Becker's Clinical Quality & Infection Control

46 QUALITY IMPROVEMENT & MEASUREMENT Unneeded tests before low- risk surgeries common, Michigan study finds By Mackenzie Bean P reoperative testing is oen unnecessary for low-risk surgeries, but remains common practice at many hospitals in Michigan, according to a study published May 17 in JAMA Internal Medicine. Mounting evidence shows such testing is ex- pensive and doesn't usually improve patient outcomes. In the worst-case scenario, it can even spur more invasive testing or surgical delays, according to researchers at the Uni- versity of Michigan in Ann Arbor. ey analyzed claims data on about 40,000 patients who had surgery to remove the gallbladder, fix a groin hernia or remove cancerous breast tissue. e surgeries were at 63 Michigan hospitals between Jan. 1, 2015 and June 30, 2019. About half of patients received at least one preoperative test, and 29.4 percent had at least two, researchers found. e most common tests were a basic metabolic panel, complete blood count and electrocardiogram. Patients who had a complete physician and medical history taken during visits billed separately were more likely to undergo preoperative testing, along with patients who were older or had multiple comorbidities. Researchers also saw wide variation in testing across the 63 hospitals and still found an overuse of testing even aer adjusting their model to account for patients who might have benefited from the tests. "There aren't that many areas in medicine where the data is pretty definitive that something is low-value, but preopera- tive testing before low-risk surgeries is certainly one of them," said Lesly Dossett, MD, division chief of surgical oncology at Ann Arbor-based Michigan Medicine and co-director of the university's Michigan Program on Value Enhancement, which helped conduct the research. n How Nebraska hospital cut patient falls in half By Mackenzie Bean K earney (Neb.) Regional Medical Center has cut its patient fall rate in half since launching a safety program last October, Kearney Hub reported June 10. When the No Falls program was implemented, Kearney Regional's fall rate was 5.7 per 1,000 patient days. This figure now sits at 2.6 per 1,000, though it did dip even lower to 1.1 for a while, according to Shari Freeman, the medical surgical unit manager who launched the program. Every patient's fall risk is detailed on a large board at each unit's nursing sta- tion, and staff reassess each patient's risk every 12 hours. High-risk patients are given yellow hospital gowns and socks and have a yellow light outside their rooms, which serve as visual indicators for staff. Kearney Regional is also implementing patient beds with better fall alarms that alert nurses if high-risk patients get out of bed. A new task force is study- ing how additional equipment could reduce falls. The hospital keeps track of how many days each department has been fall- free. This spring, the medical-surgical unit went 84 days without a fall. "If a patient falls and is injured, the average additional cost of that is $30,000, plus an increased hospital stay," Ms. Freeman told Kearney Hub, adding that most patients have been receptive to the new rules. "We tell patients, 'We are here for your safety. We don't want you to get hurt,'" she said. n CDC: Heart disease, diabetes deaths rose in 2020 By Erica Carbajal A s COVID-19 spread through the U.S. in 2020, the death rates for heart disease and diabetes saw significant increases, according to data from the CDC's Mortality Dashboard. In 2019, the death rate for heart disease was 161.5 deaths per 100,000 peo- ple. That rose to 167 in 2020 — about a 3.4 percent rise. The death rate for diabetes jumped nearly 14 percent between 2019 and 2020. In 2019, the diabetes death rate was 21.6 per 100,000 people, rising to 24.6 in 2020. While the CDC did not provide information on the reasons behind the increas- es, many studies over the last year have focused on pandemic-related delays in care. A November 2020 study published in JAMA Cardiology, for example, found the survival rate for out-of-hospital cardiac arrest dropped 17 percent during the first few months of the COVID-19 pandemic. A separate study, published May 26 in Health Affairs, found that as emergen- cy calls for heart issues fell by 27.2 percent in the Boston area, out-of-hospital cardiac arrests jumped nearly 36 percent, compared to historical baselines. n

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