Becker's Clinical Quality & Infection Control

13 INFECTION CONTROL & PATIENT SAFETY More Hospitals Are Using 'Substitute Physicians' — Are They Safe? By Mackenzie Bean M ore hospitals are hiring outside physicians to fill in for staff phy- sicians who are sick, on vacation or attending conferences. Initial research from Boston-based Harvard Medical School suggested this practice is safe for patients. For the study, which was published Dec. 5 in JAMA, researchers analyzed data on 1.8 million Medicare hospital admissions from 2009 to 2014. Here are four study findings. 1. Substitute physicians managed about 40,000 of the 1.8 million hospital admissions included in the study. 2. One in 10 physicians was replaced by a substitute physician during the study period. 3. Patients exhibited no significant changes in 30-day mortality rates when treated by a substitute physician versus a regular hospital staffer. 4. Patients treated by a substitute physician had higher Medicare Part B costs and longer lengths of stay, but lower 30-day readmission rates. "Our findings so far are reassuring, but some of the trends we found demand that we look more closely at how the system works in a more granular way," said senior author Anupam Jena, MD, PhD, the Ruth L. Newhouse associate professor of healthcare policy at Harvard Medical School. n Suspending Weekend Hospital Services Does Not Hurt Patient Outcomes, Study Finds By Mackenzie Bean E liminating allied health services — such as speech therapy or dietetics — from hospitals on the weekends does not influence patient outcomes, according to a study published in PLOS Medicine. For the study, researchers conducted two clinical trials from February 2014 to March 2015, involving nearly 15,000 patients from 12 medical or surgical wards at two hospitals in Melbourne, Australia. Researchers gradually removed all weekend allied health services from the medical wards before introducing redeveloped versions of the services based on feedback from physicians, nurses and allied health staff. Removal of the allied health services did not affect length of stay or threaten patient safety, according to the researchers. Re-establishing updated versions of the health services did not influence patient outcomes, either. Patients actually stayed slightly longer and had more adverse events when weekend allied care was in effect. "There is some evidence from randomized trials available that allied health services delivered on rehabilitation wards can be effective for improving health outcomes and reducing the length of stay," lead author Terry Haines, of Monash University in Victoria, Australia, told Reuters. "It could be a simple case of moving allied health resources from the acute medical and surgical wards over to the rehabilitation wards." n Video Shows Nursing Home Staff Laughing as Patient Died Gasping for Air By Kelly Gooch F ootage released in November reveals nursing home staff in Georgia laughed as a World War II veteran called for help numerous times, gasped for air and died, according to WXIA. e incident, which led to the death of 89-year- old James Dempsey, occurred at Northeast Atlanta Health and Rehabilitation Center in 2014. WXIA obtained the hidden camera video aer it was released as part of a lawsuit filed by Mr. Dempsey's family. e video shows Mr. Dempsey "calling for help six times before he goes unconscious while gasping for air," according to WXIA. e footage also details numerous care lapses that occurred aer he stopped breathing. Staff members failed to consistently perform CPR on Mr. Dempsey, and another nurse failed to check the veteran's vital signs. Other staff laughed when nurses faced challenges getting Mr. Dempsey's oxygen machine operational. Additionally, WXIA cites state records indicat- ing about an hour gap between when nursing home staff found the patient unresponsive and when they called 911. Mr. Dempsey's family declined a TV interview due to a settlement agreement reached with Northeast Atlanta Health and Rehabilitation Center. Operators of the nursing home, owned by Sava Senior Care, also declined a TV interview but told WXIA they were "saddened by the events, which occurred more than three years ago." ey also noted the facility has "new leader- ship, and the leadership team and the staff have worked very diligently to improve quality care and the quality of life for our residents ... e facility recently was deficiency-free during our recent annual inspection conducted by the Georgia Department of Health on May 25, 2017." e nursing home eventually fired the nurses involved in the incident. e facility is still open, but has a one-star rating from Medicare. n

• Cover