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New AHRQ Data Show Healthcare-associated Infections Greatly Increase the Length and Cost of Hospital Stays

Patient Safety and Health IT Newsletter, Issue #60

AHRQ's Patient Safety and Health Information Technology E-Newsletter summarizes patient safety news and information from the Agency.

Quote of the Month

Adults who develop health care-associated infections (HAIs) due to medical or surgical care while in the hospital have to stay an average of 19 days longer than adults who don't develop an infection. (For more information on AHRQ's new data, go to item no.1.)

Today's Headlines:

AHRQ Patient Safety News:

  1. New AHRQ data show healthcare-associated infections greatly increase the length and cost of hospital stays
  2. AHRQ seeks comments on draft report on the effectiveness of screening and treatment of C. difficile infections—due by Sept 20
  3. New study discusses the benefits of human factors engineering on intensive care units
  4. New AHRQ guide to aid hospital quality reporting
  5. Tool for commenting on PSO Common Formats version 1.1 now available
  6. Register for AHRQ's national web conference on "How to Develop a Community-Based Patient Safety Advisory Council" on September 20
  7. Latest issue of AHRQ WebM&M is available online
  8. AHRQ's NGC and NQMC have a new look
  9. AHRQ in the patient safety professional literature—some useful citations

AHRQ Health IT News:

  1. New practice-based population health report now available
  2. New patient centered medical home Web site launched
  3. HHS announces final rules on meaningful use
  4. CMS launches electronic health record incentive program Web site
  5. New report examines critical areas of research in industrial and systems engineering and health care
  6. New report provides snapshot of electronic health record vendor usability processes and practices
  7. AHRQ in the health IT professional literature—some useful citations


AHRQ Patient Safety News 

1. New AHRQ Data Show Healthcare-associated Infections Greatly Increase the Length and Cost of Hospital Stays

Adults who developed health care-associated infections (HAIs) due to medical or surgical care while in the hospital in 2007 had to stay an average of 19 days longer than adults who didn't develop an infection, (24 days versus 5 days), according to new data from AHRQ. For patients with an HAI, the rate of death in the hospital, on average, was six times as high as the rate for patients without an HAI (9 percent versus 1.5 percent). Also, on average, the cost of a hospital stay of an adult patient who developed an HAI was about $43,000 more expensive than the stay of a patient without an HAI ($52,096 versus $9,377). Other statistics include:

  • In 2007, about 45 percent of patients with HAIs were 65 or older, 33 percent were 45 to 64 and 22 percent were ages 18 to 44. However, the 45- to 64-year-old group had the highest rate of HAIs.
  • The top three diagnoses in hospitalized adult patients who developed HAIs were septicemia (12 percent), adult respiratory failure (6 percent) and complications from surgical procedures or medical treatment (4 percent).
  • The rate of infections among medical and surgical discharges peaked in 2004 and 2005 at 2.3 per 1,000 stays, then declined to 2.03, a rate similar to year 2000.

These data are from AHRQ's new statistical brief, Adult Hospital Stays with Infection Due to Medical Care, 2007. The report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in 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. 

2. AHRQ Seeks Comments on Draft Report on the Effectiveness of Screening and Treatment of C. difficile Infections—Due by Sept 20

AHRQ is seeking public comments on a new draft research review titled "Effectiveness of Screening and Treatment of C. difficile Infections." Researchers at an AHRQ Evidence-based Practice Center conducted a systematic review and synthesized evidence for the effects of diagnostic tests, prevention, and treatment of C. difficile associated disease in adult patients. Given the frequency and severity of this disease and the fact that future reimbursement policy may withhold payment for hospital-acquired infections, this is an under-researched topic. More research on effective treatment and unintended consequences of treatment, such as resistance, is needed. Select to access the draft research review (PDF File; Plugin Software Help) and for instructions on how to submit comments. Deadline to submit comments is September 20. 

3. New Study Discusses the Benefits of Human Factors Engineering on Intensive Care Units

AHRQ-funded researchers discuss the importance of human factors engineering—the science and practice of improving human performance—and its value to improving the safety of critically ill patients in a new article. Scientists and practitioners in this field have discovered and applied information about human cognitive and physical abilities and limitations to the design of tools, machines, systems, tasks, and environments for productive accurate, safe, and effective human use. Researchers, led by Matthew Scanlon, M.D., Medical College of Wisconsin, Milwaukee, and Ben-Tzion Karsh, Ph.D., University of Wisconsin-Madison, note that human factors provides a framework for understanding safety failures in critical care settings, and offers insights into how to improve medication and patient safety. "We can better understand why things do not go as planned or desired without resorting to laying blame on the many providers working in ICUs. As a result, systems can be redesigned to reduce unnecessary risk and harm in the ICU," according to the study. Findings from the study, "Value of human factors to medication and patient safety in the intensive care unit," appear in the June issue of Critical Care Medicine. Select to access an abstract of the article. 

4. New AHRQ Guide To Aid Hospital Quality Reporting

AHRQ has available a new resource, Selecting Quality and Resource Use Measures: A Decision Guide for Community Quality Collaboratives to help local health leaders who need an evidence-based primer and decision making framework to guide them in selecting measures for public reporting. Developed by the University of California's Patrick Romano, M.D. and Dominique Ritley, M.P.H., and the RAND Corporation's Peter Hussey, Ph.D., and based in part on input from Chartered Value Exchange leaders, the decision guide summarizes available empirical evidence and incorporates expert advice, best practices, and real-life case examples to illustrate the breadth of considerations and implementation options. The guide includes information on performance data, measures of quality, resource use/efficiency measures, guidance on selecting quality and resource use measures, and guidance on interpreting quality and resource use measures. Select to access the guide. A print copy is available by sending an E-mail to 

5. Tool for Commenting on PSO Common Formats Version 1.1 Now Available

AHRQ recently released Common Formats Version 1.1 for collecting and reporting patient safety information. This new release includes technical specifications for software developers to facilitate the Common Formats' widespread adoption and implementation. The Agency has contracted with the National Quality Forum (NQF) to assist with gathering and analyzing feedback on the Common Formats. The NQF tool to post comments about Common Formats Version 1.1 is available through AHRQ's PSO Web site. AHRQ appreciates the time and effort individuals invest in providing comments. All feedback received will be carefully reviewed and considered to guide the development of future versions. 

6. Register for AHRQ's National Web Conference on "How to Develop a Community-Based Patient Safety Advisory Council" on September 20

On September 20 at 2:00 PM ET, AHRQ will host a national Web conference to promote the use of AHRQ's Guide for Developing a Community Based Patient Safety Advisory Council. This guide helps hospitals assess the need to create a patient safety advisory council composed of patients, consumers, and practitioners and professionals from health care and community organizations. The goal of these councils is to foster closer relationships between hospitals and the communities they serve. The guide explains how these councils benefit patients, providers, and the community and is useful for justifying the need for an advisory council by including sample budgets, advertising plans, instructions for creating a council, measuring tools, and advice on sustaining the council. Faculty for the web conference will include the lead tool developer Kathryn Leonhardt, M.D., Aurora Health Care in Wisconsin, Milwaukee. 

7. Latest Issue of AHRQ Web M&M is Available Online

The August issue of AHRQ Web M&M is now available online. The Perspectives on Safety section highlights safety in academic medical centers and features Richard P. Shannon, M.D., of the University of Pennsylvania, known for his work in reducing health care–associated infections. In the accompanying perspective piece, Chayan Chakraborti, M.D., Marc J. Kahn, M.D., and N. Kevin Krane, M.D., of Tulane University, New Orleans, LA, discuss how to operationalize patient safety in academic medical centers. The Spotlight Case, "Weighing In on Surgical Safety," features a commentary by Jay B. Brodsky, M.D., of Stanford University, CA, and Michael Margarson, M.D., of St. Richard's Hospital, Chichester, UK, on key issues surrounding surgical safety for obese patients. The second case, "Missed Patient Assignment: Is Anyone There?" features a commentary by Dean F. Sittig, Ph.D., of University of Texas, Houston, Emily M. Campbell, R.N., Ph.D., of Oregon Anesthesiology Group, Portland, and Hardeep Singh, M.D., of Baylor College of Medicine, Houston, TX, on the risks of replacing human processes with new technology. The third case, "Emergent Triage Miss," features a commentary by Debbie Travers, Ph.D., R.N., of University of North Carolina, Chapel Hill, discussing methods to make triage safer in busy emergency departments. Physicians and nurses can receive free CME, CEU, or trainee certification by taking the Spotlight Quiz. You can easily share AHRQ Web M&M cases by using the "e-mail a colleague" feature. 

8.  AHRQ's NGC and NQMC have a new look

AHRQ's National Guideline Clearinghouse™ (NGC) and National Quality Measures Clearinghouse™ (NQMC) Web sites now offer updated design elements, a new summary display, enhanced searching, and easier access to all content, including guideline and measure metadata classifications of importance to health IT and patient safety systems/programs. Some features are not yet fully functional but will be in the near future. 

9. AHRQ in the Patient Safety 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.

Blum AB, Raiszadeh F, Shea S, Mermin D, Lurie P, Landrigan CP, Czeisler CA. U.S. public opinion regarding proposed limits on resident physician work hours. BMC Med 2010 Jun 1;8:33. Select to access the abstract.

Rivard PE, Elixhauser A, Christiansen CL, et al. Testing the association between Patient Safety Indicators and hospital structural characteristics in VA and nonfederal hospitals. Med Care Res Rev 2010 Jun; 67(3):321-41. Select to access the abstract.

Snyder RA, Fields W. A model for medication safety event detection. Int J Qual Health Care 2010 Jun; 22(3):179-86. Select to the access abstract.

Yang Y, McBride MV, Rodvold KA, et al. Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistant Staphylococcus aureus. Am J Health Syst Pharm 2010 Jun 15; 67(12):1017-24. Select to access the abstract.

AHRQ Health It News:

10. New Practice-based Population Health Report Now Available

AHRQ has released a new report, Practice-Based Population Health: Information Technology to Support Transformation to Proactive Primary Care, which focuses on the concept of practice-based population health (PBPH). The paper examines the potential benefit of greater adoption of PBPH as well as the challenges to adoption by the primary care community. Select to access the report (PDF File; Plugin Software Help). 

11. New Patient-centered Medical Home Web site Launched

AHRQ announces the launch of a new Web site devoted to providing objective information to policymakers and researchers on the patient centered medical home. The Patient Centered Medical Home Web site provides users with searchable access to a database of publications and other resources on the medical home and exclusive access to the AHRQ-funded white papers focused on critical medical home issues including: Necessary But Not Sufficient: The HITECH Act and Health Information Technology's Potential to Build Medical Homes, Engaging Patients and Families in the Medical Home, and Integrating Mental Health Treatment Into the Patient Centered Medical Home. 

12. HHS Announces Final Rules on Meaningful Use

HHS recently announced final rules to help improve Americans' health, increase safety, and reduce health care costs through expanded use of electronic health records (EHR). The announcement marks the completion of multiple steps laying the groundwork for the incentive payments program. One of the two regulations announced defines the "meaningful use" objectives that providers must meet to qualify for the bonus payments. The other regulation identifies the technical capabilities required for certified EHR technology. Select to access the announcement. 

13. CMS Launches Electronic Health Record Incentive Program Web site

CMS has launched the official Web site for the Medicare & Medicaid electronic health record (EHR) incentive programs. This Web site provides the most up-to-date, detailed information about the EHR incentive programs. The Medicare & Medicaid EHR incentive programs will provide incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. Visit the CMS EHR incentive program Web site at to learn about who is eligible for the programs, how to register, meaningful use, upcoming EHR training and events, and much more. 

14. New Report Examines Critical Areas of Research in Industrial and Systems Engineering and Health Care

Industrial and Systems Engineering and Health Care: Critical Areas of Research explores the critical areas of research at the intersection of industrial and systems engineering (ISyE) and health care, with a special emphasis on the supportive role of health IT. Investing in ISyE research may help in creating a fundamentally better health care delivery system. Achieving such breakthrough change requires new ISyE methods specific to health care, and integrating knowledge production across myriad demonstration projects and small research efforts. Innovation in health IT has the potential to support ISyE approaches to health systems design and evaluation. The report, funded by AHRQ and the National Science Foundation, provides a vision of a new health system and a detailed research and action agenda. Select to access the report (PDF File; Plugin Software Help). 

15.  New Report Provides Snapshot of Electronic Health Record Vendor Usability Processes and Practices

AHRQ has issued a new report that focuses on assessing and improving the state of usability in electronic health record (EHR) systems. Key recommendations from the project's expert panel include establishment of usability/information design of EHRs as part of the certification requirements for EHRs, basing certification on a practical and fair process of usability evaluation, and designing EHR usability certification programs in a way that focuses on objective and important aspects of system usability. Select to access the report, Electronic Health Record Usability: Vendor Practices and Perspectives, and learn more about the panel's recommendations (PDF file; Plugin Software Help). 

16. AHRQ in the 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.

Galanter W, Liu XF, Lambert BL. Analysis of computer alerts suggesting oral medication use during computerized order entry of i.v. medications. Am J Health Syst Pharm 2010 Jul 1; 67(13):1101-5. Select to access the abstract.

Goldman RE, Dubé C, Lapane KL. Beyond the basics: refills by electronic prescribing. Int J Med Inform 2010 Jul; 79(7):507-14. Select to access the abstract.

McConnochie K, Wood N, Herendeen N, et al. Integrating telemedicine in urban pediatric primary care: provider perspectives and performance. Telemed J E Health 2010 Apr; 16(3):280-8. Select to access the abstract.

Wakefield DS, Mehr D, Keplinger L, et al. Issues and questions to consider in implementing secure electronic patient-provider web portal communications systems. Int J Med Inform 2010 Jul; 79(7):469-77. Select to access the abstract.

AHRQ's Patient Safety and Health Information Technology E-Newsletter Contact:

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Page last reviewed September 2010
Internet Citation: New AHRQ Data Show Healthcare-associated Infections Greatly Increase the Length and Cost of Hospital Stays: Patient Safety and Health IT Newsletter, Issue #60. September 2010. Agency for Healthcare Research and Quality, Rockville, MD.


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