Unfortunately, the answer may be no, according to a study published in The Journal of Pediatrics.

The study makes it appear that insurance coverage may play a vital role in the care children get.

Researchers from Children’s Hospital Boston found:

• compared to children with private insurance, those with public insurance (Medicaid or CHIP) or no insurance were 22% less likely to be tested or have a procedure when they went to the emergency room, and
• children who didn’t have insurance were less likely to receive any medication than those with public or private insurance.

However, these findings didn’t hold true for children diagnosed with a significant illness.

The study was based on an analysis of emergency department (ED) visits recorded in the National Hospital Ambulatory Medical Care Survey from 1999-2008. It’s based on approximately 33,000 annual visits.

So what’s the reason for the treatment disparity?

The study authors gave some possible explanations for it:

First, children with private insurance are 11 times more likely than children without insurance or with public insurance to have a primary care physician (PCP). Therefore, when children with insurance go to the emergency room (ER) they are usually referred there by their PCP with instructions from the PCP for a specific workup, including extra tests and procedures.

Secondly, children with PCPs are less likely to go to the ER for non-emergency care.

Finally, parents who don’t have insurance or their children have public insurance are more worried about money and request fewer tests and treatments.

So are ERs skimping on care to uninsured and publicly insured kids because private insurance pays more so those kids get more attention?

It’s highly unlikely. The clinicians that work in the ER don’t know whether a child has private insurance, Medicaid or no insurance.

What do you think is the behind the treatment disparity in these patient populations? Share your opinions in the comments area below.

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While healthcare coupons may offer discounts on items and services reimbursable by the federal healthcare program, there are a lot of stipulations that have to be taken into consideration.

To help keep providers and facilities safe so they don’t break any laws, like those of the Federal anti-kickback statute, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued an advisory opinion (No. 12-02) with the following guidelines:

• Coupons may only offer discount services, not free services. And providers must give the same discount to any third-party payor or insurance carrier that the provider offers to the patient. For example, a provider may not offer a 20% discount directed only at the patient’s cost-sharing amount. The website must include information explaining that the coupons apply to the entire service, and the coupons themselves must include similar language.
• The website offering the coupon can’t be that of a provider. It would have to be a third-party marketer that charges providers a flat fee to host the coupons. Any marketing done by a healthcare provider of any type would be subject to extra scrutiny. Reason: The OIG says “healthcare providers and suppliers are in a position of trust and may exert undue influence when recommending healthcare-related items or services.”
• Coupon use can’t be relied on by providers. The OIG states that providers and advertisers would pay a set fee, consistent with fair market value to purchase the space for posting their coupons on the website. And the fee wouldn’t take into account the volume or value of any business garnered by the coupon. For example, providers would be able to see statistics regarding how many times their profile was viewed and how many times customers downloaded their coupon, but the fee charged wouldn’t vary based on these statistics.
• Personal information about the coupon purchaser can’t be shared with the provider. In other words, an account can’t be a requirement to download the coupon, and any personal information provided, such as an email address, can’t be shared with the provider.
• The coupon has to be structured like the ones people get through snail mail. To decrease the risk of violating the anti-kickback statute, the customer can’t pay anything up-front for the coupon. Prepayment of a coupon increases the likelihood of service over-utilization. The example the OIG gave was, if a person bought a prepaid coupon for service x, when that person walks into the offering provider’s office requesting service x — having already paid for service x — the offering provider might feel pressure to render it even if it isn’t medically necessary.
• Providers must comply with the discount safe harbor. Under the arrangement, providers would be the “sellers” and the customers would be the “buyers” for purposes of the discount safe harbor.  To qualify for protection under the discount safe harbor, buyers and sellers have certain reporting obligations to ensure that any discounts are shared with federal healthcare programs.

What do you think about providers offering service coupons — good idea or just too risky? Share your thoughts below.

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Twenty-six organizations received the honor of being the first granted with the Healthcare Innovation Awards. Check out what these groups did to win a total of $122.6 million.

Award winners were chosen for their:

• innovative solutions to the healthcare challenges facing their communities
• focus on creating a well-trained healthcare workforce equipped to meet the needs of the 21st century healthcare system, and
• money-saving practices.

The preliminary award winners are expected to reduce healthcare spending by $254 million over the next three years.

The projects, which receive funding for three years, include collaborations among the country’s leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations and patients’ advocacy groups.

“We can’t wait to support innovative projects that will save money and make our healthcare system stronger,” said Health and Human Services Secretary Kathleen Sebelius in a CMS press release. “It’s yet another way we are supporting local communities now in their efforts to provide better care and lower costs.”

This is only the first batch of award winners. More will be announced in early June 2012.

Here’s an overview of a few of the winning projects:

• Beth Israel Deaconess  Medical Center, Boston.  The facility is receiving $4,937,191 for its project “Preventing avoidable re-hospitalizations: Post-Acute Care Transition Program (PACT)”. It’s estimated that the project’s three-year savings will be $12.9 million. The goal of the project is to improve care and reduce hospital re-admissions for Medicare beneficiaries dually eligible for Medicare and Medicaid. These patients represent over 8,000 discharges for conditions such as congestive heart failure, acute myocardial infarction and pneumonia.

  By integrating care, improving patients’ transitions between locations of care, and focusing on a battery of evidence-based best practices, this model is expected to prevent complications and reduce preventable re-admissions. The results would be better quality health care at a lower cost in the urban Boston area.

• Pittsburgh Regional Health Initiative, Pittsburgh.The initiative is getting $10,419,511 for its project “Creating a virtual accountable care network for complex medical patients.” It’s estimated that the initiative’s three-year savings will total $74.1 million.

  The organization plans to create specialized support centers, staffed by nurse care managers and pharmacists, to help small primary care practices offer more integrated care within the service areas of seven regional hospitals in Western Pennsylvania.

  The resulting teams will provide support for care transitions, intensive chronic disease management, medication adherence, and other problems associated with a lack of communication in healthcare systems at large and the resulting fragmentation of health care for patients. This approach is expected to reduce 30-day re-admissions and avoidable disease-specific admissions.

• Regents of the University of California, Los Angeles.“UCLA Alzheimer’s and dementia care:  comprehensive, coordinated, patient-centered” project will be awarded $3,208,540, and it’s estimated three-year savings is $6.9 million.

  This award will expand a new program to provide coordinated, comprehensive patient- and family-centered care for 1,000 Medicare and Medicaid beneficiaries with Alzheimer’s disease or other forms of dementia. The goal is to reduce hospitalizations and shorten hospital stays, reduce emergency room visits, and improve patient health, caregiver health, and quality of care.

  The program will train and deploy professional and non-professional workers, and unpaid volunteers, expand a dementia registry, conduct patient needs assessments, and create individualized dementia care plans.

• University Hospitals of Cleveland, Ohio.The facilities are getting $12,774,935 for the project “Transforming pediatric ambulatory care: the physician extension team.” The estimated three-year savings will be $13.5 million. University Hospitals (UH) Rainbow Babies and Children’s Hospital at UH Case Medical Center award is for improving care for 65,000 children in Medicaid with high rates of ER visits, complex chronic conditions and significant behavioral health problems. The intervention will offer healthcare advice, referrals and coordinated services through telehealth and home nurse hotlines.

  It will also provide practice-tailored facilitation for primary care providers and financial incentives to physicians who reach quality performance targets, agree to offer extended hours and make themselves available to treat these kids.

For a complete list of award winners, click here.

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With initial symptoms reflecting those of the common influenza virus or forms of pneumonia, a diagnosis for Legionnaires takes more extensive testing, allowing symptoms to worsen and more people to be exposed.

This dangerous strain of bacteria spreads through infected water or aerosols in areas where there’s poor air ventilation.

The worst outbreak in history exposed the bacterium to nearly 16,000 people before it was contained, and in other cases, death rates reached into the double digits.

Take a look at the 12 worst Legionnaires’ outbreaks in the world, listed in chronological order:

1. Philadelphia, PA, USA |  1976
Source: Air conditioning
Death-to-infection rate: 34/221, or 15.4%
Fact: This was the first recorded outbreak of the disease, and the mysterious strain of bacteria that caused it was finally identified. 

 2. Stafford, England | 1985
Source: Hospital air conditioning unit
Death-to-infection rate: 28/175, or 16%
Fact: This marked the largest outbreak of Legionnaires disease in Britain.

3. Bovenkarspel, Netherlands | 1999
Source: Hot tub
Death-to-infection rate: 32/318, or 10%.
Fact: More deaths from this bacteria could have been recorded, but bodies had already been buried before they had identified Legionnaires as the cause of the outbreak.

4. Melbourne, Australia | 2000
Source: Cooling tower at a newly opened aquarium
Death-to-infection rate:  4/95, or 4.2%
Fact: 100% of those diagnosed with the disease had visited or passed within 500 m of the the Melbourne Aquarium in the same 4 week period, allowing scientists to pinpoint the exact source of exposure.

5. Murcia, Spain | 2001
Source: Hospital air conditioning
Death-to-infection rate: 6/100, or 1%
Fact: This is the world’s largest outbreak of the disease, where at least 16,000 people were exposed to the bacterium.

6. Barrow-in-Furness, England | 2002
Source: Contaminated cooling tower in a neighborhood arts center
Death-to-infection rate: 7/172, or 4%
Fact: The Barrow Borough Council and the architect of the arts center were charged with, but cleared of, corporate manslaughter charges, and were later fined for breaches of health and safety regulations.

7. Lens, France | 2004
Source: Cooling tower at a petrochemical plant
Death-to-infection rate: 7/59, or 11.8%
Fact: This marked the worst Legionnaires outbreak ever recorded in France.

8. Zaragoza, Spain | 2004
Source: Hospital cooling tower
Death-to-infection rate: 7/27, or 26%
Fact: Five of the seven victims of this outbreak were above the age of fifty.

9. Fredrikstad, Norway | 2005
Source: Air scrubber of a nearby factory
Death-to-infection rate: 10/56, or 17.8%
Fact: The patients that became ill in this outbreak lived over 20 km apart, but the high velocity, large drift and high humidity in the air scrubber were linked to the long-distance spread.

10. New Brunswick, NJ, USA | 2008
Source: Contaminated supply of drinking water
Death-to-infection rate: 2/6,  or 33%
Fact: Exposure to patients in the hospital where the outbreak occurred has been traced back to a sudden drop in chlorine levels in the hospital’s drinking water.

11. Dayton, OH, USA | 2011
Source: Hospital air conditioning
Death-to-infection rate: 5/11, or 45%
Fact: This was the largest outbreak of Legionnaires’ disease in Ohio since 1994.

12. Calpe, Spain | 2012
Source: Currently unknown
Death-to-infection rate: 3/18, or 17%
Fact: The infection quickly spread through a beach hotel and claimed the lives of three British vacationers before being contained.

http://www.legionellacontrol.com

http://www.hcinfo.com/

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As an academic medical center and the safety net for the St. Louis region, Barnes-Jewish Hospital sees any and all kinds of patients and conditions — making its drive for excellence especially tough.

After all, if you specialize in a few things, it’s easier to excel at them because you have a limited focus. Trying to be the best at everything, is a lot more difficult. So the hospital took on one issue at a time.

Step 1

The first step in achieving its goals was to employ “lean management.” This management system was designed to minimize waste, standardize processes and drive continuous improvement.

Standardizing patient care was key. While Barnes-Jewish Hospital standardized its processes for patient care, it allowed tailored intervention per individual patient — when appropriate. This “variation” was allowed because it benefits patients by providing care specific to their needs.

Step 2

The next step involved training the facility’s future providers. The hospital requires residents to have four hours of lean training and then they have to participate in a process improvement project.

One of these projects was for central line-associated blood stream infections (CLABSIs). Previously, the hospital’s seven intensive care units (ICUs) each had its own method for reducing CLABSI. Under the lean system, all ICUs standardized their practices in insertion, maintenance and follow-up.

For example, the clinicians who insert central lines were trained in a simulation to use evidence-based, standard practices, such as being required to wear a gown, gloves and have a sterile field.

The nurses, who maintained the catheters, had a standardized schedule for changing dressings and the hubcaps of the line.

And finally, the clinicians were trained to question the patient’s need for continued use of a central line on a daily basis using a standard checklist.

Thanks to this process improvement project, the hospital experienced a dramatic drop in CLABSIs.

Other projects tackled at the facility included: diabetes medication errors, pressure ulcers and transition of care. To read more about these click here.

Has your facility implemented any quality improvement projects? If so, tell us about them in the space provided below.

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Should nurses be allowed to administer anesthesia without a doctor’s supervision?

This is a debate that’s been plaguing hospitals around the country. It started in 2001 with a change to Medicare and Medicaid regulations. The change allowed states to opt out of a requirement that nurse anesthetists be supervised.

Many believe this is a good change. Reason: It gives increased access to healthcare for people in rural areas who have to travel outside their local community to find a facility that has an anesthesiologist.

The two sides of the debate are:

• Nurse anesthetists, who specialize in administering anesthesia. Argument: They are highly capable of administering anesthesia without the supervision of a physician, because they learn about the same drugs, equipment and standards of care as physicians do.
• Anesthesiologists, who are physicians who specialize in administering anesthesia. Argument: Anesthesia is a complex and technically demanding area of medicine that requires the skill of a physician, or at least the supervision of a physician, in case complications arise.

Colorado is one of 17 states that have decided to allow nurse anesthetists to administer anesthesia without physician supervision. Due to this decision, the state finds itself embroiled in a legal battle.

In 2010, anesthesiologist and medical societies filed a lawsuit in state court. The lawsuit asserted that allowing nurse anesthetists to deliver anesthesia without supervision wasn’t consistent with state law — a requirement for opting out of the federal rule.

However, the lawsuit was dismissed. A judge ruled the legislature did intend for the practice to be allowed. But that didn’t stop the medical societies. They appealed the ruling last May. Nationally, both sides are keeping a close watch on this case.

Colorado isn’t alone. The California Society of Anesthesiologists petitioned the State Supreme Court to take another look at its 2009 lawsuit for opting out of the supervision requirement. Much to the chagrin of the California Hospital Association, the suit hasn’t been successful. The association is on the nurses side due to the difficulty it’s had staffing anesthesiologists in facilities in California’s rural areas.

Where does your facility stand on this debate? Share thoughts in the box below.

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Transcatheter aortic valve replacement (TAVR), which allows doctors to replace a patient’s aortic valve through a small opening in the leg, is less invasive and gives patients who normally can’t undergo open heart surgery a fighting chance at survival.

The announcement of the coverage decision on May 1, is one of the first under a mutual memorandum between CMS and the FDA to get new, lifesaving technology to patients sooner.

To offer this procedure to patients, certain provider, facility and data collection criteria have to be met. Reason: It’s still a fairly new technology, and CMS and the FDA want to make sure these procedures are done by highly trained professionals in facilities that are well equipped so patients receive the safest and best care possible.

That’s why the decision states the procedure is covered under “Coverage with Evidence Development.”

The procedure will be covered for the treatment of symptomatic aortic-valve stenosis when the following five conditions — each of which has its own criteria — are met:

• The procedure is performed with a complete aortic valve and implantation system that has received FDA pre-market approval for that system’s FDA approved indication.
• Two cardiac surgeons have independently examined the patient’s suitability for open aortic valve-replacement surgery.
• The patient is under the care of a heart team: a cohesive, multidisciplinary team of medical professionals.
• The heart team’s interventional cardiologists and cardiac surgeons must jointly participate in the intraoperative technical aspects of TAVR, and
• The treating team and hospital must participate in a national registry that enrolls TAVR patients and tracks the following outcomes: stroke; all-cause mortality; transient ischemic attack; major vascular events; acute kidney injury; repeat aortic valve procedures; and quality of life.

TAVR is covered for uses that aren’t listed as an FDA-approved indication, but only when done within a clinical study that meets required conditions.

For the complete list of all the conditions, click here.

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To avoid such instances, Patient Safety & Quality Healthcare published four accepted, clinical best practices to keep wander risk patients safe:

1. Assess patients’ risk of wandering. Even though a patient may not be diagnosed as a wander-risk, it’s best to screen patients for memory problems, delirious behavior and disorientation. Facilities should also talk to members of the patient’s family to find out if any dementia-related diagnoses were made or if the patient has displayed any dementia related symptoms.
2. Closely supervise at-risk patients. Patients at risk for wandering should be placed in rooms in high staff traffic areas where there is only one way in or out — past the nurse’s desk or a supervisor’s station. In addition, it’s a good idea for hospitals to put wander-risk patients in different colored gowns so they are easily identifiable.
3. Minimize wandering triggers. Wandering can be brought about by environmental triggers. Foot traffic, activity and noise are known wandering triggers. Exit cues are another signal to patients to wander, such as elevators, staircases, doors, etc. Visual cues are another trigger such as suitcases, shoes, regular clothes, cars, etc. And finally, certain medications can cause wandering behaviors. To control the triggers, find out from family, friends or previous caregivers, if they know why the patient wanders: searching for a loved one, still believing they have a job to go to or a child to pick up, getting frightened in new environments, etc.
4. Treat the root cause. Make sure these patients feel safe and secure in their rooms. Only make room changes when there’s no other option. They can cause panic and confusion in dementia patients. Also, soft lighting and soothing music can help them feel safe and secure. Harsh environmental stimuli (bright lights, loud music) can cause patients to wander off in search of a more soothing environment. Pain and sleeplessness are other causes of wandering in dementia patients.

To ensure your protocols work for keeping wander-risk patients safe, administrators need to regularly test them.

In addition, it’s a good idea to register patients at risk of wandering with the National Silver Alert Program. It’s free and allows caregivers to electronically store important information about the patient, such a recent photo, medical records, power of attorney, living will, etc.

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People with debilitating diseases face a number of challenges that take an extensive toll on their health and finances. A person’s life can be completely changed in just a few short months as the disease progresses.

Here’s a list of debilitating diseases that significantly change the lives of millions of people:

12. Rheumatoid Arthritis (RA)

RA is an autoimmune disease that causes chronic inflammation in joints and organs throughout the body. A fairly common disease affecting 1.3 million people in America alone, RA includes symptoms that are painful and debilitating. People diagnosed with it may go through periods of remission for months or years where symptoms are not noticed. This is, however, a progressive illness that leads to joint destruction and physical disability, and there is no cure. Treatments have improved over time, and the prognosis for those with RA has improved. Physicians are now able to better control and prevent flare-ups, so patients are able to live a somewhat uninterrupted lives.

11. Schizophrenia

This brain disease is a complex mental disorder that makes it difficult for those diagnosed with it to differentiate between reality and imagined experiences, behave normally in social situations, and have normal emotional responses to everyday situations. Though genetic factors have been identified as one of the causes of the disease, mental health experts still can’t pinpoint specific causes. People who suffer with schizophrenia often spend their lives in monitored isolation due to the disease’s extreme psychological barriers that prevent them from having friends or a job. Antipsychotic medications are the most common form of treatment, and because this is a life-long illness, patients usually have to stay on these medications, which have many side effects, for their lifetime.

10. Poliomyelitis

This disease, caused by the spread of the poliovirus, affects the central nervous system and can lead to partial or full paralysis. Though vaccinations to the poliovirus have helped prevent the spread of this disease in many parts of the world, it is still a big concern today due to its extremely debilitating complications. There are three main types of the disease, each ranging in complexity and health threats: subclinical infection, which accounts for 95% of the diagnoses, causes mild discomforts and runs its course within 72 hours; nonparalytic poliomyelitis, which causes pain, stiffness and fatigue, and usually lasts one to two weeks; and paralytic poliomyelitis, which targets the brain and spinal cord, and can cause full or partial paralysis or even death.

9. Muscular Dystrophy (MD)

Muscular dystrophies are actually a group of related and inherited disorders that contribute to muscle loss and weakness over time. Each type of MD can affect children and adults, though the most severe forms usually occur in early childhood. There is no cure for these diseases, making their debilitating effects even more upsetting. The effects can target all muscles or just a  group of muscles in the body, causing severe decreases in mobility, lung failure, scoliosis, cardiac fibrosis and tightening of muscles around main joints that cause complications that lead to death.

8. Cerebral Palsy

There are several different types of cerebral palsy which affect the functions of the brain and nervous system. The cause for this disease is abnormalities or injuries to the brain during fetal development and also can occur up to the age of two years, when brains are still developing. There are several different types of this disease: spastic, dyskinetic, ataxic, hypotonic, and mixed, with symptoms ranging from mild to severe. These symptoms include muscle tightening, tremors, speech problems, slow growth and problems swallowing. There is no cure for cerebral palsy, though there are treatment plans that include therapies, surgeries or even medications to help lessen the severity of symptoms. Long-term care is usually required as this is a life-long, debilitating disease.

7. Chronic Obstructive Pulminary Disease (COPD)

COPD is a condition which makes it increasingly difficult to breathe due to permanent damage of the lungs and constricting airways, and is often a result of smoking. Coughing and breathing difficulties usually get worse as this disease progresses, and many who suffer from COPD also have chronic bronchitis and/or emphysema. Over time, those with COPD have trouble breathing, and the irreversible damage to the lungs weakens one of the most important systems in the body. The World Health Organization has named COPD one of the top single causes of death (tied with HIV/AIDS), but the good news is that though this is a chronic, debilitating and generally fatal disease, complications can be controlled and slowed down over time with medication and a healthy lifestyle.

6. Cystic Fibrosis

The cause of this disease stems from a defective gene that causes the creation of thick mucus in the lungs and pancreas, leading to life-threatening breathing problems, lung infections and digestive problems. If caught early, a treatment plan can be formulated to help lessen symptoms and improve the rate of survival. Treatments usually include antibiotics, oxygen therapy and sometimes even lung transplants, along with healthy lifestyle changes. Most children diagnosed with this disease lead relatively normal lives and can go through school and college with little or no interruptions to their daily routines. Later, however, the lung disease eventually worsens . Most live for an average age of 37 years.

5. Scleroderma

This connective tissue disorder and autoimmune disease causes changes in the skin, blood vessels, internal organs and muscles, and can occur solely on the skin level or internally throughout the entire body. Once diagnosed, symptoms usually progress slowly over time and most often lead to skin darkening, thickening and hardening, causing a tight, mask-like appearance, especially on the face. When this disease spreads to the internal organs like the heart, kidney, lungs and GI tract, the organs begin to fail, leading to complications like lung problems, cancer and heart failure. The cause of this disease is unknown and there are also no methods of prevention, so the mortality rate for those with advanced stages of the disease is high.

4. Multiple Sclerosis (MS)

MS is an autoimmune disease that affects the central nervous system, and is more common in women than in men. The extensive nerve damage caused by this disease leads to a number of symptoms like muscle spasms, difficulty walking or moving limbs, bowel and bladder problems, loss of vision, dizziness, slurred speech, trouble swallowing, and more. Some patients experience symptoms on an on-going basis, while others have periods of attacks that may last a few days or months at a time. Depending on the severity of the attacks, some people can live a “normal” life with MS, while others’ health and mobility declines over time. There are no cures for MS, though there are medications and different forms of therapies that can slow the progress of the disease.

3. Parkinson’s Disease

This brain disorder leads to bodily tremors and difficulties with movement or controlling functions. It is the most common disorder among the elderly, as it usually affects people after age 50, though some cases have been reported in those earlier in life. There is no cure for this debilitating disease, though there are medications and lifestyle changes that can help reduce the symptoms. If left untreated, the disease will get worse and lead to total disability and ultimately to a person’s death.

2. Amyotrophic Lateral Sclerosis (ALS) – Lou Gherig’s Disease

ALS affects the nerve cells in the brain and spinal cord that control voluntary muscle movement, though the core cause is unknown and no cure exists. Symptoms of the disease don’t usually come about until after age 50, though some cases have been reported in younger people. When neurons in the brain can no longer communicate with muscles, those with ALS  suffer from muscle weakening, twitching, and an inability to move their arms, legs and body. Over time, the condition gets worse. It’s when the muscles in the chest and respiratory area are affected that this disease becomes fatal.

1. Alzheimer’s and Dementia

Alzheimer’s Disease is one form of dementia that affects the way people think, behave and remember events in life. Early onset Alzheimer’s affects people prior to age 50 and is fast-moving, though the most common forms of the disorder target those in later stages of life. Symptoms start off with forgetfulness and difficulty doing more than one thing at a time. As the disorder progresses, patients have a more difficult time remembering people, places and events, and are often confused in social situations. This causes them to behave erratically and unpredictably. In later stages, those with advanced Alzheimer’s cannot understand language and can no longer perform daily functions like eating or bathing. There is no cure for this disorder, and after diagnosis, patients usually can live from 3-20 years with the disease which ultimately causes their death.

Sources: U.S. National Library of Medicine
World Health Organization

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Length of stay for these patients in the ICU doubled from a mean of 8.1 days to 15.8 days.

Two factors that increased patients’ risk for an HAI: coming from the emergency department and being over 75 years old.

So which infections were more likely to drive up the mortality rate?

• Bloodstream infection (24.7%)
• Hospital-acquired pneumonia (16.7%), and
• Surgical-site infection (10.9%).

The Premier Perspective hospital database, which was analyzed for the study, covered 20% of U.S. hospital discharges – 460,000 ICU patients. The study looked at patients over 18 with an ICU stay of at least 48 hours in 2007. Note: The researchers also looked at data from 2008 and 2009 and got similar results.

Cost analysis

What will really interest hospital executives is what the study found when it did a cost analysis based on direct variable costs and fixed overhead costs:

The infections cost an extra $16,000 per ICU stay, noted Florence Joly, PharmD,  from global evidence and value development at Sanofi in Paris, France, and lead researcher of the study. For a patient without an HAI, the cost was $21,500. For a patient with an HAI, the cost was $37,500.

Kenneth Christopher, MD, from Brigham and Women’s Hospital, Harvard Medical School, Boston, offered a word of caution concerning the study results. He noted that 25.8% of ICU patients who developed an HAI in the study were more likely to have a predisposition to infection-related supportive measures, such as endotracheal tube placement and intravascular lines.

He also pointed to a study the Centers for Disease Control and Prevention (CDC) published in 2011 on ICUs in the United States, which showed that from 2001 to 2009, central-line-associated bloodstream infection dropped 58%. The CDC report also found that the initiation of a bundle protocol was an effective method to reduce ventilator-acquired pneumonia.

So while many U.S. hospitals already have infection control practices implemented for critically ill patients and infection rates are down, it still poses a major threat to patients and a huge financial burden to hospitals.

Do you feel U.S. facilities’ practices to prevent HAI in the ICU are enough or can even more be done? Share your thoughts below.

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