Becker's Clinical Quality & Infection Control

40 Patient Satisfaction and Safety R ecent studies have found patients tend to experience more complica- tions, longer stays and higher rates of readmission to the hospital on the weekend, raising the question: What can hospitals do differently? Using predictive analytics, researchers from the Maywood, Ill.-based Loyola University Health System examined 21 hospital resources that may help hos- pitals overcome the so-called "weekend effect," identifying five factors that did just that. The researchers predicted boosting hospital resources before, during and af- ter surgeries could help combat the weekend effect. To test their theory, they examined more than 126,000 patient records at 117 hospitals in Florida, a state with a large, diverse population. They focused their research on three types of urgent surgeries that cannot typically be delayed until the weekdays: appendectomies, hernia repairs and gall bladder removals. Out of 21 hospital resources examined, the following five factors helped hos- pitals overcome the weekend effect most, followed by how many times more likely those hospitals were to overcome the weekend effect. • Fully adopted EHR system (4.74 times more likely than a hospital with- out a fully adopted EHR system to overcome the weekend effect) • Home health program (2.37 times more likely to overcome the week- end effect) • Pain management program (1.48 times more likely to overcome the weekend effect) • Increased nurse-to-bed ratio (1.44 times more likely to overcome the weekend effect) • Inpatient physical rehabilitation (1.03 times more likely to overcome the weekend effect) The team of Loyola researchers plans to conduct further studies on the effect of hospital resources on complications, longer stays and readmission rates of hospitals in California, another state with a large, diverse population. n 5 Ways Hospitals Can Combat the 'Weekend Effect' By Shannon Barnet Risk of Patient Harm in Hospitals Spikes on the Weekends By Shannon Barnet P atient admissions to hospitals may be higher doing the week but preventable complications — such as infections and falls — are more common in hospitals on weekends, according to a study published in BMJ. Researchers analyzed data from more than 351 million patients dis- charged from U.S. hospitals between 2002 and 2010 and found just 19 percent were admitted on a weekend. Despite there being fewer admissions on the weekends, hospital-acquired conditions occurred at a frequency of 5.7 percent during the weekend, compared to 3.7 percent during the week. Falls were the most common complication, comprising more than 12.6 million of the 14.3 million re- ported conditions within the dataset. The study has some limits, the authors admitted, such as its reliance on insurance billing codes, which may underestimate the number of some conditions and overestimate the incidence of others. "It is premature to conclude that factors intrinsic to the hospital on weekends like reduced staffing or the increased number of covering providers are primarily responsible for the greater number of hospi- tal-acquired conditions among weekend admissions," wrote Kumar Dharmarajan, MD, assistant professor of medicine at the Yale School of Medicine in New Haven, Conn., in an accompanying editorial. "It is not clear that the weekend is a less safe time for patients." n 4 Common Surgical Attire Safety Issues By Heather Punke W earing proper attire in the operating room can help minimize risks of surgical site infections, but it can be difficult to get OR staff to break old habits that may not conform to recommended best practices, according to Lisa Spruce, DNP, RN, director of AORN's Evi- dence-Based Perioperative Practice. In a piece for Periop Insider, Dr. Spruce uncovers four of the most common and potentially dangerous surgical attire safety lapses and how they can be rectified. 1. Not covering hair completely. Dangerous germs, like methicil- lin-resistant Staphylococcus aureus, can live in hair and isn't always removed by washing. Not covering the hair completely could allow those organisms to infect the environment. Instead, OR staff should wear a clean surgical head cover or hood that confines all the hair and ears. 2. Not covering ears. Ears are home to bacteria that could dislodge and get into the OR environment. Similarly with covering hair, the surgical head cover or hood should cover the ears as well. 3. Letting masks hang around necks. Nurses sometimes pull masks down after a case but don't remove the mask completely. The contaminated mask could contaminate the rest of the scrub attire or jacket. After every case, the mask should be removed and discarded, and nurses should only handle the mask's ties. They should then per- form hand hygiene. 4. Washing scrubs in the home. AORN recommends that ev- eryone who enters a semi-restricted or restricted area should wear scrubs washed at a healthcare-accredited laundry facility or dispos- able scrubs, as those facilities must comply with rigid standards and processes that aren't enforceable in the home. n

• Cover