Issue link: https://beckershealthcare.uberflip.com/i/1191144
40 QUALITY IMPROVEMENT & MEASUREMENT 14 hospitals with the most ER visits By Mackenzie Bean H ere are the 14 hospitals in America with the most annual emergency room visits for 2018. Totals repre- sent the number of emergency room visits tallied for a single facility, rather than total ER visits for a whole health system. This listing is based on several sources of information and all figures are verified by individual hospitals. Reporting periods represent either calendar year or fiscal year 2018. Hospitals reporting figures based on a fiscal year are denoted with an asterisk. Start and end dates for the fiscal year may vary by hospital. This is not an exhaustive list. Editor's note: This list was revised Oct. 2, Oct 3 and Oct 4. 1. Parkland Health and Hospital System (Dallas) — 242,640 visits* 2. Lakeland (Fla.) Regional Medical Center — 210,285* 3. Joseph's University Medical Center (Pater- son, N.J.) — 167,500 4. Los Angeles County + USC Medical Cen- ter — 158,968* 5. Montefiore Medical Center-Moses Cam- pus (New York City) — 158,226 6. NYC Health + Hospitals/Lincoln (New York City) — 157,203 7. Grady Health System (Atlanta) — 153,048 8. Boston Medical Center — 137,864* 9. Banner Desert Medical Center (Mesa, Ariz.) — 137,342 10. Reading Hospital (West Reading, Pa.) — 135,457 11. WellStar Kennestone Hospital (Marietta, Ga.) — 135,396* 12. Cape Fear Valley Medical Center (Fay- etteville, N.C.) — 130,879 13. Beaumont Hospital, Royal Oak (Mich.) — 129,308 14. NYC Health + Hospitals/Kings County — 128,476 n HHS creates clinician resource for tapering patients' opioid use By Gabrielle Masson H HS published a five-page guide on how to safely taper patients off opioids Oct. 10. Abrupt changes in opioid prescriptions can po- tentially harm patients if not made deliberately and collaboratively. The new HHS guide advises clinicians on how to safely reduce or discontin- ue long-term opioid use in patients with chronic pain. "This guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction," Adm. Brett P. Giroir, MD, assistant secretary for health at HHS, said in an Oct. 10 news release. HHS recommends physicians review current treatments with the patient and determine if ta- pering is appropriate based on each individual. The full guide includes an opioid tapering flowchart, the DSM-5 Opioid Use Disorder defi- nition and guidelines for special populations, among other resources. n How Mayo Clinic got staff on board with major surgical process changes By Mackenzie Bean T o decrease length of stay among surgical patients, Mayo Clinic created an Enhanced Recovery Pathway, which it strate- gically implemented across the organization and partnering institutions, David Larson, MD, division chair of colon and rectal surgery at Mayo, wrote in an article for Harvard Business Review. Rochester, Minn.-based Mayo Clinic first implemented ERP proto- cols in two colorectal surgery practices in 2009, before gradually expanding the guidelines to Mayo's entire colorectal division in 2011. To get the initiative off the ground, Dr. Larson identified a handful of nurses and pharmacists to champion these changes and closely monitored progress. From 2015-16, Mayo Clinic further expanded use of these pro- tocols to the Mayo Clinic Care Network, a group of independent health systems that pay an annual fee for Mayo resources. "Implementing the pathway within Mayo's own colorectal division was one thing; to change well-established processes at other insti- tutions was quite another," Dr. Larson wrote. The health system used several strategies to gain buy-in and trust among leaders at these institutions. For example, Mayo held a two- day meeting with the institutional teams leading these changes to discuss best practices and form a collaborative relationship. Mayo also scheduled monthly calls with each institution to address any concerns with the ERP process implementation. After the process was complete, Mayo Clinic Care Network re- duced length of stay by 33.9 percent across all sites. One institution decreased this measure by 48.7 percent and had the lowest surgi- cal readmission rate in its state. n