Observations on Operations » cnn

How Can Your Clinical Nutrition Team Help Reduce Length of Stay?

astanowski — Thu, 28 Apr 2011 15:31:37 +0000

I saw this article on CNN the other day outlining how Health and Human Services’ Partnership for Patients effort is taking aim at medical errors and healthcare costs. One of the key complications that HHS is focused on is pressure ulcers, a costly condition for hospitals. In fact, back in 2008 CMS stopped reimbursement for specific Hospital Acquired Conditions including pressure ulcers.

In 2007, CMS reported 257,412 cases of preventable pressure ulcers as secondary diagnoses. The average cost per case where pressure ulcers were listed as a secondary diagnosis is estimated to be $43,180 per hospital stay. The incidence of new pressure ulcers in acute-care patients is around 7%, with wide variability among institutions.

I was talking to one of my colleagues, Sharron Lent, who is a Registered and Licensed Dietitian and is Senior Director of Patient and Clinical Services with ARAMARK Healthcare and she was explaining the critical role that registered dietitians play on wound care teams in helping to control pressure ulcers.

Sharon told me that pressure ulcers can be a major contributor to increased length of stay. She reinforced that the major focus of registered dietitians is to provide proper hydration and nutrition to promote healing and help to prevent decubitus ulcers.

“Nutritional intervention for patients with pressure ulcers are complex individual issues,” Sharron added. “Registered Dietitians often lead teams that collaborate with physicians, nurses, physical therapists and various other specialists to initiate appropriate nutritional intervention for wound care.”

It was fascinating to hear Sharron describe the many situations across multiple settings where ARAMARK’s Registered Dietitians worked with our hospital partners to heal wounds quicker and significantly reduce length of stay.

Infection Control is Everybody’s Job

astanowski — Mon, 03 Aug 2009 14:16:35 +0000

With the healthcare reform issue swirling around Washington, we may not know what the final outcome will bring, but one thing that is fairly certain is that the cost debate around medical care will take into consideration the impact of hospital acquired infections. As the president notes “we will all need to be smarter consumers.” That means learning the risks of actually getting sicker while in the hospital. With the rise of transparency, the smart consumer will learn to look at how hospitals are working to reduce their risk of infection. I thought this recent CNN article offered an interesting perspective.

The article’s premise is that everyone through out the care continuum is responsible for helping to prevent the risk of infection … even, make that especially, the environmental service employee. How we motivate the person in that role is a function of elevating their task as more than that of a cleaning person. Here’s an example of what was reported to me recently by Chris Winn, Vice President of Operations, at Paoli Memorial Hospital (Paoli, PA) , quoted from a patient commenting about an environmental services person:

“(As a patient), I observed this young lady taking particular pride in her work. When she cleaned the floor, she commentd: “this is my floor and I want it shining.” She was very upbeat and cheerful. To her the job was one of pride and not drudgery.

I recall an old uncle of mine arrving from Ireland and dug ditches for the Union Gas Compnay in Brookly, NY. His wife had told him to be the best ditch differ and have pride in this menial labor. He did, and became superintendent of the gas works. Opprtunity was there even in the nineteen thirties, and is here today for those wanting it.”

How does this service worker think of herself? Yes… as a core part of the patient care team! She’s engaged, and is a key team member in helping to control hospital infections. I’m interested in hearing of success stories in your organizations in decreasing infections by engaging your employees.

Process is Important to Improve Emergency Department Wait Times

astanowski — Thu, 09 Jul 2009 20:32:05 +0000

No less than ten years ago, there was a little secret about how to secure first class status on airlines. If you simply approached the gate attendant about an hour before the flight left, looked kind, and asked quietly if there were any first class upgrades available, 8 out of 10 times you would get upgraded. This was true no matter what your status was. Airlines got wise to this, and changed the policy to a “status” structure.

I read this article from CNN about hospital ED throughput, and thought of my earlier airline experience.

What if everyone who presents in the Emergency Department casually drops the name of their dear friend, the CEO, or their Uncle who is the Chair of the Board, or their Grandmother a major donor? Imagine the stress on your staff!!!

Long waits in the ED have quality of care ramifications. In April 2008, the Government Accountability Office, using 2006 data, found that the average waiting time nationally was twice that recommended for the most urgent cases. People who should have been treated in 1 to 14 minutes were being seen, on average, in 37 minutes.

Press Ganey found that the average ER waiting time last year was 4 hours, 2 minutes! Yes, Press Ganey did report a slight improvement from the prior time period (2 minutes). However, throughput was seen as an area which could significantly impact satisfaction. The report stated: “Improving the actual flow of patients through the hospital impacts the entire organization down to time spent in the emergency department. Most emergency department physicians and staff know that the emergency department is at the mercy of the inpatient capacity and census.”

The answer, like the airlines, is to develop a system for ensuring that patient throughput improves. The answer is not as simple as saying to the staff “See patients quicker.” It involves making sure that equipment is available when you need it, clean beds are available for transfer of ED patients, and even that patients might know that their EDs have capacity.

If you want to see an example of a hospital that alerts its community to approximate wait time in the Emergency Department, check out Mountain States Health Alliance, www.msha.com, which posts their wait times directly on the ED…and allows patients to see which of their hospitals EDs wait times are short. The wait times are updated continuously.

By improving patient throughput, and allowing patients to know up front their waits, ED staff may be less likely targeted for name dropping…and allowed to spend more time taking care of patients.