Archive for August 2015

It’s That Time again…

It’s that time of year again, when hospitals around the country are being notified of their 30-day readmission penalties from CMS. Now in the fourth year of the program, many hospitals have come to dread the announcement of how much they are being penalized each year.1 This year the readmission reduction program will decrease Medicare payments within a total of 2,592 U.S. hospitals, for a combined total of $420 million.2 Unfortunately, safety-net hospitals were about 60% more likely than other hospitals to have been penalized in all 3 years of the program. In addition, hospitals with the lowest profit margins were 36% more likely to be penalized than those with higher margins. Despite criticisms of the program, there is no doubt that it has forced hospitals to pay keen attention to transitions of care and avoidable readmissions. And it does appear to be an effective strategy for CMS to achieve…

Conflict: Ten Rounds in the Ring with Our Inpatient Data

by Frank Zadravecz, MPH Fortunately, my research world isn’t rife with inter-colleague conflict. Data, on the other hand continues to pick fights. As researchers, we have banded together to make sense of the patient measurements, physiologic alarms, and adverse outcomes we see in our hospital. Often where we are led by the data is perplexing. Pieces that we assume would be straightforward often aren’t clear-cut, making our complex task even more convoluted. We see this complexity when we need to reference a single hospital bed across databases, chronologically determine which patients generated vital signs from that bed, and then assign alarms from a bedside monitor to both their respective patient and nurse responder. One data feed may list our single occupancy rooms in two different ways; one feed labels the bed with a number and the other with a letter. Sometimes our single beds are given conflicting labels, or not…

Welcome to Uncomfort Inn. You Can Check out Anytime You’d Like

"A good laugh and a long sleep are the best cures in the doctor’s book." -Irish proverb "You can check out anytime you'd like, but you can never leave." -Hotel California, the Eagles Welcome to the hotel that functions like a hospital. 1700 CHECK IN Hello, sir, thanks for checking in today to “UnComfort Inn”. It looks like this is your 4th visit here in the past month, you’ve attained “Double F Status,” that qualifies you for a free colon prep during your stay. Yes, sure, similar to a colonic. Can you tell me your full name and address? You gave someone all that information at the admission desk? I see. This is the lobby desk, our computers don’t communicate with the front desk, so we’ll need to confirm. Your license and credit card, then? I’ll also need your insurance information, emergency contact, political affiliation, favorite sports team, and blood…

Catch Me If You Can. With My Dirty Hands That Is.

  Economists describe preferences in two ways: revealed and stated.  Say, for example, I asked you to implement a penalty program for your team with the goal of decreasing the number of occasions members did not clean their hands after a patient encounter.  Because you know bad hands equal bad outcomes, you're apt to offer up a more than token sanction.  Maybe it's a financial levy or required service beyond the expected, but you will probably suggest a "punishment" that does not quite smart, but imparts just a bit of a sting.  Your stated preference. (more…)

On Research and the Circus

by Mimi Zander The other week I had the pleasure of attending a cat circus. It was a stage show of 10-15 cats (plus a chicken, a groundhog, and 2 curious rats) walking on tight ropes, completing dangerous jumps, and a cat band complete with drums, guitar, and cow bell. In the beginning of the show the cat herder, Samatha Martin told the audience that before we get to the really great stuff, the next few minutes will be a segment called the "Lowering of the Audience’s Expectations." We would witness tricks that weren't quite ready for prime time by cats that were not as well behaved as some of the more senior performers. One cat refused to push a shopping cart. Another cat refused to jump through two very literal hoops. The cat wranglers on stage were completely poised and pleasant while their performers sat quietly on stage, not…
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