Becker's Clinical Quality & Infection Control

81 QUALITY IMPROVEMENT & MEASUREMENT How Kaiser Permanente used new assessment criteria to reduce admissions By Megan Knowles E mergency physicians at Oakland, Ca- lif.-based Kaiser Permanente hospitals reduced admissions and cardiac stress testing by using new criteria to assess chest pain patients' risk for subsequent cardiac events, according to an article published in Annals of Emergency Medicine. "By assessing patients who come into the emergency department using HEART — a measure of history, electrocardiogram, age, risk factors and troponin, a blood test that measures heart injury — we were able to avoid unnecessary hospitalizations and cardiac testing for many patients without increasing their risk of heart damage," said Adam Sharp, MD, an emergency physi- cian at the Kaiser Permanente Los Angeles Medical Center. The researchers looked to evaluate wheth- er the HEART tool could successfully identify patients who needed observation and further testing and which patients could go home safely. e team used information in the EHRs of over 65,000 adult patients evaluated for sus- pected acute coronary syndrome at 13 Kaiser Permanente EDs in Southern California from May 2015 to June 2017. e outcomes they studied were hospital admissions, noninvasive cardiac stress test- ing and whether patients died or had heart attacks within 30 days of the ED visit. Among patients who went to the ED with chest pain, the researchers found there was a 4.4 percent decrease in hospital admissions and cardiac stress testing aer implementing HEART; no increase in missed heart attacks in patients aer HEART was implemented; and no increase in the rate of death in pa- tients aer HEART was implemented. "Our program to decrease hospitalization of patients with low-risk chest pain builds upon previous efforts to improve care by avoiding unwarranted, potentially harmful treat- ments, such as reducing the prescriptions of antibiotics for acute sinusitis and reducing diagnostic tests such as CT imaging aer head trauma," Dr. Sharp said. n Physician viewpoint: Why are we still using stethoscopes? By Mackenzie Bean T he stethoscope — invented in 1816 — is long overdue for a redesign, ac- cording to Davinder Ramsingh, MD, an anesthesiologist at Loma Linda (Calif.) University Medical Center. "Now, just over 200 years later, it is incredible to think that this technology has not been rein- vented — especially when you compare the ad- vances humankind has made in other areas," he wrote in a blog post on Loma Linda's website. Diagnostic technologies have undergone sig- nificant advancements in the medical world, but physicians still use stethoscopes as the primary tool for physical exams, despite their "widely known inaccuracies," Dr. Ramsingh noted. He said point-of-care ultrasound could prove a more effective alternative to stethoscopes for physical exams. Clinicians have primarily adopt- ed POCUS for use in emergency department settings, but Dr. Ramsingh said the technology is starting to emerge in other care settings. n Text message system may improve patient outcomes after surgery, study finds By Megan Knowles F or patients who had a total hip or knee arthroplasty proce- dure, using a text-messaging service bot for patient education may improve clinical outcomes, a study published in The Journal of Bone and Joint Surgery found. The researchers performed a randomized controlled trial of patients who underwent total hip or knee arthroplasty. Eighty- three patients were assigned to the control group who received a traditional perioperative education program and 76 patients in the intervention group who received the text-messaging service. The researchers primarily analyzed the time patients participated in in- home exercises to measure outcomes. The researchers found patients in the intervention group exercised for 46.4 minutes per day on average compared to 37.7 minutes for the control group. They also found the intervention group had improved mood and placed fewer telephone calls to surgeons' offices. "Texting patients digestible amounts of information relating to their care after hip and knee replacement can have a number of positive effects on their recovery," the researchers told Healio. "We observed that patients enrolled in their surgeon's chatbot stopped their opiate medications sooner, spent more time on their home therapy, were more satisfied, visited the emergency room less and placed fewer calls to their surgeon's office." n

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