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AHRQ Quality Indicators™ Toolkit for Hospitals Becoming a High Reliability Organization: Operational Advice for Hospital Leaders Central Line Insertion Care Team Checklist Emergency Department Tools and Resources Emergency Severity Index, Version 4 and 2012 Edition of the Implementation Handbook Efforts to Prevent and Reduce Health Care-Associated Infections The Hospital Built Environment: What Role Might Funders of Health Services Research Play? Improving Patient Flow and Reducing Emergency Department Crowding: Evaluation of Strategies from the Urgent Matters Learning Network II, Executive Summary Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals Patient Safety Culture Surveys Hospital Survey on Patient Safety Culture Hospital Comparative Database Submission Information 2012 Comparative Database Report 2011 Comparative Database Report 2010 Comparative Database Report 2009 Comparative Database Report 2008 Comparative Database Report 2007 Comparative Database Report Managing and Evaluating Rapid-Cycle Process Improvements as Vehicles for Hospital System Redesign Transforming Hospitals: Designing for Safety and Quality Users of Public Reports of Hospital Quality: Who, What, Why, and How?Using Workforce Practices To Drive Quality Improvement: A Guide for Hospitals
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Research Activities, September 2012: Hospital volume does not predict mortality for patients undergoing lung cancer surgery Studies link adverse drug interactions to elevated risk for hospitalization among the elderly Study fails to find link between guideline-based emergency treatment for pediatric asthma and patient outcomes Minority-serving hospitals have problems with quality of care and patient satisfaction
Research Activities, August 2012: State Medicaid policy changes increasingly driven by evidence Outcomes of trauma patients depend heavily on whether recommended practices are followed Patients hospitalized for burn injuries in New York have comparable outcomes at major burn centers Medicare managed care reduced preventable hospitalizations in 2004 more than fee-for-service Medicare New study counters the urban legend that insurers won't cover patients who leave the hospital prematurely Ways to reduce contrast-induced acute kidney injury from imaging procedures in patients with cardiovascular disease Discharge to skilled nursing facilities after a heart attack or heart failure explains little of variation in hospital readmissions New tool developed to reduce risks to patients during clinical handoffs Complications increase mortality of trauma patients Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life Benefits and risks of helicopter transport for trauma patients investigated Adverse drug reactions a major cause of unplanned hospitalizations of elderly veterans Treatment guideline reduces hypoglycemic events in critically ill children
Research Activities, July 2012: High-volume hospitals have low rates of adverse events for high-risk surgeries Complications and in-hospital deaths more frequent among patients who undergo anterior rather than posterior spine fusion Adjusting hospital admissions by day can help with overcrowding in children's hospitals Perceived reputation and other factors influence consumers' hospital choices Market competition has only marginal effect on hospital performance for heart failure Many surgeons do not discuss advance directives with their patients before surgery Large vessel occlusion after a mini stroke predicts functional decline Tumor necrosis factor-antagonists in patients with autoimmune diseases showed no overall increased risk of hospitalizations for serious infections than non-biologic drugs
Research Activities, June 2012: Vulnerable populations with heart failure less likely to receive early physician followup after discharge Dual Veterans Administration/Medicare users are not hospitalized more for ambulatory care sensitive conditions A hospital's ability to rescue patients from complications after high-risk surgery determines mortality rates Patients recovering in the hospital from total knee or hip replacement have increased risk of falls Contact isolation of new patients reduces adherence to process-of-care quality measures for pneumonia Magnet® hospitals offer better work environment for nurses than non-Magnet hospitals Large variations in Medicare payments for surgery underscore savings potential from bundled payment programs Remote intensive care monitoring is cost effective for sickest patients Use of pulmonary artery catheters provides no patient benefit and increases costs Decision support may aid emergency physicians in interpreting benign from serious eye movement patterns in dizzy patients Risk of venous thromboembolism low for young trauma patients without a central venous catheter Risks high for elderly patients receiving angioplasty to fix narrowed heart artery Men more likely to be readmitted to hospital after discharge
Research Activities, May 2012: Trauma centers vary in screening for deep vein thrombosis Leapfrog survey may not accurately report use of safe practices in trauma centers Lower complications are seen after laparoscopic kidney removal Health information exchange can save money by reducing admissions from the emergency department Children's hospitals are pressed to capacity by response to pandemic outbreaks Kidney-sparing surgery for children with renal tumors has equivalent in-hospital results to kidney removal surgery Increased child hospitalizations are associated with the mother's mental state and confidence in parenting
Research Activities, April 2012: Majority of conditions treated in emergency departments are treatable in primary care clinics Patient surveys are an additional useful tool for identifying adverse events occurring during hospital stays Public reporting of performance data seems to motivate and energize improvements to hospital performance Chronic Disease: Heart failure hospitalization and mortality rates drop between 1998 and 2008 Drug-eluting stents appear safe for older patients with chronic kidney disease Accuracy of ultrasound for ectopic pregnancy in the emergency department is not helped by measuring a key pregnancy hormone Clinical algorithm can identify and locate serious internal bleeding related to oral anticoagulant use Hospital readmissions higher for chronic conditions Midwest hospitals lead in newborn male circumcision rates
Research Activities, March 2012: Hospital emergency departments get tips from AHRQ on how to reduce crowding and better triage patients Learning networks can help implement strategies to improve emergency department patient flow Trauma patients with hospital-acquired infections have poor outcomes, including increased mortality risk Hawaii's experience shows that a national collaborative effort can reduce central line-associated bloodstream infections Crisis checklists for the operating room can improve safety and management Evaluation of TeamSTEPPS® implementation finds improved teamwork and clinical outcomes Guideline management of inpatient cellulitis and cutaneous abscess reduces antibiotic use EMS transport is underused by patients with a certain type of heart attack Study characterizes patients receiving out-of-hospital endotracheal intubation 24-hour intensivist care in ICUs can lead to cost savings for the sickest patients admitted at night Costs of congenital heart operations vary among hospitals Pneumococcal disease continues to lead to substantial health care use and costs ICU nurses show increasing acceptance of electronic health records Evidence lacking to support surgery for pelvic pain Study identifies attributes of surgeons more willing to provide charity care Despite recommendations against it, early discharge of late-preterm newborns remains common Hospital stays involving C. difficile infections leveled off after 300 percent increase since 1993 AHRQ publishes cancer hospitalization statistics
Research Activities, February 2012: Superficial surgical site infections are a reliable measure of hospital quality Patient flow strategies may help to address emergency department crowding New rule on when to have a trauma surgeon meet a transported trauma patient is found more sensitive than existing criteria Depending on a woman's age, hysterectomy may be the best option for resolving chronic pelvic pain and heavy bleeding
Research Activities, January 2012: Bundled payments for heart failure disease management programs can save money while reducing readmissions Interdisciplinary team training with in-situ simulation helps reduce adverse events in obstetric patients No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery Duplicate medication order errors increase after computerized provider order entry is implemented California nurse staffing mandate did not reduce nursing workforce skill levels Leg compression devices are not a significant factor in in-hospital falls A large proportion of hospitalized children receive numerous medications during their hospitalization Clostridium difficile infection rate has risen among hospitalized children since late 1990s Pediatric cardiology centers vary in treatment of infants with single ventricle congenital heart disease Cost of hospitalization highest among the non-elderly Potential role of physical therapy in ICU patients Evidence lacking on optimal transition-of-care programs for heart attack and stroke patients following hospitalization
Research Activities, December 2011: Evidence-based strategies substantially reduce the incidence of ventilator-associated pneumonia in ICUs Trauma patients are more likely to die after a major complication in high-mortality hospitals Hospital boards adopt practices to enhance oversight on quality of care Fewer than 1 in 5 emergency departments implement recommendations for HIV screening Increased estradiol levels during critical illness are associated with higher mortality Hospital lung cancer surgery volume is not correlated with lower mortality Enrollment in Medicare Advantage managed care plans reduces racial/ethnic disparities in primary care quality in some States Heart disease, cancer, and trauma-related disorders among the most costly conditions for men Knee replacements up dramatically among adults 45 to 64 years old Hospitalizations for eating disorders declined, but big increase seen in pica disorder Birth defects may be linked to high blood pressure, not use of ACE inhibitors in early pregnancy
Research Activities, November 2011: Blacks and patients at hospitals with a high percentage of black patients more likely to suffer adverse events Nurses in hospital units with a higher proportion of short-term patients take longer to respond to patient call lights Pediatric emergency department visits surged during the 2009 H1N1 flu pandemic, but few children were hospitalized Recent trends in hospital use by children and youths are a mixed bag—lower for teen pregnancies, much higher for skin infections Blood infections most costly hospital care in 2009 Updated report highlights hospitals’ progress in reducing bloodstream infections Hospital readmissions for COPD highest among black patients Uncertainty surrounds use of terbutaline to prevent preterm birth
Research Activities, October 2011: MONAHRQ gains momentum Certain factors increase risk of medication errors in the neonatal intensive care unit (NICU) Going "smooth" can help relieve weekday crowding at children's hospitals Minimally invasive heart treatments have reduced bypass surgeries and influenced valve repair and replacement Heart attack victims should use emergency transport services, not self or family to get to the hospital Physician recommendations for defibrillator therapy not influenced by race or gender More research is needed on outcomes after maternal-fetal surgery A small number of drugs are used most commonly during pediatric hospitalizations Hospital deaths from heart failure cut by half over 7 years Hospitalizations for children with influenza and skin infections increased in the last decade More than 20,000 emergency room visits for air and paintball gun injuries in 2008
Research Activities, September 2011: Fewer heart bypass surgeries performed Surgical risk score does not work well for knee and hip replacement operations Pay-for-performance project showed early gains but tapered in the fourth and fifth years Leaving the emergency department without being seen more likely at hospitals that serve more low-income patients Patients with sepsis fare better when admitted via the emergency department rather than directly to the hospital Blacks who receive heart transplants have poorer survival than other racial groups Minority status has no effect on patient outcomes in the intensive care unit The quality of children's asthma care is affected by emergency department crowding Arizona and Maryland see great drop in in-hospital deaths from pneumonia
Research Activities, August 2011: Hospital-acquired infections dramatically increase trauma patients' risk of in-hospital death and hospital stay Trigger tools have potential to detect adverse events following outpatient surgery Electronic order sets can help treatment conform to guidelines for antibiotic use after surgery Mental demands of pediatric hospital pharmacy staff have varying effects on likelihood of medication errors and adverse events Patients with heart failure are older, have more illnesses, and take more medications than earlier Parents and primary care physicians are satisfied with children's use of nonurgent emergency department services Primary anterior cervical fusion has lower in-hospital complication rates and deaths than posterior cervical fusion Six of every 10 rural emergency departments visits made by poor patients Up to $500 million in Affordable Care Act funding will help health providers improve care
Research Activities, July 2011: Language barriers related to increased hospital readmissions for Chinese- and Spanish-speaking patients Delays in reporting medical errors at Japanese hospital nearly triple that of United States hospital Hospitals with a teamwork culture have better patient safety climates Quality measures are not used with all patients who suffer heart attacks Immersive simulation training for CPR shows no benefit over standard training Patients who suffer strokes and are seen at designated stroke centers fare better in the short and long run Trauma center patients treated after hours or on weekends have no difference in mortality rates A high percentage of patients with sickle cell disease self-discharge from hospital care Two approaches help identify cardiac surgery patients at risk for postoperative kidney failure Communication problems between hospitalists and primary care providers lead to postdischarge problems for seniors Some patients hospitalized for stroke more likely to keep taking drugs to prevent another stroke Sleep apnea and pulmonary hypertension affect in-hospital outcomes of noncardiac surgery Certain factors linked to risk of early death of intensive care patients after discharge Physicians more reluctant to deactivate some life-sustaining devices than others Mandated increases in nurse staffing levels unevenly affect uncompensated care growth rates in California hospitals Pelvic ultrasound imaging by emergency physicians is highly effective in ruling out ectopic pregnancy More rural Americans treated in emergency departments for eye injuries ICUs in Michigan sustain zero bloodstream infections for up to 2 years Over 3 million look to hospitals for headache relief Most American women experience complications during delivery Readmissions in 30 days or less account for 1 in 9 hospital admissions Connecting local providers to academic medical centers using video improved hepatitis C outcomes
Research Activities, June 2011: Patient gender does not influence the management or diagnosis of acute abdominal pain in the elderly, but affects outcome Half of all annual medical expenditures are for chronic diseases Length of stays in emergency departments varies considerably Organizational culture distinguishes top-performing hospitals in patient outcomes from heart attack No consistent association found between volume or quality and outcomes of complex surgeries for cancer Dilators more cost-effective than surgery for correcting congenital condition in females Mental status deficits a major factor in elderly falls in the hospital Medication side effects, injuries up dramatically Use of episiotomy and forceps during childbirth down, C-section rates up
Research Activities, May 2011: Emergency department patients and visitors are most interested in education about stress and depression Systems to detect adverse drug events need buy-in from leaders and staff to become part of hospital routine Performing cardiac catheterization and heart surgery on different hospital admissions may reduce risk of kidney damage Surgery and imaging rates for children's kidney stones are stable, but vary greatly from hospital to hospital Hospital charges surpass the trillion dollar mark Uninsured hospital stays surged from 2003 to 2008 Low health literacy linked to higher risk of death and more emergency room visits and hospitalizations
Research Activities, April 2011: Hospital Compare data may not help surgical patients find hospitals with better outcomes Obese patients with hypertension and diabetes have a greater risk of dying after noncardiac surgery Certain hospital characteristics influence mortality after complications following high-risk surgery Physicians cultivate colleagues' esteem differently at low- and high-prestige hospitals Parents using electronic kiosk provide more accurate clinical information than emergency room providers Decision support intervention prompts clinicians to update patients' problem lists in their medical records Adverse drug event surveillance tailored to hospitalized children Rates of pneumonia dramatically reduced in patients on ventilators in Michigan intensive care units Patients' income and where they live influence hospitalization for chronic lung disease
Research Activities, March 2011: Re-engineered discharge project dramatically reduces return trips to the hospital Hospitals with a high volume of sepsis admissions have lowest mortality rates Hospitals face dilemmas about disclosure of large-scale adverse events Most process-of-care events do not harm transplant patients, but they boost costs and lengthen hospital stays Person-to-person transmission of E. coli resistant to fluoroquinolone drugs is rare among hospital patients Automated screening of patient electronic medical records is only the first step to identifying a medication problem Better adherence to diabetes medications means fewer hospitalizations and emergency department visits Hospitals with more patients who receive angioplasty within 90 minutes of a heart attack have lower mortality rates Hospitalizations for bacterial pneumonia in Texas towns bordering Mexico three times higher than the national average Kidney stone rates in children may be on the rise Better hospital quality of care for the elderly is associated with lower mortality after discharge Aching back sends more than 3 million to emergency departments Operating room procedures account for nearly half of hospitals' treatment costs Growth in Medicaid patient hospital admissions outpace those for privately insured patients
Research Activities, February 2011: Hospitals vary greatly in the quality of their trauma care Trauma care costs less at hospitals with lower mortality rates Routing ambulances to cardiac surgery-equipped hospitals more cost effective than building more such hospitals Nearly one-third of emergency department visits involve nonideal care events Emergency departments have increasingly become the health care safety net for adults insured by Medicaid Routine opt-out HIV emergency department screening only slightly improves identification of patients with HIV infection Ketorolac, a pain medication, is underused in children operated on for bladder reflux Higher in-hospital complication rate for primary posterior versus primary anterior cervical fusion One in 16 women hospitalized for childbirth has diabetes More than one in five hospital patients in 2008 were born in 1933 or earlier
Research Activities, January 2011: Most acute-care hospitals follow national guidelines for the prevention and treatment of MRSA infections Hospitalists modestly improve quality of care Greater use of preventive measures needed for hospitalized patients with suspected venous thromboembolism Serious complications from bariatric surgery are fewer when done by high-volume hospitals and surgeons Treatment for blocked carotid arteries varies depending on where you live Community hospitals care for psychiatric patients in medical-surgical beds when psychiatric units are full Patients taking only salmeterol seen in the emergency department for asthma more likely to be hospitalized Rates of emergency department use greater among women and low-income, older, and rural Americans
Research Activities, December 2010: Surgical infection prevention measures reduce postoperative infections when used together, but not singly Fragmentation of care for complex diabetes patients may be associated with greater use of the emergency department Uncontrolled asthma events among Massachusetts patients declined between 2002 and 2007 Patients with inherited cancer syndrome need help with decisions and long-term support from their surgeons Four million hospital admissions potentially unnecessary Hospitalizations for medication and illicit drug-related conditions on the rise among Americans aged 45 and older Hospital charges for 1 in 20 hospital stays average $18,000 a day
Research Activities, November 2010: AHRQ patient safety indicator can be used to identify cases of hospital-acquired collapsed lung Clopidogrel increases bleeding risk in cardiac patients with drug-eluting stents Hospital report cards on coronary bypass surgery are more accurate when based on 2-year data One-fifth of mothers do not receive recommended antenatal corticosteroids before delivery of premature infants Potentially avoidable hospitalizations high among Medicare and Medicaid patients Most public hospitals are in rural areas
Research Activities, October 2010: Health care-associated infections greatly increase the length and cost of hospital stays Quality improvement initiative successful in sustaining reduction in bloodstream infections caused by catheters Patients with financial worries or no insurance delay going to the hospital for a heart attack Rural elderly with dementia are hospitalized more often for conditions that primary care visits might have caught The role of hospital care in general medical care has declined over time Risks, benefits of emerging heart valve replacement technique not fully understood Treating Americans with diabetes cost hospitals $83 billion Potentially avoidable hospitalizations for heart failure lowest in mountain States Oregon and Vermont show fewest hospitalizations for children with asthma
Research Activities, September 2010: Assessment of hospital computerized physician order entry systems finds many medication errors are missed Certain patients with lupus are more likely to end up in the emergency department three or more times a year Relative inefficiency of rural critical access hospitals must be balanced against their contributions to care access and quality Obstetrician malpractice claims lead to small reduction in inpatient deliveries, but not C-section rates Early followup with a physician reduces readmissions for Medicare patients hospitalized for heart failure Heart bypass surgery death rates drop sharply Mental disorders and/or substance abuse related to one of every eight emergency department cases Blacks hospitalized for high blood pressure five times more often than whites New study finds rotator cuff injuries treatable, but evidence unclear whether surgery is preferable
Research Activities, August 2010: Emergency physicians suggest ways to reduce errors in patient handoffs during shift changes Hospital risk managers more likely than physicians to recommend error disclosure, but less likely to apologize Patient preferences are important when making clinical decisions for those who can't, but other factors also play a role Minority patients are less likely to have surgery performed by high-volume surgeons and hospitals Lower mortality rates after surgery at high-volume hospitals due to fewer complications and other factors Remote supervision of stroke therapy is safe and effective at smaller hospitals Studies explore rapid treatment of sepsis and cardiac arrest Surgical simulation training improves speed and confidence in residents learning endoscopic sinus surgery Thoracic surgeons can help patients stop smoking with a brief smoking cessation program Deaths from hospital complications drop, disparities remain Cost of hospital treatment for blood infection surges
Research Activities, July 2010: One in four patients experiences revolving-door hospitalizations Patients at small urban hospitals are more likely to suffer from pressure sores than those at small rural hospitals Study suggests caution in interpreting impact of nurse staffing levels on postsurgical complication rates Patient outcomes are better than hospital volume for identifying high-quality bariatric surgery centers New approach reduces microemboli responsible for neurologic injury following open-heart surgery Implantable heart defibrillator is effective in reducing deaths among older heart failure patients Body fat distribution in obese trauma patients is not linked to increased inflammation, infections, or mortality Performance measures requiring antibiotics for pneumonia have not boosted antibiotic use in nonpneumonia patients Hospitalization rates have declined over 5 years for patients with HIV infection, but disparities still exist Nearly 9 percent of children experience agitation during sedation for nonsurgical procedures Computerized provider order entry significantly reduces medication errors in an ambulatory setting No additional benefit seen with remote offsite monitoring of ICU patients Hospital heart attack deaths plummet
Research Activities, June 2010: Respiratory syncytial virus is more serious than the flu in young children Nonplatinum chemotherapy agents more likely to lead to hospitalizations for older women with ovarian cancer Developing community health resources entices more elderly patients to seek hospital care locally Patients who undergo knee ligament reconstruction do better when the doctor or hospital perform it frequently Higher nurse-patient ratios result in societal cost benefits for some hospital areas Medicare Advantage enrollees are admitted to hospitals with higher mortality rates than Medicare fee-for-service enrollees Paramedics sometimes interrupt CPR to open airway Study reveals high rates of rehospitalizations and emergency pain treatment for sickle cell disease Black children are more likely to be hospitalized for a ruptured appendix than white children For 1 in 10 Medicaid patients, it's back to the hospital in a month
Research Activities, May 2010: Hospital charges for the uninsured have soared Adverse events occurring during pediatric sedation are recorded in charts but not always reported Study provides insights into problems confronting quality improvement educational programs in rural hospitals Some patients are more satisfied when they are given usually unnecessary antibiotics for upper respiratory infections Emergency department treatment of asthma with systemic corticosteroids is not always timely General hospitals are stepping up specialty services in response to competition from single specialty hospitals Treating blood infections tops annual hospital cost increases Why women are admitted to the hospital Patients who take a proton-pump inhibitor with medicine to prevent blood clots are less likely to be hospitalized for bleeding ulcers
Research Activities, April 2010: Patients admitted to the hospital on weekends wait for major procedures To reduce hospital deaths, managing surgical complications may be as important as preventing them FACE cards have a small positive effect on hospital patients' ability to identify their physicians Rotavirus was culprit in one-fourth of children's diarrhea-related emergency department visits prior to vaccine Computer display helps reduce the rates of ventilator-associated pneumonia in surgical intensive care units
Research Activities, March 2010: Venous thromboembolism is rare in young trauma patients, but a better understanding of its risk factors is needed Simulation training in the operating room improves competency for the entire operating room team One patient safety indicator may offer a glimpse at a hospital's overall safety record Pain management in emergency departments has improved but can still be better Octogenarians fare well after aortic valve replacements Hospital discharge software slightly boosts patient and outpatient physician satisfaction More than half of all hospital procedures are outpatient Medicare pays for nearly half of rural hospital stays
Research Activities, February 2010: Being overweight prior to transplant surgery slows improvement in the physical functioning of liver transplant patients COPD drug triad associated with reduced death and hospitalization rates Children with cerebral palsy who undergo gait assessment before surgery are less likely to need additional surgery later Primary care doctors often don't know that a child sought care for asthma in the emergency department ICU scoring system better predicts the risk of death for trauma patients Trauma triage system tends to overestimate injury severity Use of bedside ultrasound by hospital emergency departments is not yet common practice in California Emergency departments treat 3.5 million crash victims a year
Research Activities, January 2010: Administration of antimicrobials just prior to surgery reduces the risk of surgical site infections Simulating equipment failures can be useful to hone anesthesia providers' skills Fewer public psychiatric hospital beds may lead to higher suicide rates MEPS respondents underreport emergency department and office visits, but accurately report hospital stays Individuals who seek care for coughs and colds in emergency departments have social support
Research Activities, December 2009: Common attention deficit-hyperactivity disorder drugs have similar risk for emergency visits for cardiac problems Public reporting of hospital antibiotic timing for patients with pneumonia is not linked to antibiotic overuse or overdiagnosis Telemedicine reduces children's emergency department visits for nonemergency problems Laptop test in an emergency department can help detect subtle cognitive deficits following concussions Certain types of hospitals are more likely to use computerized physician order entry Staff willingness to change and adapt is important when implementing electronic pharmacy systems Patient deaths in hospitals cost nearly $20 billion
Research Activities, November 2009: Children are commonly harmed by adverse events in intensive care units Quality of care may be more important than volume when it comes to heart bypass surgery Treating aging baby boomers costs hospitals $56 billion Hospitalizations for coronary artery disease, heart attack, and stroke are down significantly Blood transfusions have more than doubled Childbirth and deliveries are becoming more complicated Falls send more than 2 million seniors to emergency departments
Research Activities, October 2009: Physician-owned single specialty hospitals may prod nearby hospitals to increase nurse staffing levels Four in 10 emergency department visits are billed to public insurance Patients are increasingly leaving hospitals against medical advice
Research Activities, September 2009: Increasing the number of primary care physicians can reduce the rate of hospitalizations for bacterial pneumonia Leakage problems following surgery for rectal cancer can be managed with a minimally invasive approach Hyperdense basilar artery on unenhanced CT scan predicts a clot in the artery and poorer outcome among stroke patients Air leak test does not accurately predict problems after breathing tube removal in children Sports-related injuries account for one in five of children's emergency department visits Osteoporosis-linked fractures rise dramatically
Research Activities, August 2009: Hospitals with better safety climates have fewer events that can potentially harm patients Medicare claims data identify hospital-acquired catheter-associated urinary tract infections with limited accuracy Accurate secondary diagnosis codes improve risk adjustment of inpatient mortality rates A greater number of different chronic conditions increases hospital readmissions and costs Hospital system type affects mortality rates Common definitions and reverse triage can help hospital planners meet surge capacity demands during emergencies Only a few academic emergency departments have dedicated pharmacists More education is needed to improve delirium and sedation management in intensive care units Performance obstacles negatively affect how ICU nurses perceive the quality and safety of care they deliver Diagnostic codes alone may misclassify bacterial infections among hospitalized patients with rheumatoid arthritis
Research Activities, July 2009: Better short-term survival of blacks with heart failure is linked to less severe illness at hospital admission Quality and accessible primary care is linked to fewer emergency department visits by Medicaid-insured children Children with acute bone infections can be switched from intravenous to oral antibiotics before hospital discharge The number of hospitalized children on antifungal therapy has increased along with use of newer antifungal agents Elderly patients on digoxin, recently discharged from the hospital, are at higher risk for drug-related toxicity Getting patients admitted to a hospital floor reduces length of stay and congestion in emergency departments Evidence-based practices improve pain management and lower costs for patients hospitalized for hip fracture Surgical Apgar score can help pinpoint patients at risk for major complications and/or death after surgery Several practices of hospital governing boards are linked to improved quality of care Examining processes, not outcomes, improves patient safety in hospitalsStudy uncovers factors that determine when rural hospitals convert to critical access hospital designation Both patient and hospital factors drive discharge costs of coronary artery bypass graft surgery Hospitalizations for asthma, diabetes, and other conditions are much higher among the poor
Research Activities, June 2009: Type of beta blocker may affect mortality after hospitalization for heart failure Caregivers of individuals with Alzheimer's dementia are more likely to visit emergency departments or be hospitalized when depressed Deaths and rehospitalizations for elderly patients have not decreased despite advances in heart failure therapies Discharge process reduces hospital use in the 30 days following discharge Substance abuse is linked to readmissions for mood disorders Patient safety events make hospital stays longer and more costly Staff perceptions of hospital patient safety differ by department and position WalkRounds program enhances the patient safety climate in hospitals Study outlines the challenges of conducting quality improvement studies at rural and small community hospitals The cost and impact of medical errors continue long after hospital discharge
Research Activities, May 2009: Hospital reports on patient safety incidents can be useful in identifying the contributing factors, but often need more detail Eating disorders are sending more Americans to the hospital
Research Activities, April 2009: Some patients choose safer hospitals when an insurer offers an incentive program Perception of patient safety climate in hospitals varies by management level and clinical discipline Quality improvement collaborative fails to improve infection prevention in surgical patients Focused review is more effective than random review in discovering errors in surgical pathology cases ICU nurses handle medical errors differently than they say they do on survey Nearly a fifth of elderly patients are readmitted after a hospital stay for psychiatric care Depression and substance abuse treatment hospitalizations declined for Medicare beneficiaries over a decade Care quality disparities exist for children seen in urban versus rural hospitals Simulation exercise for hospital resuscitation teams pinpoints training and patient safety issues Antibiotic use and diarrhea are factors in hospital room contamination with vancomycin-resistant organisms Older males with underlying health conditions are at a high risk of dying from intestinal bleeding in hospitals Hospitalists and general internists provide similar quality of care for patients with congestive heart failure The Northeast United States has the most hospitalizations for brain cancer
Research Activities, March 2009: Educating patients before hospital discharge reduces readmissions, emergency department visits, and saves money Economic and housing instability are linked to poor access to health care and higher rates of hospitalization Hospitals spend less for patients in Medicare Advantage than for patients in fee-for-service Medicare Winter weather hospitalizes thousands and kills hundreds 10-State project to study methods to reduce central line-associated blood stream infections in hospital ICUs
Research Activities, February 2009: Quality of care and working conditions influence job satisfaction of surgical residents Multiple approaches are needed to reduce hospital prescribing errors Veterans Administration hospitals have a generally positive safety climate, but there is room for improvement Leadership support and fair work distribution keep morale high during quality improvement initiatives Hospitals' cost for the top six cardiovascular treatments is nearing $60 billion Hospitalizations are declining for digestive system bleeding Hospitals spend less for patients in Medicare Advantage than for patients in fee-for-service Medicare
Research Activities, January 2009: Patients reveal adverse events in the hospital that are not documented in the medical records More women than men are hospitalized for chest pain with no known cause Inpatient treatment for elderly nondementia psychiatric illnesses is shifting into less expensive settings Daily hemodialysis is cost-effective for intensive care patients with acute kidney injury Pressure ulcers are increasing among hospital patients
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