Phil Factor, DO, FCCP
Professor of Medicine and Vice Chair, Quality & Safety – UA Department of Medicine
This is the first entry in the University of Arizona Department of Medicine’s Quality and Safety Blog. Part of my mission this year is to build “a safety culture” in the department, both on the academic side and via our clinical partners at Banner – University Medical Center, the Southern Arizona VA Health Care System (SAVHCS) and Tucson Medical Center (TMC). This is to help keep each of us aware of the possibility of medical errors and hospital-acquired conditions. Achieving this mindset is a first step toward error-free health care.
So, for a first entry, let me ask you if you know the Agency for Healthcare Research and Quality (AHRQ) top patient safety recommendations?
No? Here are the top 5 (of 22) ready-for-adoption patient safety strategies from a systematic review conducted by the RAND Corporation’s AHRQ-funded Evidence-based Practice Center:¹
1. Improve hand hygiene compliance. The link between dirty hands and nosocomial, or health care-associated, infections has strong backing in epidemiological literature, and the importance of hand hygiene has been emphasized by the Joint Commission, U.S. Centers for Disease Control & Prevention, and World Health Organization. Yet rates of hand washing are low, averaging 39 percent, with many doctors. Hand hygiene rates are considered a surrogate marker for an institution’s commitment to patient safety. The good news for us is that compliance with hand washing policy at Banner – UMC Tucson hit 91.2 percent in October!
2. Use barrier precautions to stop the spread of infections. Along with hand hygiene, barrier precautions (gowns and gloves) are key to reducing the 1.7 million health care-associated infections that occur in the United States each year, which the CDC says kill about 99,000 patients annually. Don’t forget to tie yours gowns before you enter the room!
3. Implement care bundles to prevent central line-associated bloodstream infections. When placing central lines or PICCs, you should wear a cap, mask, sterile gown and gloves, and a full body drape should be placed on the patient. The CDC recommends wearing a cap, sterile gloves and using a small fenestrated drape when placing arterial lines.
4. Use real-time ultrasonography when placing central lines. Relying on “landmark” approaches often results in multiple attempts to place a central line. Multiple sticks lead to complications and higher infection rates. For every 1,000 patients, ultrasonography-guided central-line placement helps avoid 90 complications.
5. Use protocols to reduce catheter-associated urinary tract infections (CAUTIs). CAUTIs are responsible for one million health care-associated infections in the United States each year. The most important step in preventing these is to reduce use of indwelling urinary catheters — many are unnecessary and many are left in much longer than they should be. Physicians and nurses should ask themselves daily if the catheter is still required for patient care and their institutions should provide reminders electronically or on paper. These reminders can cut CAUTI rates by more than half!
For more, see AHRQ’s “10 Patient Safety Tips for Hospitals.”
Finally, the increased emphasis on patient safety in recent years has yielded some good news.² In December of last year, the AHRQ reported that in the three years since passage of the Affordable Care Act (2011, 2012, 2013), there were 1.3 million fewer hospital acquired conditions and 50,000 fewer in-hospital deaths than expected. This giant leap forward is attributed to the ACA’s value-based purchasing strategies and CMS’ “Partnership for Patients” goals.
If there are patient safety and quality topics you are curious about, feel free to let me know (email@example.com) and I’ll see what I can do.
About the Author
Phillip H. Factor, DO, FCCP, joined the faculty at the University of Arizona College of Medicine in October 2012. He also is chair of the Critical Care Committee, co-chair of the Readmission Reduction Task Force and Bioethics Committee, and secretary-treasurer of the Medical Executive Board for Banner – University Medical Center, whose hospitals and clinics serve as the UA Health Science colleges primary teaching sites. He has held previous posts at the Albert Einstein College of Medicine at Yeshiva University, Columbia University College of Physicians & Surgeons, Northwestern University Feinberg School of Medicine, University of Illinois at Chicago and University of Chicago.