the monthly publication for or decision makers the monthly publication for or decision makers joint
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January 2013 Vol 29, No 1
The monthly publication for OR decision makers
Joint project targets prevention for colorectal surgical infections
Safer surgery: Ten elements to help improve patient care and revenue
Seven hospitals working with the Joint Commission and the American College of Sur- geons (ACS) on a 2-year project to reduce colorectal surgical site infections (SSIs) have saved more than $3.7 million by avoiding an estimated 135 SSIs, the commission announced in November 2012.
The commission is pilot testing the approach used in the project with the aim of rolling out tar- geted solutions for all accredited hospitals in 2013.
Joint Commis- sion President Mark Chassin, MD, FACP, said colorectal sur- gery was cho- sen as a focus because it ’s a
common major surgery with a significant rate of complications, particularly SSIs. Also, complica- tion rates vary widely, suggesting
For hospitals, quality and rev-enue are increasingly inter-twined. Performance on qual- ity measures like appropriate an- tibiotic administration, surgical site infection rates, and patient
experience is being woven into reimburse- ment by Medi- care and pri- vate payers.
Your hospi- tal likely will have some pay-
ment at risk for not meeting and improving on quality measures. But it can also benefit from supe- rior performance.
Better-performing health sys- tems can negotiate more favor-
able rates from insurers and at- tract physicians, who also benefit from doing well on quality met- rics. That in turns attracts more patients, bringing more surgical volume and market share.
It’s a shift for hospitals that are used to fee-for-service payment in which they perform a service, submit a claim, and expect to be paid.
In this issue, OR Manager be- gins a series on page 8 titled Ten Elements of Safer Surgery, focus- ing on how your department can improve care for patients and in turn improve your business. The series is based in part on Safer- Surgery, an initiative of Advocate Health Care, a 10-hospital system in the Chicago area. ❖
Continued on page 6
Inside OR Manager
OR BUSINESS MANAGEMENT New workshop planned for OR business managers .....5
PATIENT SAFETY Solid OR governance is the foundation for safety ........8
PATIENT SAFETY Hospitals share data to prevent colorectal SSIs .......... 11
OR BUSINESS MANAGEMENT Standardizing to control costs of spinal implants ..................14
HUMAN RESOURCES Succession: Identifying and mentoring OR leaders ..........16
GI ENDOSCOPY Scope storage: Don’t get hung up on a number ...........19
OR BUSINESS MANAGEMENT A checkup for your OR’s value analysis process ..........21
Quality reporting for ASCs is off to a good start ......................... 24
Helping to avoid postdischarge nausea and vomiting ......................28
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3OR Manager Vol 29, No 1January 2013
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When you read the dis-turbing reports linking nurses’ stress, burn- out, and workload to worse pa- tient outcomes, you wonder why staff and patient safety aren't ad- dressed together.
In just one example, a study found a high rate of nurse burn- out was related with higher rates of catheter-associated urinary tract infection and surgical site infec- tion (Cimiotti J P, et al. Am J Infect Cont. 2012;40:486-490).
A new report from the Joint Commission bridges the gap, tying together the twin objectives of making health care safer for pa- tients and workers alike.
Too often, these efforts run on parallel tracks—the quality de- partment focuses on patient safety, occupational health addresses em- ployees, risk management deals with sentinel events, and so forth.
The report urges that these silos be spanned and makes the case for why these programs should be seamless.
Actually, there’s a lot of over- lap—a culture of safety for pa- tients won’t take root if the staff who provide care are neglected.
The report brings together prin- ciples of high-reliability organi- zations, professional guidelines, health and safety regulations, and Joint Commission standards.
Return on investment Case studies illustrate the return on investment and other benefits organizations have seen from these programs−better staff reten- tion, fewer sick days, higher pa- tient satisfaction, lower workers comp costs, and fewer lawsuits.
One case study highlights how St Vincent’s Medical Cen- ter, Bridgeport, Connecticut, has made employee safety part of its high-reliability culture. Employee safety is defined similarly to pa- tient safety:
• serious safety event: reaches the employee and results in lost work time
• precursor safety event: reaches the employee, results in mini- mal harm or no detectable harm with no lost time
• near miss event: does not reach the employee; error is caught by a barrier designed to detect and prevent the event. Data is tracked and trended on
employee safety events, just as it would be for patients.
St Vincent’s leaders have ad- opted practices that advance safety: • storytelling: sharing stories of
harm that happened locally • daily huddles: briefings to re-
view safety events and concerns housewide and at the unit level
• senior leader rounding: lead- ers adopt departments to round with patients and employees on safety issues
• safety coaches: staff serve as front-line coaches to promote safety among their peers. The report is a good re