Posts Tagged ‘patient safety’

Changing Healthcare, One Story at a Time: Taking Sepsis Awareness to the Maryland General Assembly

Watch as MedStar Institute for Quality & Safety Center for Healthcare Narratives presents a visual case study of how our healthcare stories and narratives can influence lasting change across the country. Viewers are reacquainted with Cheryl Douglass, a sepsis survivor who needlessly lost four limbs to the disease, and her husband Paul who once again team up with Jeanne DeCosmo, director of Clinical Quality, to raise awareness on the disease that still takes hundreds of thousands of lives each year. They find themselves in the office of Pegeen Townsend, MedStar’s vice president of Government Affairs, who recognizes the power in their story and takes the first video version of their story to the Maryland General Assembly. The rest is history, and you can watch the video to find out how the Douglass’ story continues to leave a lasting impact in sepsis and in healthcare across Maryland and the country.

Be the first to comment - What do you think?  Posted by admin - May 13, 2019 at 11:20 pm

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Healthcare-Associated Infections in the United States

A new CDC video depicts progress and challenges in combating healthcare-associated infections in the United States.

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Be the first to comment - What do you think?  Posted by admin - April 26, 2019 at 3:20 am

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How to Engage Your Health Care Leader

Need help getting leadership support for your quality improvement project?

IHI’s Derek Feeley shares the four key components every successful elevator pitch needs.

Icons by: Yannick, Eucalyp – Available at

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Be the first to comment - What do you think?  Posted by admin - March 15, 2019 at 3:20 am

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Don Berwick Talks Politics and Health Care

IHI’s Don Berwick explains why he believes that being a political bystander is not a neutral position when it comes to health care.

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Be the first to comment - What do you think?  Posted by admin - January 9, 2019 at 7:20 am

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Why Health Care Boards Need to Know Quality Improvement

Why Health Care Boards Need to Know Quality Improvement

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IHI’s Derek Feeley on the need for health care boards to learn about quality improvement

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Champion Medical Technologies debuts new name, website | Business Wire

Champion Medical Technologies debuts new name, website | Business Wire

Photo by: Luca Bravo / Unsplash

LAKE ZURICH, Ill.–()–Champion Medical Technologies, a provider of systems that help hospitals

better manage implantable devices and tissue, has renamed itself to more accurately reflect its corporate

mission. The company also debuted a new website, logo and motto,

“Freedom to do more good.”

“We have long thought that Champion Medical sounds more like a product

company; it has a clinical tone that doesn’t really represent what we’re

about,” said Peter I. Casady, the company’s co-founder and CEO. “We

think of Champion as solving a broader challenge, one that spans

healthcare, in reducing costs and increasing patient safety.”

Champion is an innovator in the market space created by the advent of unique

device identifiers (UDIs), mandated for device makers by the Food

and Drug Administration. Implantable devices now arrive at hospitals in

packaging with barcodes that include UDIs, but hospitals need systems to

help make use of this information. Champion’s thorough understanding of

UDIs informed its creation of UDITracker®

and GraftTracker®, solutions that help hospitals and health

systems take advantage of barcoding to accurately track and trace

medical device implants through the entire chain of hospital custody.

“As a technology provider we empower hospitals to make healthcare safer

and more affordable, which to us translates into ‘freedom to do more

good,’ ” Casady said. “Automating many of the tedious tasks of inventory

control – such as tracking supplier compliance status and

certifications, identifying and flagging recalls, and managing tissue

implant records – frees hospital staff to spend more time giving their

patients the very best care possible. I can’t think of a better

representation of our corporate mission than that.”

The new

website more clearly focuses on UDITracker and on the issue of UDIs

in healthcare. “We want our website to be a valuable resource on this

important safety and quality issue, one that helps us advocate for

better use of UDIs by hospitals and health systems,” Casady said.

About Champion

Champion Healthcare Technologies is a privately held healthcare

information technology company and leader in providing medical device

management systems for hospitals. Its goal is to empower healthcare

providers with the insights they need to improve patient safety and

drive down operating costs. For more information, visit,

call (866) 803-3720 or email

Be the first to comment - What do you think?  Posted by admin - December 20, 2017 at 5:37 am

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News from the agency for healthcare research and quality.

News from the agency for healthcare research and quality.

Organizational silence threatens patient safety

Organizational silence refers to the tendency for people to do or

say very little when confronted with significant problems or issues in

their organization or industry. In a recent article, Kerm Henriksen,

Ph.D., and Elizabeth Dayton, M.S., of the Agency for Healthcare Research

and Quality (AHRQ), describe the individual, social, and organizational

factors that contribute to organizational silence and can threaten

patient safety. They cite several individual factors that contribute to

clinician silence. For example, the availability heuristic suggests that

if relatively infrequent events that harm patients go unreported and are

not openly discussed, clinicians don’t believe these events are a

problem at their hospital. A second factor is self-serving bias. People

tend to view themselves as “above average” in their chosen

field of work and so “why do things differently?” Successes

are attributable to their own abilities but failures are blamed on

situational factors. Finally, members of all organizations display a

strong tendency to perpetuate the status quo and not speak up or rock

the boat.

Several social factors also underlie clinician silence. There is

great pressure to conform in order to gain acceptance and work

harmoniously with coworkers. Diffusion of responsibility is also a

problem. In clinical settings, individual roles and responsibilities are

often assumed rather than clearly spelled out. Under these conditions of

diffused responsibility, components of care that should be attended to

are often missed. Also, managers who seek blame and attribute error to

the individual failings of careless or incompetent staff create a

microclimate of distrust.

Finally, three areas of organizational vulnerability that warrant

closer attention are unchallenged beliefs, the perceived qualities of

the good worker who “works around” problems rather than

focusing on the contributory factors to the problem, and lack of

understanding of the interdependence of complex clinical systems. The

authors recommend that health care leaders and managers value dissent

and multiple perspectives as signs of organizational health, and

question agreement, consensus, and unity when they are too readily


See “Organizational silence and hidden threats to patient

safety,” by Dr. Henriksen and Ms. Dayton, in the August 2006 HSR:

Health Services Research 41(4), pp. 1539-1554. Reprints (AHRQ

Publication No. 06-R060) are available from the AHRQ Publications


Prescription drug benefits limits for Medicare beneficiaries are

associated with less use of prescription drugs, worse clinical outcomes,

and higher hospitalization costs

The caps placed on Medicare drug benefits are associated with less

use of prescription drugs and poor clinical outcomes, without any net

cost savings, concludes a new study. In elderly patients with chronic

diseases, the caps were associated with poorer adherence to drug therapy

and poorer control of blood pressure, lipid levels, and glucose levels.

The differences in use of prescription drugs for those with caps were

substantially larger during the months after they exceeded the cap than

during earlier months. Beneficiaries whose benefits were capped had

higher rates of non-elective hospitalizations, visits to the emergency

department, and death than those whose benefits were not capped.

Thus, the savings in drug costs from the cap were offset by

increases in the costs of hospitalization and emergency department care.

These findings suggest a need to closely monitor the effects of the new

Medicare drug benefits and, possibly, to modify cost sharing for drugs

that are effective in treating chronic diseases, suggests John Hsu,

M.D., M.B.A., M.S.C.E., of Kaiser Permanente. He and fellow researchers

at Kaiser, Harvard University, and the University of California, San

Francisco compared the clinical and economic outcomes in 2003 among

157,275 elderly Medicare+Choice beneficiaries, whose annual drug

benefits were capped at $1,000, and 41,904 beneficiaries whose drug

benefits were unlimited because of employer supplements.

Those with capped benefits had pharmacy costs for drugs applicable

to the cap that were 31 percent lower than those whose benefits were not

capped, but their total medical costs were comparable (with a

non-significant 1 percent difference). Among those who used drugs for

hypertension, high cholesterol, or diabetes in 2002, those whose drug

benefits were capped were 30 percent, 27 percent, and 33 percent more

likely, respectively, to be nonadherent to long-term drug therapy in

2003. These subgroups also had higher respective blood pressure,

cholesterol, and blood-sugar levels in 2003 than their counterparts

without drug benefit caps. The study was supported in part by the Agency

for Healthcare Research and Quality (HS13902 and HS10803).

See “Unintended consequences of caps on Medicare drug

benefits,” by Dr. Hsu, Mary Price, M.A., Jie Huang, Ph.D., and

others, in the June 1, 2006, New England Journal of Medicine 352(22),

pp. 2349-2359.

Medical malpractice laws capping damage payments appear to lower

State health care expenditures by 3 to 4 percent

Twenty-eight States have enacted laws that limit the payment for

damages to patients in medical malpractice cases. These laws appear to

reduce State health care expenditures by 3 to 4 percent, concludes a

study by researchers Fred J. Hellinger, Ph.D., and William E. Encinosa,

Ph.D., of the Agency for Healthcare Research and Quality (AHRQ). Payment

limits may reduce expenses by curtailing the practice of defensive

medicine (physicians ordering tests, procedures, and visits because of

their concern about malpractice liability risk).

Drs. Hellinger and Encinosa used a multivariate model and 1984,

1988, 1994, and 1998 data on State health care expenditures and a

variety of other State characteristics to estimate the impact of State

tort reform laws that directly limit malpractice damage payments of

State health care expenditures. The model included data from before and

after the enactment of cap laws in 15 States, factors that adjusted for

other types of malpractice liability reforms, and other factors

affecting a State’s health care expenditures (for example, income

and proportion of uninsured).

Based on the model, the mean reduction in State health care

expenditures due to caps was equal to $92 per capita. The robustness of

findings across a variety of specifications provides reasonably strong

support for the argument that laws capping non-economic damage payments

reduce health care costs, note the authors. However, they caution that

other types of State laws may have affected health care expenditures and

that their findings relied on State data only. They recommend that

future studies include more variables and use data from other sources

and different time periods. They also call for studies that examine

whether or not the level at which damages are capped is related to

health care expenditures, and whether or not reductions in health care

spending attributable to these laws are related to poorer health


See “The impact of state laws limiting malpractice damage

awards on health care expenditures,” by Drs. Hellinger and

Encinosa, in the August 2006 American Journal of Public Health 96(8),

pp. 1375-1381. Reprints (AHRQ Publication No. 06-R073) are available

from the AHRQ Publications Clearinghouse.

Increasing the time that nurses spend with nursing home residents

is key to improving their job satisfaction

The work of nurses and certified nursing assistants (CNAs) at U.S.

long-term care (LTC) facilities is physically difficult and emotionally

exhausting with a turnover rate of more than 100 percent among these

frontline workers. Increasing the time that nurses spend with nursing

home residents is key to improving their job satisfaction, concludes a

study supported by the Agency for Healthcare Research and Quality

(HS12031). Researchers found that nurse satisfaction was primarily

influenced by intrinsic feedback from nursing home residents: for

example, when residents tell them how much their care has helped them or

meant to them or when nurses are able to see the tangible results of

their efforts (such as the satisfaction of seeing a resident eat well at

a meal as a result of patient coaching).

The researchers conducted job design and satisfaction surveys of

1,146 employees of 20 Massachusetts LTC facilities. They also

interviewed 144 employees representing all staffing levels from nursing

directors to CNAs, and observed 37 frontline nurses and CNAs. Contrary

to expectations, CNAs were more satisfied with their jobs than nurses

and reported significantly higher levels of intrinsic feedback from

residents, with whom they worked more closely than nurses. Nurses spent

more time coordinating patient care than tending to patients.

For CNAs, satisfaction was influenced by task identity, autonomy,

and intrinsic feedback. However, satisfaction among nurses was

influenced only by intrinsic feedback from residents. In fact, nurses

described lack of interaction with residents as the worst part of their

jobs, along with the burden of paperwork they had to complete. The LTC

administrators interviewed in this study said that retaining nurses was

their main concern. The researchers suggest that managers may improve

nurse retention rates by hiring nurses who are seeking less direct

patient care and more managerial positions. Another approach would be to

permanently assign individual nurses to certain residents with whom they

could build relationships.

See “An exploration of job design in long-term care facilities and its effect on nursing employee satisfaction,” by Denise A.

Tyler, M.A., Victoria A. Parker, D.B.A., Ryann L. Engle, M.P.H., and

others, in the April 2006 Health Care Management Review 31(2), pp.


Influenza is the most deadly illness for the very elderly

Nearly 8 percent of patients age 85 and older who are hospitalized

for influenza do not survive the disease. This death rate is more than

twice the 3 percent for hospitalized patients aged 65 to 84, according

to a new report by the Agency for Healthcare Research and Quality


Influenza, or flu, is a contagious respiratory illness caused by

viruses. Flu kills more than 36,000 Americans each year and afflicts

between 5 and 20 percent of the U.S. population, according to Federal

estimates. Experts endorse vaccinations though November and December

since most flu activity occurs in January or later in most years.

The study also concluded that:

* More than 21,000 people were hospitalized specifically for

influenza in 2004–a 62 percent decrease from 2003 but twice the number

of hospitalizations in 2001.

* Elderly patients were the most likely to be hospitalized for

influenza. Among those 65 or older, there were 28 hospitalizations per

100,000 population, a rate that is over 3 times higher than the rate for

children younger than 18 (8 hospitalizations per 100,000). Among younger

adults (aged 18 to 44 and 45 to 64), there were 2 to 4 hospitalizations,

respectively, per 100,000 population.

* Among those elderly patients who were hospitalized for influenza

or had influenza in addition to other problems, about 75 percent were

admitted through hospital emergency departments.

* Patients hospitalized for influenza stayed an average 5.3 days,

slightly longer than the 4.6 average days for other illnesses.

These statistics are from the Nationwide Inpatient Sample, a

database of hospital inpatient stays that is nationally representative

of all short-term, non-Federal hospitals. The data are drawn from

hospitals that comprise 90 percent of all discharges in the United

States and include all patients, regardless of insurance type as well as

the uninsured. For more data, go to Hospital Stays for Influenza, 2004:

HCUP Statistical Brief #16, at

Be the first to comment - What do you think?  Posted by admin - April 28, 2017 at 2:47 pm

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Cottage Health System’s eHealth Partnership Aims to Link Physician Community through Eclipsys’ PeakPractice and HealthXchange | Business Wire

Cottage Health System’s eHealth Partnership Aims to Link Physician Community through Eclipsys’ PeakPractice and HealthXchange | Business Wire

Photo by: / Unsplash

ATLANTA–(BUSINESS WIRE)–Eclipsys Corporation (NASDAQ: ECLP), The Outcomes Company®,

today announced that Cottage Health System (Cottage) of Santa Barbara,

CA, will utilize a combination of the company’s ambulatory and health

information exchange (HIE) solutions to support its eHealth Partnership

initiative. Designed to promote improved safety and overall quality of

care, the eHealth Partnership will utilize Eclipsys’ PeakPractice™

electronic medical record (EMR)/practice management (PM) solution, along

with Eclipsys HealthXchange™, powered by Medicity, to link participating

community physicians with Cottage’s Sunrise Enterprise™ inpatient

technology environment. The arrangements will centralize the

availability of secure access to the latest electronic patient data

across facilities to improve the continuity of care, enhance practice

efficiency and support caregivers in their decision making both in the

physician office and in the hospital – all key areas that impact both

patient and provider satisfaction.

Physician Choice for More Connected, Safer Care; Supports

Achieving Expected ARRA Criteria

In an effort to accelerate physician participation in the eHealth

Partnership, Cottage will subsidize the purchase, maintenance and

support of the PeakPractice EMR for medical staff members of the

healthcare system. Because of the vendor-neutral technology of Eclipsys

HealthXchange, physicians interested in participating in the eHealth

Partnership will have the choice to implement PeakPractice, or keep

their heritage EMR system. In addition, all physician practices that

participate in the eHealth Partnership will be connected to Eclipsys

HealthXchange for no additional integration costs. Participating in the

initiative also will serve to aid both Cottage and local physicians in

achieving the expected “Meaningful Use” criteria of the American

Recovery and Reinvestment Act (ARRA) of 2009.

“We are excited about the opportunities in improving communication among

providers, care quality, continuity and, most importantly, safety

associated with PeakPractice and the HealthXchange platform,” said

Alberto Kywi, vice president and chief information officer of Cottage

Health System. “This new ability to communicate and exchange data with

our community providers will assist us in our mission to provide

superior health care through a commitment to our communities and to our

core values of excellence, integrity and compassion.”

Cottage and Eclipsys: Partners through the Years

The selection of PeakPractice and HealthXchange builds upon a strong

relationshipbetween Eclipsys and Cottage. Cottage selected

Sunrise Critical Care™ for clinical documentation in 1998, then chose

Eclipsys in 2000 for its accounting and patient finance management

needs. A few years later, Eclipsys was again selected to deliver a new,

more advanced electronic health record (EHR) solution that could further

support the fluid needs of its multi-entity environment and teaching

hospital. Since then, Cottage has achieved significant outcomes in

patient safety, physician adoption and the overall revenue cycle process

– increasing average monthly collections from $14 million to $21

million, reducing net days receivable by more than 50 percent and

reducing average billing holds from $10 million to less than $1 million.

“Healthcare providers are facing many industry challenges, including

meeting federal stimulus requirements associated with ARRA,” said Jay

Deady, Eclipsys’ executive vice president, Client Solutions. “Through

the use of Eclipsys’ PeakPractice and HealthXchange solutions, Cottage

can achieve greater continuity of care and enhanced patient safety

across its care community, reducing costs, improving outcomes, and

making great strides in tackling these industry challenges.”

“PeakPractice is a very appealing solution with a high ease of use and

flexibility that was developed and designed to integrate and automate

all of the paper work and clinical documentation required for a

community practice setting,” continued Mr. Deady. “We look forward to

supporting Cottage in connecting all healthcare provider constituents in

their care community and in providing local physicians with the tools

and connectivity they need to better manage their clinical and financial


Support for Interoperability and Medical History Requirements of

ARRA “Meaningful Use”

In order to receive ARRA stimulus incentives, eligible healthcare

providers must demonstrate “meaningful use” of interoperable EHR systems

that assist with the exchange of health information with other providers

to support more coordinated care. Eclipsys’ HealthXchange offers an

adaptable, scalable and secure HIE platform that will facilitate the

sharing of patient information across disconnected EMRs in place at

multiple practices in the care community. Cottage also selected

PeakPractice’s patient portal and kiosk to support the enhanced exchange

of personal health information with their physicians, including

medications and known allergies.

About Cottage Health System

Cottage Health System, formed in 1996 as the not-for-profit parent

organization of Santa

Barbara Cottage Hospital (and its affiliated Cottage

Children’s Hospital and Cottage Rehabilitation Hospital), Goleta

Valley Cottage Hospital, and Santa

Ynez Valley Cottage Hospital, is guided by a volunteer board of

directors from the greater Santa Barbara community and provides the

residents of the Central and South Coast with exemplary healthcare,

continuous improvements in medical practice, and a commitment to its

communities. For more information, visit

About PeakPractice

PeakPractice is an award-winning Microsoft .NET-based EMR/PM solution

offering an integrated database designed to tightly align the clinical

and administrative workflows of single, multi-specialty or

multi-facility environments. PeakPractice includes e-prescribing,

patient portals, patient kiosk, supply chain management, image

management and a Web portal for physicians and patients. The solution is

highly scalable and can be delivered via a hosted service model or run

on-site in the client’s own environment.

About Eclipsys HealthXchange

Eclipsys HealthXchange, powered by Medicity, provides singular

connectivity to consolidated EHR software data through a browser-based

clinical application that can be accessed by physician practices,

clinics, hospitals, labs, imaging centers, pharmacies and other

healthcare facilities. Widespread, secure access to interoperable EHR

data helps Eclipsys’ clients to increase patient safety, drives

clinician and administrative productivity, and fosters a more holistic

and proactive approach to patient care.

About Eclipsys

Eclipsys is a leading provider of advanced integrated clinical, revenue

cycle and performance management software, clinical content and

professional services that help healthcare organizations improve

clinical, financial and operational outcomes. For more information, see

or email

Statements in this news release concerning the implementation of and

features and benefits provided by Eclipsys software, ARRA qualification,

evidence-based content and services are forward-looking statements and

actual results may differ from those projected due to a variety of risks

and uncertainties. Implementation and client-specific configuration of

Eclipsys software can be complex and time-consuming. Results depend upon

a variety of factors and can vary by client. Each client’s circumstances

are unique and may include unforeseen issues that make it more difficult

than anticipated to implement or derive benefit from Eclipsys software

or services. The success and timeliness of the company’s services will

depend at least in part upon client involvement, which can be difficult

to control. Eclipsys is required to meet specified performance

standards, and the contract can be terminated or its scope reduced under

certain circumstances. ARRA qualification requires compliance with

standards that are still evolving, and satisfaction of those standards

may be delayed. More information about company risks is available in

recent Form 10-Q and 10-K filings made by Eclipsys from time to time

with the Securities and Exchange Commission. Special attention is

directed to the portions of those documents entitled “Risk Factors” and

“Management’s Discussion and Analysis of Financial Condition and Results

of Operations.” Eclipsys, The Outcomes Company, PeakPractice,

HealthXchange, Sunrise Enterprise, and Sunrise Critical Care are either

registered trademarks or trademarks of Eclipsys Corporation (or its

subsidiaries) in the United States and certain other countries. Other

product and company names in this news release are or may be trademarks

of their respective companies.

Be the first to comment - What do you think?  Posted by admin - March 4, 2017 at 11:41 pm

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