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March 2009

Patient Sharing Among Hospitals Could Impact Spread of Infectious Diseases

CDC MRSA photo Twenty-two percent of people who are discharged from acute-care hospitals are readmitted at different hospitals within one year, according to a study released today by the University of California, Irvine School of Medicine.  This has big implications for the spread of infectious diseases, as hospitals typically only track direct transfers of patients from one hospital to another.  Patients can carry organisms like MRSA for long periods of time, even if they aren't actively experiencing symptoms of infection.  As a result, they can bring these organisms with them from one facility to another, even with gaps between admissions.

The study was conducted by Susan S. Huang, MD, MPH, assistant professor and hospital epidemiologist and colleagues, and funded by both UC Irvine and the National Institutes of Health's Models of Infectious Disease Agent Study (MIDAS).  The study analyzed nearly 240,000 patient admissions at 31 acute care hospitals in Orange County, CA using a retrospective evaluation of 2005 California Hospital Discharge Data.

2009 Safe Practices Released by National Quality Forum

The National Quality Forum has released the 2009 Safe Practices for Better Healthcare.  These 34 evidence-based practices build on six years of development, and represent practices that should be implemented in every hospital.

The 2009 report adds new practices in areas such as pediatric imaging, glycemic control, organ donation, catheter-associated urinary tract infection, and multi-drug resistant organisms. The report updates other previously endorsed practices based on new evidence, including the pharmacist’s role in medication management and pressure ulcers, and an entire chapter on healthcare-associated infections.  Some of the Safe Practices remain the same, such as hand hygiene and management of patients in ICUs by doctors with special training in critical care.

The Texas Medical Institute of Technology funded the project.  The National Quality Forum will be holding webinars throughout the year to review implementation strategies for the Practices.

Diagnotic Errors Warrant Attention Too

In a commentary released earlier this week in the Journal of the American Medical Association, Drs. David Newman-Toker and Peter Pronovost of Johns Hopkins suggest that far too little attention has been paid to diagnostic errors and the harm they cause.   In comparison to wrong-site surgeries, medication errors and hospital acquired-infections, they argue, diagnostic mistakes may account for a greater number of medical problems and preventable deaths.

While the patient safety movement has highlighted the need for "systems" approaches to reducing medical mistakes, as opposed to better training of individual physicians, for example, it has not focused on the need to improve systems for diagnosis.  Instead, the emphasis has been on the individual physician's ability to diagnose early and correctly.

Newman-Toker and Pronovost suggest that computerized decision support tools and and checklists can help physicians check for critical diagnoses and each patient's level of risk for certain diseases.

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