Becker's Hospital Review

166 CMO / CARE DELIVERY 3.3% of ED Visits 'Avoidable,' Study Finds By Morgan Haefner A study published in Internation- al Journal for Quality in Health Care found 3.3 percent of U.S. ED visits may be "avoidable." For the analysis, researchers — led by Renee Hsia, MD, a professor in the de- partment of emergency medicine at University of California San Francisco — conservatively defined "avoidable" visit as one in which an ED patient does not require diagnostic or screening ser- vices, procedures or medications and is discharged. Study authors used this definition to analyze National Hospital Ambulatory Medical Care Survey data from 2005 to 2011. Researchers examined 115,081 re- cords comprising 424 million ED visits for patients ages 18 to 64 who visited the ED and were sent home. e study unveiled the top five com- plaints representing the 3.3 percent of avoidable ED visits included toothache, back pain, headache and other symp- toms concerning psychosis and throat soreness. During the study period, the top three ICD-9 discharge diagnoses were alcohol abuse, dental disorders and depressive disorders. Alcohol-related disorders and mood disorders represented 6.8 percent of avoidable visits and dental disorders reflected 3.9 percent. "A significant number of 'avoidable' ED visits were for mental health and dental conditions, which the ED is not fully equipped to treat," researchers noted. "Our findings provide a better under- standing of what policy initiatives could potentially reduce these 'avoidable' ED visits to address the gaps in our health- care system, such as increased access to mental health and dental care." n CNAs Often Fail to Swap Out Contaminated Medical Gloves, Study Finds By Mackenzie Bean C ertified nursing assistants fre- quently exhibit inappropriate glove use in long-term care facilities, which can put patients at risk of infection, according to a study published in the American Journal of Infection Control. For the study, researchers examined CNA glove use through a random sampling of 74 patient care events in which CNAs aided patients with toilet- ing and perineal care at a long-term care facility. Researchers defined inap- propriate glove use as not swapping out contaminated gloves for fresh ones or touching a surface with con- taminated gloves. CNAs wore gloves for 80.2 percent of touch points, but failed to change gloves at 66.4 percent of glove change points. More than 44 percent of the gloved touch points were defined as contaminated, and all contaminated touches occurred with gloved hands. Notably, replacement gloves were available on all units during the patient care events. "Gloves are an essential component of standard precautions, and proper use of gloves is a critical component of best practices to prevent [health- care-associated infections]," said Lin- da Greene, RN, 2017 APIC president. "This is especially important in long- term care, where residents are more vulnerable to infection and stay for extended periods. Facilities must con- tinually educate healthcare providers about the importance of appropriate glove use to prevent infection and monitor adherence to this practice." n 26% of Readmissions Are Medication Related, Study Shows By Anuja Vaidya R esearchers studied the impact of a quality improvement practice designed to identify and categorize potentially preventable medication-related hos- pital admissions. They published the results in the Journal of the American Pharmacists Association. The practice involves pharmacists systematically assessing readmissions of high- risk patients to determine the reasons for the admission and whether each was potentially preventable and medication related. They applied the practice to 401 readmissions. Here are three study findings. 1. Of the 401 readmissions, 26 percent were potentially preventable and medi- cation related. 2. The most common categories were: • Nonadherence due to patient choice: 23.8 percent • Untreated condition for which medication is indicated: 13.3 percent • Dose too high: 10.5 percent • Dose too low: 10.5 percent 3. The percentage of readmissions that were potentially preventable and medi- cation related was significantly higher in more rural areas (30 percent) compared to urban areas (17 percent). n

• Cover