Becker's Clinical Quality & Infection Control

28 QUALITY IMPROVEMENT & MEASUREMENT Geisinger surgery pilot cut lengths of stay in half By Morgan Haefner D anville, Pa.-based Geisinger Health System's surgical redesign pro- gram, ProvenRecovery, cut hospital stays for some surgery patients in half since launching almost two years ago, the health system said. Geisinger launched its ProvenRecovery pilot in June 2017. The pro- gram aimed to speed up recovery time, improve pain management and decrease opioid use among certain surgery patients. Geisinger said Nov. 15 it will extend the program to 42 surgical procedures affecting about 15,000 surgery cases each year. The system expects ProvenRecovery to reach 100 surgical specialties by the end of 2019. The ProvenRecovery pilot led to an 18 percent decrease in opioid use across the health system. Patients who underwent neurosurgery and colorectal sur- gery saw their hospital stays cut in half. For colorectal surgery patients in par- ticular, earlier discharges resulted in an average savings of $4,556 per case. "In my 35 years in surgery, this is the innovation with the greatest potential to improve the patient experience, save lives, reduce complications and be less disruptive to patients," Neil Martin, MD, Geisinger's chief quality officer and chair of Geisinger's neuroscience institute, said in a news release. "With ProvenRecovery, we are empowering patients to be health- ier before surgery, leading to fewer surgical complications and patients returning to their lives sooner." n Low RN staffing levels linked to higher patient mortality risk By Mackenzie Bean I ncreasing the number of unreg- istered nursing assistants used to care for hospitalized patients may not be a safe solution to the nationwide nursing shortage, according to a study published in BMJ Quality & Safety. For the study, researchers examined staffing level data on registered nurs- es and unregistered nursing assistants at a large acute care hospital in the U.K. The clinicians treated 138,133 adult patients admitted to 32 wards between April 2012 and March 2015. Researchers measured staffing levels as hours per patient per day relative to a specific ward's average. Across all 32 wards, registered nurses had an average staffing level of 4.75 hours per day, compared to 2.99 hours per day for nursing assistants. On average, patients experienced two days of low staffing levels for nurses and nursing assistants within the first five days of their hospital stays, which equated to cumulative shortfalls of 23 and 15 minutes, respectively. The overall mortality rate for patients across all wards was 4 percent during the study period. Researchers found the risk of dying rose 3 percent for every day a patient had low registered nurse staffing levels. In contrast, every additional hour a nurse spent caring for a patient was associated with a 3 percent drop in mortality risk. Both low and high nursing assistant staffing levels were also linked to a higher mortality risk. "The findings of this paper suggest potential benefits from increasing the availability of [registered nurses] on acute hospital wards," the researchers said in a press release. "However, in England, RN shortages look set to continue in the short term. ... [These] are unlikely to be remedied by in- creasing the numbers of lesser trained nursing staff in the workforce." n Top-ranked hospitals demonstrate worse readmission rates for heart failure, study finds By Mackenzie Bean T op-ranked hospitals for heart care do not always demonstrate better patient outcomes than nonranked hospitals, according to a study published in JAMA Cardiology. For the study, researchers sought to determine whether hospitals named to U.S. News & World Report's list of best hospitals for cardiology and heart surgery outperformed non- ranked hospitals on mortality rates, readmission measures and patient satisfaction scores. Researchers analyzed data on 3,552 hospitals nationwide between 2017-18. ey looked at 30-day mortality and readmission rates for three heart conditions: acute myocardial infarction, heart failure and coronary artery bypass graing. Researchers also examined patient satisfaction data provided by Medicare recipients over age 65 who responded to the Hospital Consumer Assessment of Healthcare Providers and Systems between 2014-18. Top-ranked hospitals demonstrated lower 30-day mortality rates across all three heart conditions compared to nonranked hospitals. ey also demonstrated similar readmis- sion rates for acute myocardial infarction and coronary artery bypass graing. However, top-ranked hospitals had higher readmission rates for heart failure than nonranked hospitals. Patient satisfaction was consistently higher at top-ranked hospitals. "is discrepancy between readmissions and other performance measures raises concern that readmissions may not be an adequate metric of hospital care quality," the researchers concluded. n

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