A Comparison of Estimated Cost Savings from Potential Reductions in Hospital-Acquired Conditions to Levied Penalties Under the CMS Hospital-Acquired Condition Reduction Program

Sankaran, Roshun; Gulseren, Baris; Nuliyalu, Ushapoorna; Dimick, Justin B.; Sheetz, Kyle H.; Arntson, Emily K.; Chhabra, Karan R.; Ryan, Andrew M.

doi:10.1016/j.jcjq.2020.05.002

Cited by 3 publications

(2 citation statements)

References 19 publications

(18 reference statements)

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“…The most common and costly HACs considered largely preventable include catheter-associated urinary tract infections (CAUTIs), stage 3 or 4 hospital-acquired pressure injuries (HAPIs), and patient falls. 3 4…”

Section: Background and Significancementioning

confidence: 99%

“…The most common and costly HACs considered largely preventable include catheterassociated urinary tract infections (CAUTIs), stage 3 or 4 hospital-acquired pressure injuries (HAPIs), and patient falls. 3,4 Prevention strategies often focus on the reduction of a single HAC rather than considering how actions to prevent one condition could have unintended consequences for another HAC. Shared risk factors of advanced age, mobility constraints, and physical and cognitive impairments can increase the possibility of a patient developing multiple HACs (MHACs).…”

Section: Background and Significancementioning

confidence: 99%

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Dashboard Design to Identify and Balance Competing Risk of Multiple Hospital-Acquired Conditions

et al. 2022

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Background Hospital-acquired conditions (HACs) are common, costly, and national patient safety priority. Catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure injury (HAPI), and falls are common HACs. Clinicians assess each HAC risk independent of other conditions. Prevention strategies often focus on the reduction of a single HAC rather than considering how actions to prevent one condition could have unintended consequences for another HAC. Objectives The objective of this study is to design an empirical framework to identify, assess, and quantify the risks of multiple HACs (MHACs) related to competing single-HAC interventions. Methods This study was an Institutional Review Board approved, and the proof of concept study evaluated MHAC Competing Risk Dashboard to enhance clinicians' management combining the risks of CAUTI, HAPI, and falls. The empirical model informing this study focused on the removal of an indwelling urinary catheter to reduce CAUTI, which may impact HAPI and falls. A multisite database was developed to understand and quantify competing risks of HACs; a predictive model dashboard was designed and clinical utility of a high-fidelity dashboard was qualitatively tested. Five hospital systems provided data for the predictive model prototype; three served as sites for testing and feedback on the dashboard design and usefulness. The participatory study design involved think-aloud methods as the clinician explored the dashboard. Individual interviews provided an understanding of clinician's perspective regarding ease of use and utility. Results Twenty-five clinicians were interviewed. Clinicians favored a dashboard gauge design composed of green, yellow, and red segments to depict MHAC risk associated with the removal of an indwelling urinary catheter to reduce CAUTI and possible adverse effects on HAPI and falls. Conclusion Participants endorsed the utility of a visual dashboard guiding clinical decisions for MHAC risks preferring common stoplight color understanding. Clinicians did not want mandatory alerts for tool integration into the electronic health record. More research is needed to understand MHAC and tools to guide clinician decisions.

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Section: Background and Significancementioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

Dashboard Design to Identify and Balance Competing Risk of Multiple Hospital-Acquired Conditions

et al. 2022

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The Impact of Mindfulness-Based Stress Reduction Techniques on Nurse Burnout in an ICU

Comstock¹

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Practice Problem: Central Line Associated Bloodstream Infections (CLABSI) are a preventable hospital acquired infection which contributes to patient morbidity, mortality and rising healthcare costs. PICOT: The PICOT question that guided this project was: In adult inpatients with central venous catheters, does the use of a two-person dressing change team, compared to a single person procedure, decrease the rate of central line associated bloodstream infections over the course of 8 weeks? Evidence: The prevention of CLABSI is most effective when multifaceted line maintenance bundles are implemented and adherence to these bundles nears 100% (Schreiber et al. 2018). Intervention: A two-person, evidence-based dressing change procedure was implemented for all central line dressing changes, known as the sterile buddy. The role of this additional bedside nurse was to assist the dressing change through an extra set of hands and to provide real-time sterile technique feedback to the primary nurse. Outcome: The intervention did not lead to a statistically significant change in the rate of CLABSI, however there was a reduction in the overall number of observed CLABSI compared to both the prior year and the 6 months preceding to the intervention. Conclusion: The implementation of a sterile buddy was an effective intervention that resulted in a decline in the total of CLABSI, and although not statistically significant, resulted in an estimated cost savings of $56,000 when compared to the year prior and an estimated cost savings of $112,000 when compared to the 6 months preceding the intervention.

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Improve the Risk of Central Line-Associated Bloodstream Infections with Central Line Dressing Changes through a Team Approach

Vincent¹

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Practice Problem: Burnout among nurses has been linked to turnover, negative patient safety and quality outcomes, and higher costs for institutions. PICOT: The PICOT question that guided this project was, in ICU nurses (P), what was the impact of the use of MBSR techniques (I), versus the current state in which no MBSR techniques are practiced (C), on self-reported BO (O), over the course of eight weeks (T). Evidence: A total of 14 studies were identified in the literature that directly support the implementation of this project. Themes from the literature show that mindfulness-based stress reduction techniques such as meditation, yoga, and gratitude may reduce nurse burnout. Intervention: A variety of mindfulness-based stress reduction (MBSR) techniques were implemented including a pre-shift “loving kindness” meditation, a five minute “Lunch Break Yoga” practice, and a post-shift gratitude reflection. Outcome: Data demonstrated that 88.9% of the participants reported reduced levels of burnout. A paired t-test showed a statistically significant reduction in BO. Conclusion: The use of MBSR techniques may provide a method to reduce burnout, possibly improving retention and outcomes, reducing costs for institutions.

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A Comparison of Estimated Cost Savings from Potential Reductions in Hospital-Acquired Conditions to Levied Penalties Under the CMS Hospital-Acquired Condition Reduction Program

Cited by 3 publications

References 19 publications

Dashboard Design to Identify and Balance Competing Risk of Multiple Hospital-Acquired Conditions

Dashboard Design to Identify and Balance Competing Risk of Multiple Hospital-Acquired Conditions

The Impact of Mindfulness-Based Stress Reduction Techniques on Nurse Burnout in an ICU

Improve the Risk of Central Line-Associated Bloodstream Infections with Central Line Dressing Changes through a Team Approach

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