medicare Part A hospital insurance and subject to uncapped out-of-pocket charges under Medicare Part B.

The paper’s lead author, Ann M. Sheehy, MD, MS, FHM, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison and member of SHM’s Public Policy Committee, has testified before Congress on the issues of patient observation status and Medicare’s RAC program.

“The increase in RAC audits has prompted the growth, or at least been one of the factors in the growth, of observation care across the country,” Dr. Sheehy says.

The recent study by Dr. Sheehy and colleagues focused on Medicare Part A complex reviews at three academic hospitals between 2010 and 2013. All 8,110 RAC audits that occurred during the time period, from the more than 100,000 Medicare encounters at those institutions, all challenged billing status, never the care delivered. To manage these audits, each institution needed 5.1 full-time employees. “It’s very costly for hospitals and the government to manage this process,” Dr. Sheehy says.

The report also found that the mean duration for appeals of RAC decisions was 555 days. “It’s pretty easy to say that’s a failure of due process,” Dr. Sheehy says. “It’s hard for a hospital to have payments tied up for two or three years and still have enough money to take care of patients.”

Likewise, the RAC reporting was not transparent, Dr. Sheehy notes. Most successful hospital appeals were won during the discussion period, but because that is not part of the formal appeal period, the RACs didn’t report those numbers, meaning that most favorable decisions for hospitals did not appear in federal appeals reports. “We feel that any report of RAC accuracy is meaningless without reporting what happens in discussion, where most overturns are occurring,” Dr. Sheehy says.

“It is a process that’s flawed at this point,” Dr. Sheehy adds. “We hope this paper will contribute in some way to RAC reform, and that will help providers.”

Visit our website for more information on avoiding Medicare audits.

The process of determining outpatient and inpatient status for hospitalized Medicare beneficiaries needs reform, according to a recent article in the Journal of Hospital Medicine.

These status determinations, made by Recovery Audit Contractors (RACs), are a growing concern for hospitals as increasing numbers of Medicare patients are hospitalized as outpatients under observation status and are not covered by Medicare Part A hospital insurance and subject to uncapped out-of-pocket charges under Medicare Part B.

The paper’s lead author, Ann M. Sheehy, MD, MS, FHM, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison and member of SHM’s Public Policy Committee, has testified before Congress on the issues of patient observation status and Medicare’s RAC program.

“The increase in RAC audits has prompted the growth, or at least been one of the factors in the growth, of observation care across the country,” Dr. Sheehy says.

The recent study by Dr. Sheehy and colleagues focused on Medicare Part A complex reviews at three academic hospitals between 2010 and 2013. All 8,110 RAC audits that occurred during the time period, from the more than 100,000 Medicare encounters at those institutions, all challenged billing status, never the care delivered. To manage these audits, each institution needed 5.1 full-time employees. “It’s very costly for hospitals and the government to manage this process,” Dr. Sheehy says.

The report also found that the mean duration for appeals of RAC decisions was 555 days. “It’s pretty easy to say that’s a failure of due process,” Dr. Sheehy says. “It’s hard for a hospital to have payments tied up for two or three years and still have enough money to take care of patients.”

Likewise, the RAC reporting was not transparent, Dr. Sheehy notes. Most successful hospital appeals were won during the discussion period, but because that is not part of the formal appeal period, the RACs didn’t report those numbers, meaning that most favorable decisions for hospitals did not appear in federal appeals reports. “We feel that any report of RAC accuracy is meaningless without reporting what happens in discussion, where most overturns are occurring,” Dr. Sheehy says.

“It is a process that’s flawed at this point,” Dr. Sheehy adds. “We hope this paper will contribute in some way to RAC reform, and that will help providers.”

Visit our website for more information on avoiding Medicare audits.