Becker's Hospital Review

43 FINANCE CMO / CARE DELIVERY US hospitals often fall short on childbirth care, USA Today investigation finds By Alyssa Rege R oughly 50,000 women are severely in- jured every year during childbirth, while 700 mothers die. Approximately half of those deaths could be prevented with adequate care. However, a July 26 USA Today investiga- tion found hospitals nationwide skip essential safety practices to prevent such outcomes. USA Today investigators obtained more than a half-million pages of internal hospital qual- ity records and examined more than 150 childbirth cases that went wrong. Reporters also contacted 75 birthing hospitals and con- ducted staff interviews to uncover if they fol- low recommended procedures for care. Here are four findings from the investigation: 1. e publication obtained records through federally funded quality programs for doz- ens of hospitals in New York, Pennsylvania and the Carolinas for 2015 and 2016. ose records indicated less than 50 percent of ma- ternity patients were promptly treated for high blood pressure that put them at risk for stroke. In Pennsylvania, data for roughly a dozen hospitals showed mothers were treated for childbirth-related complications 49 to 67 percent of the time. 2. Several agencies, including Medicare and e Joint Commission, require hospitals to disclose relevant information, such as com- plication rates, and post the findings online. Medicaid, which helps pay for an estimated 50 percent of the nearly 4 million births that take place per year, has not set standards for child- birth complications. e Joint Commission, which sets safety standards for U.S. hospitals, does not require hospitals and health systems to report how oen their healthcare providers fail to follow proper safety procedures related to childbirth, researchers discovered. 3. However, one state has reduced maternal death rates by 50 percent. In California, pa- tient safety experts and hospitals have imple- mented practices now endorsed by leading medical societies as the gold standard of care. 4. USA Today cited several specific cases of pa- tients who suffered severe complications from childbirth but were not provided proper care. In 2013, a patient in Ohio bled internally for hours. By the time she was admitted to another hospital for surgery, her delivery hospital had nearly run out of blood and the patient's heart stopped. In South Carolina, one of the nation's leading birthing hospitals sent a patient home with her newborn despite the patient exhibit- ing high blood pressure. When she returned to the emergency room with even higher blood pressure, hospital staff allegedly made her sit in the waiting room where she suffered a stroke and ultimately died. "Our medicine is run by cowboys today, where everyone is riding the range doing whatever they're wanting to do," Steven Clark, MD, a professor at Baylor College of Medi- cine in Houston, told the publication. "It's a failure at all levels, at national organization levels and at the local hospital leadership lev- els as well." n Hospital Compare spotlights hospitals' sepsis performance By Megan Knowles C MS on July 25 added hospitals' sepsis perfor- mance data to its Hospital Compare website. Hospital Compare users can view a new sepsis care measure under the website's timely and effective care tab. Users can then compare their hospital's score to state and national averages. Nationally, the average percentage of patients who re- ceived appropriate care for severe sepsis and septic shock is 49 percent, according to Hospital Compare. The sepsis performance measure is based on data from the first quarter of 2017 through the third quarter of 2017. The preview period for this change spanned from May 4 to June 2. "With each release, the most recent quarter is added, and older quarters removed, so a full rolling year's worth of performance data are included, similar to oth- er chart abstracted measures," CMS said in a February 2018 educational webinar on the Hospital Inpatient Quality Reporting Program. The first full year of sepsis data will be available by Oc- tober. n Bacteria growing more resistant to hospital disinfectants, study finds By Megan Knowles A lthough alcohol-based disinfectants are a critical com- ponent of hospital infection control, a multidrug-resis- tant bacterium is becoming more tolerant to alcohols in hospital disinfectants, a study published in Science Transla- tional Medicine found. The researchers tested alcohol tolerance of 139 hospital iso- lates of Enterococcus faecium obtained between 1997 and 2015. They found E. faecium isolates after 2010 were 10 times more tolerant to killing by alcohol than the older isolates they tested. E. faecium that developed resistance to alcohol sanitizers were better able to resist isopropanol surface disinfection and colonize the guts of mice researchers used in the study, the study found. "These findings may help explain the recent increase in this pathogen in hospital settings," the researchers wrote. "A glob- al response to E. faecium will need to include consideration of its adaptive responses not only to antibiotics but also to alcohols and the other active agents in disinfectant solutions that have become so critical for effective infection control." n

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