10-State Project to Study Methods to Reduce Central Line-Associated Bloodstream Infections in Hospital ICUs
Patient Safety and Health IT Newsletter, Issue #51
Quote of the Month
"We are excited about this project, which will spread the knowledge that we learned in one of [AHRQ's] initial patient safety research projects. This new project will help hospitals in their ongoing efforts to provide the patients they serve with the safest, highest quality care possible." (For more information on activities from AHRQ's new project to help reduce central line-associated bloodstream infections in hospital intensive care units, go to item no.1.)
—Carolyn M. Clancy, M.D., Director, AHRQ
- 10-State project to study methods to reduce central line-associated bloodstream infections in hospital ICUs
- Funding limit increased to $300 million for contracts to support AHRQ’s National Resource for Health Information Technology
- Educating patients before they leave the hospital reduces readmissions, emergency department visits and saves money
- New reports on telehealth, barcode medication administration, and inpatient computerized provider order entry now available
- AHRQ awards contract to develop criteria to assess the evidence base for patient safety practices
- Materials from AHRQ's recent technical assistance conference call on health IT funding opportunity announcements
- Latest issue of WebM&M is available online
- Special AHRQ-funded journal issue highlights impact of health IT on child health
- Call for nominations for 2009 John M. Eisenberg patient safety and quality awards program
- AHRQ in the patient safety and health IT professional literature—some useful citations
1. 10-State Project to Study Methods to Reduce Central Line-Associated Bloodstream Infections in Hospital ICUs
As part of an AHRQ-funded project, hospital associations in 10 States have been selected to participate in a program to test methods of reducing central-line associated blood stream infections in hospital intensive care units (ICUs). The States are California, Colorado, Florida, Massachusetts, Nebraska, North Carolina, Ohio, Pennsylvania, Texas, and Washington. In addition, the California Hospital Patient Safety Organization, the North Carolina Center for Hospital Quality and Patient Safety, and the Ohio Patient Safety Institute will participate in the project. The hospital associations and patient safety groups were chosen to participate based on their capability and infrastructure to implement the safety protocols being tested in the project. In addition, they provide a broad geographic representation. Last October, AHRQ awarded a 3-year, $3 million contract to the Health Research and Educational Trust, an affiliate of the American Hospital Association, to coordinate the project. The project will continue the work that originated at the Johns Hopkins University School of Medicine in Baltimore and was later implemented statewide in Michigan by the Johns Hopkins Quality and Safety Research Group and the Michigan Health and Hospital Association. The project will implement a comprehensive unit-based patient safety program across the 10 States to help prevent infections related to the use of central line catheters. Select to read our press release announcing participating States and our earlier press release on the award of the contract.
2. Funding Limit Increased to $300 Million for Contracts to Support AHRQ's National Resource Center for Health Information Technology
AHRQ recently issued a solicitation for proposals for multiple task order contracts through which individual Task Orders will be awarded to maintain, serve, and support the AHRQ National Resource Center for Health Information Technology. AHRQ is now announcing that it has modified the ceiling amount for all contracts (including options) to $300 million instead of the previously stated $75 million. Individual ceiling amounts will be established for each base contract awarded based on the anticipated level of work required under each of the following four domain areas:
- Support for Health Information Technology (IT) Program Management, Guidance, Assessment and Planning
- Health IT Technical Assistance, Content Development, Program Related Projects and Studies
- Health IT Dissemination, Communication and Marketing
- Health IT Portal Infrastructure Management and Website Design and Usability Support
In addition, AHRQ has extended the due date for receipt of proposals to February 26 at 12:00 p.m., EST. Also listed in the amended solicitation are responses to questions that have been received as a result of the Request for Proposals. Select to view the solicitation.
3. Educating Patients Before They Leave the Hospital Reduces Readmissions, Emergency Department Visits and Saves Money
Patients who have a clear understanding of their after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information. Fewer hospital readmissions and emergency department visits also translate to lower total costs. The AHRQ-funded study found that total costs (a combination of actual hospitalization costs and estimated outpatient costs) were an average of $412 lower for the patients who received complete information than for patients who did not. The study, "A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial," is published in the February 3 issue of the Annals of Internal Medicine. Select to read our press release and select to access the abstract.
4. New Reports on Telehealth, Barcode Medication Administration, and Inpatient Computerized Provider Order Entry Now Available
AHRQ's National Resource Center for Health Information Technology has released the following new reports on telehealth, barcode medication administration, and inpatient computerized provider order entry:
- Using Telehealth to Improve Quality and Safety provides an overview of technical and organizational challenges faced by AHRQ health information technology grantees when developing, implementing, or evaluating telehealth interventions. The telehealth projects fall into the following four areas: provider-to-provider communication with patients present, provider-to-provider communication without patients present, telemonitoring, and health education.
- Using Barcode Medication Administration to Improve Quality and Safety summarizes key findings from grantees who have examined how applications such as barcode medication administration can improve the quality, safety, efficiency, and effectiveness of health care. The report focuses on lessons learned, challenges, and opportunities associated with introducing these applications into real-world clinical settings so that others who wish to implement and use barcode medication administration and electronic medication administration record technologies can learn from the experiences of these AHRQ projects.
- Inpatient Computerized Provider Order Entry (CPOE) summarizes key findings from grantees who have implemented computerized provider order entry interventions in hospital settings. Researchers are from geographically diverse areas in the United States, including urban and rural areas. The report discusses details on grantees' successes, failures, and lessons learned. Major themes from the report include staffing, resource allocation, project scope, workflow, order set design, vendor relations, interoperability, customization and system integration, training, technical support, and alert fatigue.
5. AHRQ Awards Contract to Develop Criteria to Assess the Evidence Base for Patient Safety Practices
AHRQ has awarded a contract to develop a set of criteria to be used for assessing the evidence base for the effectiveness and safety of patient safety practices (PSPs) in future evidence reviews and for use by implementers of PSPs. The $1 million contract, Assessing the Evidence for Context-Sensitive Effectiveness and Safety of Patient Safety Practices: Developing Criteria, was awarded to RAND, the Johns Hopkins University, and the University of California-San Francisco, working in partnership with the Karolinska Institute (Sweden) and a technical expert panel. AHRQ recognizes that there is a need for a suitable set of criteria by which to assess which patient safety practices will work and are safe in specific settings. All across the country, providers, hospitals, health systems and policymakers are attempting to improve the safety of patient care, and are looking for guidance on what works. This 1-year initiative will be the first to take into account the complexity of patent safety interventions in the real world and tie those components to research and evaluation considerations. Those considerations include assessment of theoretical models for designing PSPs and the usefulness of innovative methods for evaluating intervention results. For more information, please contact the AHRQ Project Officer, Denise Dougherty at Denise.Dougherty@ahrq.hhs.gov; (301) 427-1868.
6. Materials from AHRQ's Recent Technical Assistance Conference Call on Health IT Funding Opportunity Announcements
On January 13, AHRQ hosted a technical assistance conference call to provide an overview of AHRQ's new health IT funding opportunity announcements (FOAs) and information relevant to the health IT Special Emphasis Notice. During the call, AHRQ staff provided information found in the FOAs and responded to callers' requests for clarification. The transcript and text version of the slide presentation from the conference call are now available. AHRQ's health IT initiative is part of the Nation's strategy to put health IT to work in health care. Since 2004, AHRQ has invested more than $260 million in contracts and grants to more than 150 communities, hospitals, providers, and health care systems in 48 states to develop knowledge about and encourage adoption of health IT practices that improve quality. Select for more information on AHRQ's health IT projects and reports.
7. Latest Issue of WebM&M Is Available Online
The January issue of AHRQ WebM&M is now available online. The Perspectives on Safety section addresses disclosure of errors to patients and the role of apology. The section features Thomas Gallagher, M.D., of the University of Washington, Seattle, WA, discussing new developments in the field of patient disclosure practices. In an accompanying perspective piece, Allen Kachalia, M.D., J.D., of the Brigham and Women's Hospital and Harvard Medical School, Boston, MA, describes the components of disclosure and covers issues of ethics and liability. The Spotlight Case features Jesse Pines, M.D., of the University of Pennsylvania, Philadelphia, PA, discussing the issues of continuity of hospital care, emergency medical services destination decisions, and patient transfers. The second case features Curtiss Cook, M.D., of Mayo Clinic, Scottsdale, AZ, discussing outpatient insulin pump therapy and highlights safety measures when these patients are hospitalized. The third case features Lydia Siegel, M.D., and Tejal Gandhi, M.D., both of the Brigham and Women's Hospital, Boston, MA, discussing strategies for improving safety in outpatient chemotherapy. Physicians and nurses can receive free medical education (CME), continuing education units (CEU), or trainee certification by taking the Spotlight Quiz. You can easily share AHRQ WebM&M cases by using the "Email a colleague" feature.
8. Special AHRQ-Funded Journal Issue Highlights Impact of Health IT on Child Health
The January supplement issue of Pediatrics, funded by AHRQ, features 14 articles on the enormous impact the use of health IT has on the quality of health care for children. The special issue also points out the challenges that need to be overcome to realize fully the potential of health IT to improve the quality and efficiency of health care. Many of the articles found in the supplement were commissioned as part of a conference held in March 2006 in Orlando, FL, cosponsored by AHRQ, the National Initiative for Children's Healthcare Quality, the Public Health Informatics Institute, and the All Children's Hospital Foundation. Below are links to abstracts of select articles:
- It is Time! Accelerating the Use of Child Health Information Systems to Improve Child Health by Fairbrother G and Simpson LA. Select to view the abstract.
- Alliance for Pediatric Quality: Creating a Community of Practice to Improve Health Care for America's Children by Miles PV, Miller M, Payne DM, Perelman R, Saffer M, and Zimmerman E. Select to view the abstract.
- Linking Children's Health Information Systems: Clinical Care, Public Health, Emergency Medical Systems, and Schools by Hinman AR, and Davidson AJ. Select to view the abstract.
- The Public Role in Promoting Child Health Information Technology by Conway PH, White PJ, Clancy C. Select to view the abstract.
9. Call for Nominations for 2009 John M. Eisenberg Patient Safety and Quality Awards Program
The Joint Commission and the National Quality Forum are accepting applications for the 2009 John M. Eisenberg Patient Safety and Quality Awards, which recognize individuals and health care organizations that are making significant contributions in improving the safety and quality of patient care. Select for more information on the awards, including categories of awards, nomination forms, and information on past award recipients, access the Joint Commission's Web site. The deadline for submitting nominations is April 20.
10. AHRQ in the Patient Safety and Health IT Professional Literature-Some Useful Citations
We are providing the following hyperlinks to abstracts of journal articles describing AHRQ-funded research. If you are having problems accessing the abstracts because of firewalls or specific settings on your individual computer systems, you should ask your technical support staff for possible remedies.
Encinosa WE, Hellinger FJ. The Impact of Medical Errors on Ninety-Day Costs and Outcomes: An Examination of Surgical Patients. Health Serv Res 2008 Dec;43(6):2067-85. Select to access the abstract.
Frankel A, Grillo SP, Pittman M, et al. Revealing and Resolving Patient Safety Defects: The Impact of Leadership WalkRounds on Frontline Assessments of Patient Safety. Health Serv Res 2008 Dec;43(6):2050-66. Select to access the abstract.
Gurwitz JH, Field TS, Rochon P, et al. Effect of Computerized Provider Order Entry with Clinical Decision Support on Adverse Drug Events in the Long-Term Care Setting. J Am Geriatr Soc 2008 Dec; 56(12):2225-33. Select to access the abstract.
Kuppermann M, Norton ME, Gates E, et al. Computerized Prenatal Genetic Testing Decision-Assisting Tool: Randomized Controlled Trial. Obstet Gynecol 2009 Jan; 113(1):53-3. Select to access the abstract.
Lazarus R, Klompas M, Campion FX, et al. Electronic Support for Public Health: Validated Case Finding and Reporting for Notifiable Diseases Using Electronic Medical Data. J Am Med Inform Assoc 2009 Jan-Feb; 16(1):18-24. Select to access the abstract.
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