Becker's Hospital Review

169 FINANCE CMO / CARE DELIVERY 4 Strategies to Mitigate ER Overcrowding By Anuja Vaidya A study, published in Annals of Emergency Medicine, exam- ined emergency room overcrowding and identified strate- gies to help healthcare facilities mitigate this issue. For the study, researchers interviewed stakeholders at hospitals that were divided into three performance categories: low, high or highest improving in terms of lengths of stay and boarding times, as measured based on statistics that 2,619 U.S. hospitals provided to CMS. The researchers selected four hospitals in each of the three catego- ries and talked to 60 stakeholders overall, including nursing staff, ER directors, directors of inpatient services and CMOs, among others. The researchers found four key strategies that can help reduce ER overcrowding: • Involving executive leaders to ensure overcrowding is a hospi- tal priority with clear goals • Breaking down silos and implementing comprehensive strate- gies across the hospital • Gathering and using data to improve operations by providing real-time feedback to staff and predicting patient flow • Holding people accountable and addressing issues immediately The National Institutes of Health funded the study. n CMS Grants Quality Reporting Exceptions to Hospitals Affected by Irma By Mackenzie Bean H ospitals and other healthcare provid- ers affected by Hurricane Irma will be granted exceptions under certain Medicare quality reporting and value-based purchasing programs, according to a Sept. 14 CMS notification. The exemption applies to healthcare providers located in areas Federal Emergency Manage- ment Agency designated as a major disaster area. Right now, all counties in Florida, as well as several municipios in Puerto Rico and coun- ty-equivalents in the U.S. Virgin Islands, are la- beled major disaster areas. Providers in affected areas will be given excep- tions without having to fill out an Extraordinary Circumstances Exceptions request. "[A]ll of the exceptions are being granted to assist these providers while they direct their resources toward caring for their patients and repairing structural damages to facilities," CMS wrote in the notice. n The 2 Most Effective Operating Room Practices to Reduce SSIs By Mackenzie Bean P rioritizing patient skin and wound hy- giene, and tracking and reporting pa- tient outcomes are the most effective operating room practices to reduce surgical site infections, according to a study pub- lished in the Journal of the American College of Surgeons. For the study, researchers polled surgeon leaders at 20 Texas hospitals affiliated with the Texas Alliance for Surgical Quality, a collab- orative of the American College of Surgeons National Surgical Quality Improvement Program. In the survey, physicians ranked surgery, anesthesia and nursing adherence rates for 38 infection control practices in six categories: attire, preoperative preparation, during-surgery protocols, antibiotics, post- operative care and outcomes reporting. Researchers also analyzed outcomes data on risk-adjusted odds ratios for surgical site infections using ACS NSQIP hospital-level risk-adjusted reports for July 2016. Most hospitals reported maximum adher- ence for surgical care improvement project metrics, such as removing hair at the surgical site with clippers and properly using preven- tative antibiotic. Hospitals with the lowest SSI rates had the best compliance for eight other infection control practices, including preoperative showers, the use of clean in- struments for wound closure and dressing changes and transparent internal reporting of SSI data. Infection control practices relat- ing to operating room attire did not correlate with SSI rates. "e best performing hospitals were vigilant about skin prep, using a clean closure and giving antibiotics appropriately — all those things that happened right at the level of the wound," said lead author omas Aloia, MD, a surgeon at the University of Texas MD Anderson Cancer Center in Houston. "In addition, the hospitals that reported out their data on a formal basis — monthly or quarterly — to their surgeons, departments, and institutions also had the highest perfor- mance." n

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