Becker's Clinical Quality & Infection Control

78 QUALITY IMPROVEMENT & MEASUREMENT Stricter rules for accrediting bodies met with industry debate By Mackenzie Bean H ealthcare organizations are split on whether the White House should impose stricter regulations on healthcare accreditation bodies to limit con- flicts of interest, reported The Wall Street Journal. The Trump administration is debating whether to con- tinue approving accreditation groups that also operate consulting arms, which charge hospitals for their help to gain accreditation. CMS has also proposed rule changes that would prevent such financial arrangements in the accreditation market. As of March, the agency has received 120 public com- ments on the proposal. The Joint Commission told CMS it uses a firewall between its accreditation services and a consulting sub- sidiary. "A firewall has been in place since 1987 and has been enhanced over the years to remain up to date with the structure and operations of the organizations," the accrediting body wrote in its comment to CMS. Other accrediting organizations, like the nonprofit URAC, are encouraging CMS to address financial arrangements between accreditors and healthcare facilities. "We believe these may also constitute a conflict of inter- est, as it may provide some with undue influence over the accreditation process," former URAC President and CEO Kylanne Green wrote in a comment letter to CMS. n How Barnes-Jewish Hospital cut unnecessary UTI testing in half By Mackenzie Bean A simple change to St. Louis-based Barnes-Jewish Hospital's electronic ordering system helped cut the number of unnecessary urine culture tests or- dered for suspected urinary tract infections nearly in half, according to a study published Feb. 21 in Infection Control and Hospital Epidemiology. For the study, researchers from the Washington Univer- sity School of Medicine in St. Louis implemented several interventions to reduce unnecessary testing for UTIs. In an email to Barnes-Jewish Hospital staff, the researchers en- couraged the use of a urine dipstick test to identify signs of infection before ordering a bacterial culture test. Researchers also modified the hospital's electronic order- ing system to include the use of a urine dipstick test as a default before a culture test. In the 15 months before the intervention's implementation, physicians ordered 15,746 urine cultures. In the 15 months after, physicians ordered just 8,823 cultures, which marks a 45 percent decrease and translates to $104,000 in saved laboratory costs. "Over-testing for UTIs drives up healthcare costs and leads to unnecessary antibiotic use, which spreads antibiotic resistance," senior author David Warren, MD, an infectious disease specialist and professor of medicine at Washing- ton University, said in a press release. "We were able to reduce the number of tests ordered substantially without diminishing the quality of care at all, and at a substantial cost savings." n Better hospital care cannot prevent most sepsis deaths, study finds By Mackenzie Bean S epsis is the leading cause of death in U.S. hospitals, but im- proved hospital care alone may not be enough to prevent the deadly condition, according to a study published in JAMA Network Open. For the study, researchers reviewed medical records for 568 adults admitted to six academic and community hospitals between Jan. 1, 2014, and Dec. 31, 2015. Patients either died in the hospital or were discharged to hospice care. Researchers rated the preventability of each sepsis-related death using a six-point scale. Four study findings: 1. Sepsis was involved in 52.8 percent of hospitalizations and deemed an immediate cause of death in 34.9 percent of cases. 2. e most common underlying causes of death among sepsis patients were solid cancer (21 percent), chronic heart disease (15.3 percent), hematologic cancer (10.3 percent), dementia (9.7 percent) and chronic lung disease (9 percent). 3. Inadequate hospital care, such as delayed antibiotics, was evident in 22.7 percent of the 300 sepsis-associated deaths researchers identified. 4. However, only 11 sepsis-associated deaths were identified as "defi- nitely" or "moderately preventable." Researchers labeled another 25 sepsis deaths as "possibly preventable." "Further innovations in the prevention and care of underlying con- ditions may be necessary before a major reduction in sepsis-associat- ed deaths can be achieved," researchers concluded. n

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