Patient Safety

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    Can Private Rooms Save Costs by reducing HAIs?: a Monte-Carlo Simulation Study for Cost-Benefit Analyses of a Public Safety-net Hospital
    (2019-03-05) O'Neill, Liam PhD; Park, Saehwan
    Purpose: Private patient rooms (PPRs) have long been hypothesized to lower the risk of critical hospital-acquired infections (HAIs) including methicillin-sensitive staphylococcus aureus (MSSA), methicillin-resistant staphylococcus aureus (MRSA) and central-line associated bloodstream infections (CLABSIs). Moreover, there has been an increasing interest in “evidence-based design” and how structural elements influence health and financial outcomes. However, evidences have been weak from management and policy perspectives. Extant literature consists either expert opinions or case studies based on a single hospital. This simulation study investigated whether cost-savings from reductions in HAIs justify additional construction and operating costs of hypothetical All-PPR renovation projects. Methods: We conducted probabilistic Monte-Carlo cost-benefit analyses of converting the existing space occupied by bay rooms to PPRs for a large (537-bed) public safety-net hospital, based on known quantities drawn from the Texas Inpatient Public-Use Data File (IP PUDF). Three HAIs (two staphylococcus aureus infections – MSSA and MRSA – and CLABSI acquired during hospitalizations) were considered in this study. Two patient-level statistical models were developed to predict the effect of PPRs on hospital-acquired MSSA/MRSA risk and the effect of MSSA/MRSA on hospital costs, by using logit regression and generalized linear regression models respectively. Medicare payments were used as a proxy measure for hospital hosts. Attributable costs were estimated by taking difference between matched groups. Potential confounders including patient mix, hospital characteristics, nurse staffing, occupancy rates, physical space, procedure classes, and clinical burden were adjusted in both predictive models. We also used our previous CLABSI study to identify and estimate relevant variables (acquisition risk and attributable cost) of CLABSIs. Results: Despite uncertainty in cost estimates and infection risks, our simulation findings indicated that the cost savings from the reduction of HAIs meaningfully offset huge construction costs and operating expenses for the target hospital, ultimately contributing to positive net benefits ($4,122,019; 95% CI was [$772,996, $7,471,043]). The mean value of internal rate of return (IRR) over 5-year analysis period was 8.71% (95% CI= [3.83%, 13.58%]), outperforming the threshold of cost of capital for healthcare facility sector (5.8%). Even after considering randomness of various conditions, the likelihood of renovation project success (as defined by IRR greater than 5.8%) exceeded 87% with 5,000 repeated simulated trials. Conclusions: Our study shows that although All-private room facilities are costly to build and operate, they can result in substantial cost-savings on top of improved safety (fewer adverse events and/or deaths).
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    Study of trends in opioid prescription for chronic abdominal pain from 2009-2014 using National Ambulatory Medical Care Survey (NAMCS) data
    (2019-03-05) Adams, Ann; Aryal, Subhash; Maack Rangel, Jessica; Dodgen, Leilani
    Purpose: Chronic abdominal pain (CAP) is a common reason for health care visits affecting approximately 25% of adults. Often opioids are prescribed to treat CAP, though there is not much evidence to support this. Opioid use has been connected to increased morbidity and mortality of patients including drug misuse, abuse and exacerbation of abdominal pain. The purpose of this study is to examine national trends in prescriptions of opioids for treating CAP using National Ambulatory Medical Care Survey (NAMCS). Methods: NAMCS data were retrieved from the National Center for Health Care Statistics (2009-2014). The original data were paired into two-year groupings. We conducted stratified analysis and combined analysis for each 2-year period. We categorized patient diagnoses via the clinical classification software (CCS). Patient data were included if they were 18 or older and the reason for visit was CAP (including: Stomach pain, cramps, spasms, generalized lower or upper abdominal pain, and liver, gallbladder, or biliary tract pain). Certain types of abdominal pain were excluded including: pain from injury, infectious/parasitic diseases, neoplasms, diseases of the genitourinary system and pregnancy/childbirth complications. Logistic regression was used to determine trends in the number of visits where opioids were prescribed, and factors related to opioid prescriptions. Results: Visits for 2009-2010, 2011-2012, 2013-2014 were 10.3 million, 9.7 million and 10.2 million respectively. During the same time periods the estimated number of opioid prescriptions for treating CAP were 300 thousand, 400 thousand and 100 thousand respectively. There were no significant differences in the number of opioid prescriptions between time periods (p [greater than] 0.05). Conclusions: Even though an increasing trend for opioid prescriptions was reported in the literature for treating abdominal pain for 1997-1999 (7.9% increase) and 2006-2008 (15.5% increase), this analysis revealed the opioid prescription rate during this study period was not statistically different from year to year. Further analyses will incorporate additional data from the National Hospital Ambulatory Medical Care Survey (collected with NAMCS) which only contains hospital outpatient visits. This will contribute to a more robust, evidence-based analysis about practices in opioid prescribing, and inform the work of clinicians and public health officials working to address the US opioid epidemic today.
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    Evaluation of Team STEPPS training in Skilled Nursing Facilities
    (2019-03-05) Ross, Sarah; Severance, Jennifer; Agena, Valerie; Oderberg, Jane; Sang, Nancy
    Purpose Skilled nursing facilities (SNF) face many challenges in providing safe and competent care to a frail population. Surveys of SNF staff reveal poorer levels of safety culture compared to their hospital counterparts. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based interprofessional training program designed to teach tool to promote teamwork, communication, and patient safety. Implementation of TeamSTEPPS has led to improvements in patient safety culture in hospital settings, but there is a lack of evidence of benefit of TeamSTEPPS in SNF. Method Our research team adapted the TeamSTEPPS curriculum for implementation at two area SNF. We conducted three TeamSTEPPS training sessions to direct care staff (n=139). The trainings were delivered between October 2017 and June 2018. Focus group sessions comprised of the direct care staff (n=119) were then conducted at each facility between August and September 2018. The questions asked focused on staff perception on using communication tools, the training program itself, and feedback on program improvements. The comments from each of the sessions were than categorized to overarching themes. Results Thematic analysis of responses resulted in six major themes, communication, accountability, leadership/authority, implementation of the training, need for training and burn out. A majority of the comments from both facilities focused on the implementation of the training, communication, and accountability. Staff comments about the training implementation were positive and that they enjoyed the delivery method of the training and were able to apply the training to practice. Staff acknowledged that the communication tool led to improvements in communication between the staff from different shifts. Staff members also noted that they became more aware of their own roles and accountability to patient safety. Conclusion TeamSTEPPS training was well received by the direct care staff, and there were reports of improved communication and safety awareness. We anticipate that as direct care staff at SNF use TeamSTEPPS tools a positive impact will be seen on patient safety culture. Considerations for implementation of TeamSTEPPS tools in SNF requires a tailored approach. Barriers to success include high turnover in both leadership and direct care staff.
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    How Dirty is Your Phone?—Linking Restroom Behavior to Cell Phone Contamination at a Health Science Center
    (2019-03-05) Reynolds, Conner; Williams, Trevor; Underwood, Jacob; Jowitt, Janet Dr.; Lindsley, Joshua
    1. Purpose Preventable medical errors are the third leading cause of death in the United States annually, accounting for 251,000 lives annually. Healthcare-acquired infections (HAIs) account for nearly 40% of this population, costing the healthcare system $28.4-33.8 billion each year. Current efforts monitoring sources of HAI have set their focus on device-associated infections (i.e. central line, catheter, and ventilator-associated infections). Yet, in a recent Multistate Point-Prevalence Survey of Health Care-Associated Infections, device-associated HAI only accounted for 25.6% of instances detected. The rising prevalence of smartphone usage has also prompted researchers to target mobile phones as potential vectors for infectious transmission in healthcare. One potential area accounting for significant cellphone contamination is use in restrooms. 2. Methods In the present study, we surveyed students for their restroom cell phone usage. Following the survey, we then assessed the degree of contamination using an ATP Luminometer. 3. Results Using an ATP luminometer to measure surface contamination, students’ phones demonstrated an average level of 1702.09 ± 165.90 RLU/100 cm2. When correlating these contamination levels with survey behavior, some interesting things begin to emerge. There was a significant protective effect of hand washing, with a higher likelihood of washing leading to lower contamination levels (rs(101) = -.172, p 4. Conclusion Cell phones offer a world of information at the provider’s fingertips, allowing for higher quality care than ever before. However, these can easily become contaminated and are rarely disinfected. Taken together, the results of this study establish some of the first evidence for cell phone use behavior leading to surface contamination. To prevent these new smart devices from becoming fomites for infectious spread, it is the responsibility of health systems to implement cleaning protocols. This may reduce the overall rate of HAIs and preventable medical errors for patients across the United States.
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    Opioid overdose: Patients’ knowledge of and ability to manage the life-threatening crisis
    (2019-03-05) Gardea, Jessica; White, Annesha; Elrod, Shara; Coons, Leslie
    Purpose: Increasing naloxone access for opioid users has become a nationwide initiative. Naloxone can be a lifesaving medication, yet it is essential that patients understand when and how to use it and can communicate this to others. Most information about people’s knowledge of opioid overdose management comes from populations of illicit drug users. Additionally, there is little data demonstrating the efficacy of overdose education provided by pharmacists. The purpose of this study is to determine patients’ baseline knowledge, immediate recall, and long-term retention of opioid overdose management after receiving education from pharmacy personnel in a pain and palliative care clinic. Methods: Patients deemed high risk for opioid overdose will be prescribed naloxone and receive overdose management education from a pharmacist during a clinic visit in Tarrant County, TX. Before the education, demographic data will be collected and patients will complete a 10-question assessment on opioid overdose. Six of the 10 questions evaluate patients’ knowledge on overdose risk factors and management. The remaining four questions also assess knowledge regarding overdose, but may provide insight into patients’ perception of and confidence to manage opioid overdose. Additionally, patients will be evaluated on their knowledge of the prescribed naloxone device. Patients will be taught how to use the device, and a checklist will be utilized to evaluate the patient’s understanding via teach-back. Following the encounter, patients will complete the 10-question assessment again to measure immediate knowledge retention of overdose management. At the patient’s next follow-up visit (within 1-3 months), patients will complete the assessment and perform teach-back to evaluate long-term knowledge retention. ANOVA will be used to analyze scores on the knowledge assessment, and a paired t-test will be utilized to analyze device checklist scores. Descriptive statistics will be used for secondary analysis of specific questions and steps on the device checklists. Results: N/A Conclusions: N/A