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Hospitals Face Medicare Crackdown On Injuries

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Finally, Medicare will examine a variety of avoidable safety problems in patients that occurred from July 2011 through June 2013, including bedsores, hip fractures, blood clots and accidental lung punctures. Over the next few years, Medicare will also factor in surgical site infections and infection rates from two germs that are resistant to antibiotic treatments: Clostridium difficile, known as C. diff, and Methicillin-resistant Staphylococcus aureus, known as MRSA.

Vidant is worse than average in catheter-associated urinary tract infections and serious complications from surgery in the latest statistics Medicare published on its Hospital Compare website. But in more recent data the medical center voluntarily reports on its website, the number of catheter and urinary tract infections dropped during 2013. Joan Wynn, Vidant Health’s chief quality and safety officer, said complications rates are dropping this year as well.

The prospect of penalties is “difficult when you know how much your performance is improved,” said Wynn. She said Vidant has taken many steps to reduce complications, added patients to internal committees and now reveals on its website the number of infections, patient falls, medication errors and bed sores.

Vidant asked Handron, a retired nursing professor injured in 2009, to tell her experience to the trustees and make a video for the medical staff talking about it. She continues to advise the hospital. “I know they’re going in the very right direction,” Handron said. “I would have absolutely zero concern about myself or a family member going to Vidant for anything now.”

Nationally, rates of some infections are decreasing. Catheter-related infections, for instance, dropped 44 percent between 2008 and 2012. Still, the CDC estimates that in 2011, about 648,000 patients—1 in 25—picked up an infection while in the hospital, and 75,000 died. 

Rates of urinary tract infections have not dropped despite efforts. These infections are more likely the longer a line is left in, but sometimes they are not removed promptly out of convenience for the nurse or patient or simply institutional lethargy. Swedish Medical Center in Seattle, which has higher urinary catheter infection rates than do most hospitals, has given nurses more authority to remove catheters so long as they follow guidelines for when removal is appropriate, said Dr. Michael Myint, Swedish’s vice president for quality and patient safety. “Historically, they would just wait for the physician’s order to come through,” Myint said.

Medicare has been pressuring hospitals for several years to lower rates of injuries to patients. In 2008 Medicare started refusing to reimburse hospitals for the extra cost of treating patients for avoidable complications. A subsequent study by Harvard researchers found no evidence that the change led to lower infection rates.

“With infections, we are moving in the right direction,” said Lisa McGiffert, who directs the patient safety program at Consumers Union, “but I would not say we are anywhere near where we need to be.”

Fri, Jun 20 2014

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