Prophylactic Antibiotics: Too Little, Too Much or Just Right?
By Ronald A. Savrin, MD, MBA, Medical Director
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- American College of Surgeons (ACS)
- American Society of Anesthesiologists (ASA)
- Centers for Disease Control and Prevention (CDC)
- Association of Perioperative Registered Nurses (AORN)
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
To achieve the goal of improving surgical care, the SCIP elected to address vascular surgery, coronary artery bypass grafting (CABG), non-CABG cardiac surgery, arthroplasty of the hip or knee, colon surgery and hysterectomy. A panel of experts identified a variety of clinical standards, or "quality measures," which were identified as having a significant impact on reducing surgical complications and upon which there was general and overwhelming agreement. These quality measures included the broad clinical areas of infection, cardiovascular disease, venous thromboembolism, respiratory conditions, and vascular access. Among the most prominent measures were those involving the use of prophylactic antibiotics.
Overwhelming evidence
Although microbial resistance is ever changing, and new antibiotics are being constantly developed, there is overwhelming evidence for the proper use of perioperative prophylactic antibiotics. On the basis of this evidence and the consensus of expert opinion, the SCIP established the following as the first three quality measures:
- Prophylactic antibiotics received within one hour prior to surgical incision
- Appropriate prophylactic antibiotic selection for surgical patients
- Prophylactic antibiotics discontinued within 24 hours after surgery end time (within 48 hours after surgery end time for cardiac surgery)
Hospitals participating in the Annual Payment Update (APU) will publicly report their performance on measures 1 (SCIP-Inf-1) and 3 (SCIP-Inf-3) beginning with 3rd quarter 2006 data. Clinical and fiscal objectives will merge as measures to reduce surgical complications match those that determine, in part, reimbursement.
Preoperative timing of prophylactic antibiotics
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Appropriate antibiotics, properly administered, can significantly reduce surgical site infections. To be most effective, antimicrobials must be administered within 60 minutes before incision time. |
The effectiveness of prophylactic antibiotics was demonstrated conclusively by Burke1 in 1961. Lesions produced experimentally by contamination with Staphylococcus aureus were reduced by antibiotics administered prior to contamination. If antibiotics were administered 3 hours after contamination they had no effect on lesion size.
Stone, et al.2 in 1976 studied the clinical importance of the timing of prophylactic antibiotics in patients undergoing gastric, biliary or colon surgery. Cefazolin administered 1 hour prior to incision reduced the incidence of wound infections from 15 to 3 percent. Additional doses of Cefazolin given during the 8- to 12-hour period preoperatively failed to achieve a further reduction in infection. If antibiotics were delayed until 1 to 4 hours postoperatively they failed to significantly reduce surgical site infection as compared to those receiving no antibiotics. Prophylactic antibiotics must be administered prior to incision and to achieve the highest serum and tissue levels at the time of surgery, the antibiotic should be administered (prior to, but) as close to the time of incision as possible.
In patients receiving Cefazolin, DiPiro et al.3 showed that significantly higher serum levels were achieved at the time of incision (148 mg/L) and at 2 hours (57 mg/L) and 3 hours (39 mg/L) post-incision when the drug was administered by the anesthesia team as compared to being given “on call” (87 mg/L, 37mg/L, and 25mg/L, respectively). Tissue levels at the time of incision and at the time of wound closure were also higher when the anesthesia team administered the drug. The overwhelming evidence, therefore, suggests that the first dose of prophylactic antibiotics should be given within 60 minutes before incision unless a flouroquinolone or vancomycin is used, in which case administration should begin within 120 minutes before incision.4
Appropriate selection of prophylactic antibiotics
In determining the most appropriate antibiotic for prophylactic use, several factors should be considered. First and foremost, the antibiotic should be effective against the pathogens most likely to be encountered. Since adequate tissue levels are desirable throughout the duration of the operative procedure, from incision to skin closure, the half-life of the drug should be considered. Factors such as cost, safety and potential drug resistance should also be considerations. Finally, antibiotics with an unnecessarily broad spectrum of activity and those used to target specific drug resistant strains should be avoided so as to avoid promoting the development of further resistance. Current recommendations are shown in the accompanying table.5 The antibiotic of choice for most of the procedures listed is usually a β-lactam preparation. On rare occasions, an alternative drug may be used. The Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee guidelines state, "the routine use of vancomycin in antimicrobial prophylaxis is not recommended for any kind of operation."6 However, there are situations that are not routine and may justify the use of vancomycin as a preoperative prophylactic antibiotic. A relative or absolute contraindication to β-lactam agents warrants careful consideration. It is not uncommon for patients to report an allergy to a wide variety of drugs, but true drug allergies are less common. If there is a documented history of an allergic response or adverse drug reaction to a β-lactam antibiotic, an alternative antibiotic such as vancomycin, clindamycin or combination therapy would be appropriate. Although there is a trend of increasing use of vancomycin as a prophylactic antibiotic, there is no evidence to support its use in such a setting.
| Current Recommendations for Prophylactic Antibiotics | ||
| Procedure | Approved | If Known (β-Lactam Allergy) |
| Cardiac & Vascular | Cefazolin or Cefuroxime |
Vancomycin or Clindamycin |
| Hip/Knee Arthroplasty | Cefazolin or Cefuroxime |
Vancomycin or Clindamycin |
| Hysterectomy | Cefotetan Cefazolin Cefoxitin Cefuroxime Ampicillin/Sulbactam |
Clindamycin + Gentamycin Clindamycin + Quinolone Clindamycin + Astreonam Metronidazole + Gentamycin Metronidazole + Quinolone Clindamycin (monotherapy) |
| Colon: Oral |
Mechanical bowel preparation + Neomycin Sulfate + Erythromycin base (or) Neomycin Sulfate + Metronidazole for 18 hours preoperatively |
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| Colon: Parenteral | Cefotetan Cefoxitin Cefazolin + metronidazole Ampicillin/Sulbactam |
Clindamycin + Gentamycin Clindamycin + Astreonam Clindamycin + Quinolone Clindamycin + Astreonam Metronidazole + Gentamycin Metronidazole + Quinolone |
In a randomized study Finkelstein et al.7 showed there was no significant difference in infection rate between the group given cefazolin and the group given vancomycin prophylactically, although among those who did develop a wound infection postoperatively, those given cefazolin were more likely to have infections caused by methicillin resistant staphylococcus aureus (MRSA). In specific patients known to be colonized with MRSA, vancomycin may be appropriate for prophylactic use. However, the mere existence of a "high" prevalence of MRSA at a given institution should not justify the use of vancomycin for prophylaxis since there is no evidence to show that the routine use of vancomycin as a preoperative prophylactic antibiotic in such a setting reduces the incidence of surgical infections. Indiscriminant use of vancomycin as a prophylactic antimicrobial will only promote the emergence of resistant strains and further compromise care, and should be condemned.
Duration of prophylactic antibiotic administration
Appropriate antibiotics, properly administered, can significantly reduce surgical site infections. To be most effective, antimicrobials must be administered within 60 minutes before incision time. Just as it is important to attain sufficient serum and tissue levels of the antibiotic at the time of incision, it is important to maintain those levels throughout the duration of the operative procedure. Accordingly, dependant upon drug half-life and other considerations, it may be appropriate to administer additional doses of the antibiotic during the operative procedure. Evidence suggests that administration of prophylactic antibiotics after wound closure is unnecessary and that continued use for more than a few hours postoperatively provides no additional benefit.4
The prolonged administration of prophylactic antibiotics serves only to foster the development of resistant bacterial strains. On a molecular level, the fibrin matrix associated with the freshly closed wound is essentially avascular and relatively impenetrable to systemic antibiotics. Unless the antibiotic is already incorporated into the meshwork of the healing wound it will have little or no effect on bacteria within that milieu. Accordingly, the American Society of Health System Pharmacists (ASHP) Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery8 recommends that "for most procedures, the duration of antimicrobial prophylaxis should be 24 hours or less."
As early as 1986, Heydemann and Nelson9 showed that, in patients undergoing hip or knee joint replacement, there was no difference in the infection rate whether cefazolin was given only intraoperatively or for 2 days, 3 days or 7 days postoperatively. Studies have shown similar findings in patients undergoing vascular, gastrointestinal or gynecologic procedures.
The American Association of Orthopaedic Surgeons (AAOS)10 has stated "the proper duration of antibiotics used in a prophylactic manner is usually short. The majority of published evidence demonstrates that continuing to administer antibiotic prophylaxis beyond wound closure is not necessary. Studies comparing single-dose prophylaxis to multiple-dose prophylaxis have not shown any benefit from the additional doses. Limiting the administration of antibiotics to within the first day after surgery promotes cost containment and limits the opportunity for antibiotic toxicity and the development of antibiotic resistance in local organisms. No evidence exists that continuing prophylactic antibiotics until all catheters and drains have been removed will lower infection rates." Their conclusion is clear: "the duration of antimicrobial use should not exceed 24 hours after the incision is made."
There is less agreement with regard to the optimal duration of antibiotics in patients undergoing cardiac surgery. The Society of Thoracic Surgeons (STS) Workforce on Evidence Based Surgery published an analysis11 of this issue. Studies cited in this review showed no significant difference in surgical site infections between patients treated with a single dose of prophylactic antibiotics and those with multiple doses over a period of 48 to 96 hours postoperatively and led to the conclusion that that "there is some evidence that single-dose prophylaxis or 24 hour prophylaxis may be as effective as 48-hour prophylaxis."
Although many cardiac patients have multiple drains and catheters in place for several days, the STS determined that "the duration of antibiotic prophylaxis should not [emphasis added] be dependent on indwelling catheters of any type" and recommended that decisions regarding the continuation of antibiotic prophylaxis not [emphasis added] be guided by the presence of indwelling catheters. Recognizing that the duration of antibiotic use is related directly to the development of resistant bacterial strains such that the optimal duration of prophylactic antibiotic use is the shortest time required to minimize the probability of surgical site infection, the workforce summarized their conclusions by stating that "there is no evidence that prophylaxis administered for longer than 48 hours is more effective than a 48-hour regimen" and that the optimal practice is that "antibiotic prophylaxis is not continued for more than 48 hours postoperatively." In fact, a 24-hour regimen or even a single preoperative dose may provide essentially the same protection with an even lower risk.
A vested interest
Physicians, hospitals, third-party payers and, most importantly, patients, with their goals and objectives aligned, have a vested interest in establishing care processes that promote the consistent practice of these established quality care measures. They are all stakeholders in a system that demands that it provide the right care at the right time to every patient every time. SCIP is an effort to achieve this goal. The resultant care guidelines are designed to reduce the incidence of surgical complications and should have the unanimous support of all healthcare professionals and their patients. Administration of an appropriate antibiotic as close to — but prior to — the time of incision as possible, and discontinued within 24 hours postoperatively (48 hours for cardiac patients) should be a routine best practice for applicable procedures.
Reference:
1. Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 1961; 50:161-8.
2. Stone HH, Hooper CA, Kolb LD, Geheber CS, Dawkins EJ. Antibiotic Prophylaxis in gastric, biliary and colonic surgery. Ann Surg 1976; 184:443-52.
3. DiPiro JT, Vallner JJ, Bowden TA, Clark BA, Sisley JF. Intraoperative serum and tissue activity of cefazolin and cefoxitin. Arch Surg 1985; 120:829-32.
4. Bratzler DW, Houck PM for the Surgical Infection Prevention Guidelines Writers Workgroup. Antimicrobial prophylaxis for surgery: An advisory statement from the national Surgical Infection Prevention project. CID 2004:381706-1715.
5. Specification Manual for National Hospital Quality Measures, Release Notes: Measure Information Form Version 2.1a. Centers for Medicare & Medicaid Services & Joint Commission on Accreditation of Healthcare Organizations. Available at: http://www.qualitynet.org/dcs/ContentServer?cid=1149703587104&pagename=QnetPublic%2FPage%2FQnetTier3&c=Page, Accessed September 27, 2006.
6. Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of Surgical Site Infection, 1999 Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. April 1999;27(2):97-132.
7. Finkelstien R, Rabino G, Masiah T, et al. Vancomcin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin resistant staphylococcal infections. J Thorac Cardiovasc Surg 2002; 123:326-32.
8. ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. Available at http://www.ashp.org/bestpractices/tg/TG_Surgical.pdf, Accessed September 28, 2006.
9. Heydemann JS, Nelson CL, Short-term preventive antibiotics. Clin Orthop Relat Res. 1986 Apr;(205):184-7.
10. Prokuski LJ. Duration of prophylactic antibiotics. AAOS Bulletin, Feb 2006. Available at: http://www.aaos.org/News/Bulletin/feb06/fline7.asp last accessed October 3, 2006
11. Edwards FH, Engelman RM, Houck P, and Shahian DM. The Society of Thoracic Surgeons Practice Guideline Series :Antibiotic Prophylaxis in Cardiac Surgery, Part I: Duration. Ann Thorac Surg 2006;81:397-404.
Compare and Prepare: Using Hospital Compare to Share Your Quality Improvement Stories
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Hospital marketers and public relations staffs in Ohio continue to receive calls from local media about their hospital’s data, and they in turn may want to get information out to hospital employees, Board of Directors, volunteers and others. Since the public data were made available late in 2004 on a provider-focused site, many stories have already been published or broadcast.
In addition to talking with the media about your hospital’s data, the Hospital Quality Alliance-CMS publication of quality data for nearly all of the nation’s hospitals is an opportunity to continue your conversation about quality improvement with many constituents, including physicians and staff, the Board of Directors, donors, and your community.
Talking about Hospital Compare as a resource
You may want to develop your own facts about how quality information impacts your hospital and the care you provide on a daily basis. The following is information about Hospital Compare and the Medicare Hospital Quality Initiative that may be helpful:
- The Hospital Quality Alliance, a group led by the American Hospital Association, the Federation of American Hospitals, and the American Association of Medical Colleges, promotes the public reporting of specific quality measures. The group members include the nation’s hospitals, CMS, consumer and employer groups, a national accrediting organization, the Agency for Healthcare Quality and Research and others.
- Hospitals nationwide have voluntarily submitted quality-of-care information on three common conditions that affect adult patients: heart attack, heart failure and pneumonia.
- This is the first time national comparison data about hospital quality have been made available directly from CMS and the Hospital Quality Alliance to consumers. Previous publications and resources have been directed to professionals.
- The quality measures include appropriate inclusions and exclusions to enable a more scientific-based, “apples to apples” comparison of different hospitals on a national basis.
- Hospital Compare is not a “top 100 hospitals” scorecard. Instead, it is a tool that can be used as the beginning of a conversation with a patient’s healthcare provider about the quality of care certain hospitals provide, what the hospitals are doing to improve, and what that means for the patient’s care.
- Hospital Compare is a dynamic resource, representing four successive calendar quarters, which is updated periodically to best meet consumers’ needs. In the future, it will include additional quality measures and will also add a patient satisfaction survey section to the Web site.
- CMS’s involvement in Hospital Compare is one component of its Hospital Quality Initiative, which in turn, is part of a national initiative to improve the quality of care in our nation’s nursing homes, home health agencies and hospitals.
You may also wish to refer more general inquiries on hospital quality to Ohio KePRO at 1-800-385-5080, the Medicare regional office or the Ohio Hospital Association.
Telling your quality improvement story
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Demonstrating system improvements and a willingness to use the data to improve care tells the community that you take this information and your responsibilities seriously. |
Remember that talking to a reporter is like talking to a member of the public or a potential patient–the information published in your local newspaper provides a resource to the readers and allows you the opportunity to tell your story.
If your hospital is working with Ohio KePRO or has participated in educational programs offered by us, you may want to tell the reporter about that as a way to demonstrate your serious commitment to quality improvement. To the extent that you can put the face of a patient or patients into your quality improvement story, it will be more appealing, have more impact, and generally gain greater media interest than a story that relies upon data alone.
If you have other examples of quality improvement efforts or systems changes that improved your quality of care, offer those to reporters inquiring about the quality data.
These “success stories” work well when you are reacting to an inquiry or call, or you can approach the media proactively to demonstrate your commitment.
If your performance on the measures is good
Be sure to tell the media why it is good. If you can tell the media what you are doing to measure and ensure good care, it will show that your institution is committed to providing high quality care to every patient, every time. Let the media know that you are using the data to do an even better job, and talk about your quality improvement efforts, including any work with Ohio KePRO.
Use good scores as an opportunity to acknowledge your staff and bolster employee morale.
This overall approach will support the importance of the Hospital Compare data and of quality improvement initiatives and will likely reinforce your hospital’s credibility.
If your performance on the measures is below average
Your hospital will gain credibility by acknowledging challenges if you can show that you are changing your systems to correct any problems. If you have recent data that show improvement, share that with the media to let them know that you are making progress – the information posted on Hospital Compare may have yet to be updated to reflect your progress. This is an opportune time to demonstrate your organization’s commitment to quality. By getting concrete feedback on your performance, you are now turning that knowledge into action.
You may also wish to point out that you voluntarily reported this information because of your commitment to quality improvement, reminding the media that reporting is not a mandatory exercise.
Demonstrating system improvements and a willingness to use the data to improve care tells the community that you take this information and your responsibilities seriously.
In recent news articles, Duke University Hospital, the VA Hospital System, Austin, Texas’s Seton Medical Center and others took this approach, acknowledging poor performance on one or more measures and describing their efforts to change. As a result, these institutions came away with a positive image, in part because they could show that they were improving.
A reminder about using Hospital Compare or the Medicare brand for marketing purposes
The quality measures listed on Hospital Compare should not be used, through advertising, marketing or public relations materials or other means of communications, to imply an endorsement by CMS or the Hospital Quality Alliance or as a form of rating or ranking by CMS or the Hospital Quality Alliance.
Reference:
Artemis March: Quality Matters, The Commonwealth Fund. Volume 19, June 2006. Online at
http://www.cmwf.org/publications/publications_show.htm?doc_id=378546
Hospital Validation: Keys to Success
By Karen S. Terlaak, RN, Quality Improvement Project Leader
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Process
- Abstraction is the individual’s primary focus OR the same person is completing the same abstraction.
- One Core Measure is abstracted at a time.
- Uncertainties are discussed prior to a decision.
- A re-review of abstraction is completed to identify missing information or discrepancies.
- Each chart is reviewed for completion prior to mailing to CDAC.
Training
- The abstractor is well trained.
- The abstractor is current on quarterly changes and updates.
- Multiple resources are used: Vendor tool, Specifications Manual for National Hospital Quality Measures, QualityNet Quest.
- The Case Detail Report is used as a learning tool.
Some of our “Best Practice” hospitals’ processes are unique to their own facility. Their individual methods are highlighted below, with their permission.
Kettering Medical Center:
- A Documentation Specialist, who is an RN, abstracts while the patient is in the hospital.
- The Clinical Outcomes Specialist, also an RN, re-abstracts, examining for any variance.
- Clinical Outcomes Managers then review charts to identify opportunity for improvement.
The Toledo Hospital:
- An RN abstracts all records and takes detailed notes. For records not meeting criteria, a second person reviews the records and notes—an RN for AMI and HF and a data analyst for PN.
Bay Park Community Hospital:
- Collaboration between the Nursing (their abstractor is a RN) and Pharmacy staff results in improved documentation and consistency in data abstraction.
- Notes are taken during the abstraction process.
Cuyahoga Falls General Hospital:
- One chart is abstracted at a time. The data is then entered into the computer.
- Notes are taken on the back of admission slips for each patient to identify needed data.
Highland District Hospital:
- A forcing function has been added to their data entry program, which prevents completing the abstraction process until all the measures have been addressed.
Blanchard Valley Regional Health Center:
- Reminders are provided to physicians regarding required data elements via notes in the chart or by phone calls to the office.
Barnesville Hospital:
- Work sheets are placed on chart reminding the physician that the chart is being abstracted.
- Laminated reminders for the AMI & HF patient charts are used to prompt physician documentation.
- All charts are abstracted concurrently.
McCullough-Hyde Memorial Hospital:
- Measures that fail validation are double-checked by the CART Administrator and the Department Manager where the patient resided.
Mercy Medical Center:
- Quality Improvement staff work with departments to share findings and improvement methodologies when data are missing.
The University Hospital of Cincinnati:
- Established a collaborative inter-rater reliability program with physicians, specific Nurse Manager champions, and Coding staff in order to re-review a random sampling of cases prior to data submission. Identified abstracting errors are used for further training for abstraction staff. Identified coding errors are returned to Medical Records staff.
- Two physician champions review cases, in-service the QMS and Coding staff, and work with other physicians on appropriate documentation requirements relative to these core measures.
University Medical Center—Toledo:
- Use an Excel spreadsheet of core measures to look for patterns of medical practice that do not demonstrate measure compliance.
- Once non-compliant cause is identified, improvement activities are initiated.
Special thanks to Alliance Community Hospital, Fairfield Medical Center, Defiance Regional Medical Center, Memorial Hospital of Union County, and the aforementioned facilities for taking the time and effort to share their methods of success to benefit others.
Reference:
For additional information regarding the above methods, please contact Karen Terlaak at Ohio KePRO: 216-447-9604 Ext. 2142,or KTerlaak@ohqio.sdps.org.
Project Assists Implementation of Health Information Technology
By Patricia Nelson, RN, Quality Improvement Project Coordinator, and Rita Bowling, MSN, MBA, CPHQ, Director, Acute Care Services
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All participating hospitals received their survey results earlier this year from their Ohio KePRO Project Leader. After a period of planning and implementing improvements, hospitals will retake the survey to see if they have overcome some of their barriers and are more likely to have a successful implementation.
CPOE
The readiness assessment for CPOE is divided into five categories: Strategy, Structure (Culture), Technology, Management Control Processes, and Clinical IT Project Management. The results of the first assessment survey show that the areas for greatest improvement are Structure and Culture. Questions in this section deal with whether the hospital understands and has planned for the substantial commitment of time and money to implement this technology. Questions of culture and interaction with the medical staff are addressed as well as previous success in working with physicians and staff in dealing with variation in processes throughout the hospital.
Management Control Processes is also an area of many barriers to success. This section addresses the culture of the organization in such issues as innovation, communication, blame, tolerance and their capacity for change. In contrast, higher scores were seen in the Technology and Project Management categories. Many hospitals have already chosen the vendor or specific system they want to install and the IT Department is ready and capable of handling the installation of the system. This assessment clearly points out that implementation of CPOE goes far beyond the technology itself and will be more successfully used by all staff if the hospital addresses these other issues in their planning process.
Barcoding
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The use of barcoding at the point of care enables staff to improve upon medication safety and appropriate patient identification. |
The greatest area of opportunity for improvement in this process was in the section on Patient Education. This area is frequently seen as something to think about at the end of the implementation process, but can clearly allow for a more patient centered process if addressed early in the planning. Patients can play a vital role in preventing errors and should be part of the process.
Another area for improvement is in addressing Environmental Factors such as lighting, work spaces, noise, interruptions, etc. These issues can have a great impact on the success of technology implementation. The highest scores were obtained in the areas of drug orders and standardization of processes involving drugs. This could indicate the high level of assessment that has occurred in deciding that barcoding would be an answer to patient safety issues and medication errors.
Telemedicine
The Telemedicine assessment survey can be used to help guide project design or to assess a program that has been started but may not be utilized to its full potential. Questions are geared to assessment of your facility, your professional staff and the community. They address such issues as: administrative culture, willingness of physician staff to participate, how barriers in the community are overcome, continuing education experiences and equipment resources.
If you wish to see these surveys or want further information, please contact your Ohio KePRO project leader.
The hospitals participating in this project are now using the information from their respective baseline report in developing an action plan to address areas for readiness improvement. Ohio KePRO project leaders are working with SIOC teams to expand action plans to include specific interventions to overcome barriers found. Examples of these interventions include:
- Board of Directors support
- SIOC team composition that includes:
- Active senior leader
- Physician champion with wide physician participation in system design
- Frequent communication about the project in multiple ways
- Improve computer literacy by providing staff opportunities for practice through the use of e-mail, intranet and the Internet.
o Active senior leadership
o Frontline physicians
o Frontline nursing staff
o Pharmacy
o Technical IT experts
o Vendor and equipment information
o Patient safety benefits
o Staff training
o Projected implementation
o Support during roll-out
o References about success stories (see links below)
These hospitals will complete the appropriate readiness survey again in the summer of 2007. They are also encouraged to adopt concurrent monitoring of their survey answers as a means to ensure change in their readiness toward a successful technology implementation.
References and Resources
- Safety Scan | Diana Olsen | http://Health-care-it.advanceweb.com/common/editorial/editorial.aspx?CC=63202
- Electronic Health Record Implementation Strategies | Allison Foley, MD | http://Health-care-it.advanceweb.com/common/editorial/editorial.aspx?CC=66776
- Health Information Links |http://Health-care-it.advanceweb.com/common/editorial/editorial.aspx?CC=678
- Wake Forest Case Study | HealthLeaders; February 2004 | www.HealthLeaders.com/news
- Clinical Information Systems | Where are we today, where do we need to be and how do we get there? | Straight Talk | Modern Healthcare and PricewaterhouseCoopers | Charles S. Lauer | http://www.pwchealth.com/cgi-local/printpage.cgi?url=st200201.html
- Creating a Technologically Superior Organization | Helen V. Thompson, MS | http://Health-care-it.advanceweb.com/common/editorial/editorial.aspx?CC=1152
- If You Build It (Right) They Will Come: The Physician–Friendly CPOE System | By John Fitzpatrick, M.D., and Jason Soonju Koh | http://www.healthmgttech.com/archives/0105/0105if_you_build.htm
- Children’s Hospital, Pittsburgh successful CPOE implementation | Safe Way,s an article by Mark Hagland, August 2004 | Children’s took on CPOE to get the most for its safety dollar | www.healthcare-informatics.com
Acute Care Services Team
Ronald A. Savrin, MD, MBA
Rita Bowling, RN, MSN, MBA, CPHQ
Jennifer Bitterman, RHIA, MBA
Ann Fitzsimons, RN, MBA
Dawn Knopp, RN, BSN, CPHQ
Donna Moore, RN, MBA, CPHQ
Patricia Nelson, RN
Liz Simpson
Barbara G. Stiebeling, RN, MSN
Karen S. Terlaak, RN
Mona D. Wendell, RN, BA, MBA
Medical Editor: Ronald A. Savrin, MD, MBA
Editor: Robert A. Feigenbaum, MS
Associate Editor: Barbara G. Stiebeling, RN, MSN
To Contact Us
E-Mail: hospital@ohqio.sdps.org
Provider QIC Line: 1.800.385.5080
Rock Run Center, Suite 100 · 5700 Lombardo Center Drive · Seven Hills, OH 44131 · www.ohiokepro.com
Ohio KePRO, the Medicare Quality Improvement Organization (QIO) for Ohio, is working with committed hospitals, nursing homes, home health agencies, and physicians throughout the state who are dedicated to the common goal of Continuous Quality Improvement for Medicare beneficiaries.
Publication No. 8031-OH-017-11/2006. This material was prepared by Ohio KePRO, the Medicare Quality Improvement Organization for Ohio, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
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