News and Views

Medical errors continue to be a major problem in the US healthcare system, with hospital acquired infections (HAC) becoming an area of greater focus and where significant financial penalties are being incurred. Medicare has added one especially dangerous--or even potentially fatal--adverse event, iatrogenic pneumothorax during central line placement, to its HAC list. Along with putting patients in peril, the mistake can also increase hospital costs by up to $45,000 per incident, according to a study by the Agency for Healthcare Quality and Research (AHRQ). 

Many excellent studies show that ultrasound guidance can powerfully improve the safety and success of this very common procedure. In fact, in one randomized study of 900 critical care patients, use of ultrasound visualization reduced the rate of collapsed lung during central line placement to zero, compared to 2.4 percent for blind placement. 

Dr. Sierzenski is the Director of Emergency, Trauma and Critical Care Ultrasound for Christiana Care Health System’s Department of Emergency Medicine. He is also the Chair, Government Policy & Public Relations for the American College of Emergency Physicians Ultrasound Section and a Master's Candidate in Health Quality and Safety at the Jefferson School of Population Health.

In his article that advises American Hospital Association member trustees, Rodney Hockman, MD warns that hundreds of hospitals are likely to be penalized by Medicare for patient injuries under the Hospital-Acquired Condition (HAC) Reduction Program starting in October 2014. He points out that each penalized hospital stands to lose nearly $434,000 in Medicare reimbursements on average, with large hospital systems and those with a high volume of Medicare payments potentially facing much greater losses should they provide unsafe care.

Dr. Hochman points to institutions using a bundle of best practices to address this,  including 353-bed White Memorial Hospital, part of the Adventist Health System in Los Angeles, to eliminate two of the serious complications used to determine penalties under Medicare’s HAC Reduction Program: pneumothorax and central line-associated bloodstream infections (CLABSIs).  Both conditions are now included on AHRQ’s list of patient safety indicators. 

In this article for Becker's Orthopedic Review, Dr. Don A. Buford explains both the clinical evidence and benefits for the use of diagnostic ultrasound for shoulder evaluation. In particular, evidence for the use of ultrasound as the first imaging study in cases of suspected rotator cuff tear. Dr. Buford, an orthopedic surgeon, also covers the benefits of ultrasound to patients, his clinical practice and the costs to the healthcare system. As the healthcare system moves toward both Appropriate Use Criteria for imaging and lower costs, this article explains why it is time to implement such practices.

Healthcare Financial Management Association Blog
Paul R. Sierzenski, MD

 

The emerging healthcare environment requires expanded patient access while minimizing the cost of care. This is of particular importance for accountable care organizations that are assuming significant risk and must develop more innovative ways to deliver care to drive better outcomes and wring out inefficiencies. Our practice has experienced this struggle on a daily basis as patients, who needed a surgical consult, were frustrated with limited access. Our clinical schedule was filled with non-surgical candidates. This created a paradox where the most specialized health system resources (e.g., surgeon and MRI) were being allocated to a continuum of care that did not result in better care or outcomes, while also increasing physician and patient frustration. The long-standing dilemma was that the wrong patient was often in the wrong clinic leading to an inefficient and circuitous path for the delivery of appropriate care. When evaluating our practice it was clear that we could improve our allocation of available resources with the outcome being happy patients and happy physicians within a healthcare system that was delivering high quality, low cost, appropriate care.

Executive Insight
By Diku Mandavia, MD, FACEP, FRCPC

Yahoo! Health, Day in Health
By Lisa Collier Cool

Dr. Bahner underscores that since the 1980s, emergency ultrasound performed by emergency physicians at the point of care has been recognized as a valuable technology to improve the department.  Employing ultrasound at the bedside, he asserts, can reduce medical errors, provide more efficient real-time diagnosis, and in certain clinical scenarios, supplement or replace more expensive imaging modalities such as CT and reduce patient exposure to ionizing radiation.  This article details how ultrasound can improve procedural success and safety such as invasive procedures like nerve blocks and central venous catheter placement, prevent costly errors and discussed the future of emergency ultrasound which has grown since the American College of Emergency Physicians (ACEP) published its first specialty-specific ultrasound guidelines.

Patient Safety & Quality Healthcare
Diku Mandavia, MD, FACEP, FRCPC, Chief Medical Officer at SonoSite, and clinical associate professor of emergency medicine at the University of Southern California