Becker's Clinical Quality & Infection Control

5 INFECTION CONTROL & PATIENT SAFETY Viewpoint: Why hospital mergers raise patient safety problems By Megan Knowles A lthough hospitals and health systems oen cite the pursuit of "better patient care" as reason for mergers or acquisitions with one another, research shows partnerships and trans- actions may put patients at a higher risk for harm in the short term, three authors wrote in an op-ed published by STAT. Hospitals can improve patient safety during mergers and affiliations, but they must make intentional efforts to ensure patients receive the best care in a deal's aermath, the authors argue. Here are six insights from the op-ed, written by Susan Haas, MD, co-principal investigator for Boston-based healthcare solutions firm Ariadne Labs, which aims to reduce patient safety risks with health system expansion; William Berry, MD, associate director and senior adviser at Ariadne Labs; and Mark Reynolds, president and CEO of CRICO/Risk Management Foundation: 1. Since 2014, there have been over 100 hospital or health system mergers and acquisitions across the U.S., with a high of 115 M&As in 2017. "Although much is known about the financial impact of hospital and health system mergers and acquisitions, we know almost nothing about how they affect patient care or patient safety," the authors wrote. 2. e authors note how merger talks oen start with network devel- opment leaders, instead of leaders with a background in medicine, and clinicians are rarely included in the process early on. "It's usually not until aer the deal has been completed that [clinicians] are asked to work out the necessary arrangements to fill gaps and coordinate and standardize clinical care," the authors wrote. "at's too late." 3. As part of their ongoing research, the authors polled physicians in their research group whose practices were involved in a M&A. ey interviewed more than 70 clinicians (mostly physicians) and business staff involved in network development to assess whether patient safety risks happen due to system expansion. 4. Aer hearing several stories involving risks to patient safety, the authors identified three key sources of risk: • New patient populations. A health system's patient population may change aer an expansion, the authors wrote. "Even if more providers and support staff are hired, staff members who interact with and care for these patients elsewhere in the hospi- tal or health system may need new knowledge and support." • Unfamiliar infrastructure. To meet financial goals, institu- tions may intentionally standardize supplies, processes, equip- ment and protocols during a system expansion. ese opera- tional changes can contribute to delays, oversights or confusion on behalf of the medical staff. "Failing to connect with patients and understand their problems can lead to medical errors," the authors wrote. "Errors can also arise from using equipment incorrectly or prescribing a medication incorrectly based on new formulary." • New settings for physicians. Clinicians may have to travel to practice at another institution aer a system expansion. "As a result, they can be faced with infrastructure, responsibilities, team members, and a clinical culture that can vary significantly — and unexpectedly — from those at their home institution." For example, one surgeon told researchers she got lost trying to find a patient she was trying to help due to an issue with accessing the correct building. In another instance, a surgeon had trouble lo- cating the room in a radiology suite where a patient had stopped breathing and needed a breathing tube inserted immediately. 5. e authors have developed several free toolkits and created a guide for clinical and nonclinical leaders. "We believe that such vari- ations arise normally and are not in themselves a problem. But they can become a problem when they are not surfaced and addressed before physicians are assigned to new settings," the authors wrote. 6. e authors now plan to focus on developing tools to (a) support clinicians when they are deployed to new institutions and (b) help minimize difficulties transferring patients between hospitals within a network when the patient's condition changes. "ere are no signs that the pace of hospital and health system mergers and acquisitions will slow," the authors wrote. "Incorporat- ing early, clinician-led evaluation of the potential patient safety risks from system expansion is a practice every health care system should incorporate into its planning process." n Human tracking of hand hygiene compliance inadequate By Anuja Vaidya A study published in the American Journal of Infection Control examined direct human audit rates and compared them with automated sur- veillance rates for hand hygiene compliance. Researchers conducted the study at a large Australian teaching hospital. The hospital used automated surveil- lance while simultaneously performing mandatory human audits for 20 minutes each day in a medical and a surgical ward. Researchers collected data from three quarterly reporting periods in 2014 and another three in 2015. The study found direct human audit rates for the medical ward were inflated by an average of 55 percentage points in 2014 and 64 percentage points in 2015, which was 2.8 to 3.1 times higher than automated surveillance rates. The rates for the surgical ward were inflated by an average of 32 percentage points in 2014 and 31 per- centage points in 2015, around 1.6 times higher than automated surveillance rates. Overall, human audits collected an average of 255 hand hygiene opportunities, whereas automation collected 578 times more data, averaging 147,308 opportunities per quarter. n

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