Quality

On Dec. 15 at a White House Roundtable, the U.S. Department of Health and Human Services (HHS) unveiled its Sustainable and Climate Resilient Health Care Facilities Initiative [PDF], with a new guide to help health facilities enhance their resilience to extreme weather events. Part of the President’s Climate Action Plan, the guide offers a planning framework, case studies of responses to historical extreme weather events, and emerging practices for improving infrastructure resilience. A best practices document and accompanying web-based toolkit are planned for 2015.

HHS considers climate change one of the top public health challenges of our time, and hospitals are an essential part of the country’s responsiveness to the negative impacts of heat waves, floods, wildfires, worsened air pollution, and extreme storms and their aftermath. Damage to hospitals themselves is another key issue, one that was dramatically illustrated by the ravages of Hurricane Katrina in 2005. Climate change is expected to increase the severity of some extreme weather and could alter the range and intensity of infectious diseases, according to the HHS report.

Steps for building a climate-resilient healthcare sector, outlined in the new guide, start with raising awareness among health professionals about climate-related health impacts, particular issues in their regions, and specific resilience strategies. The guide also recommends assessing the vulnerabilities of health facilities, communities, and at-risk populations; building partnerships with energy, transportation, and other sectors of the community; and developing robust communication channels.

On Dec. 15 at a White House Roundtable, the U.S. Department of Health and Human Services (HHS) unveiled its Sustainable and Climate Resilient Health Care Facilities Initiative [PDF], with a new guide to help health facilities enhance their resilience to extreme weather events. Part of the President’s Climate Action Plan, the guide offers a planning framework, case studies of responses to historical extreme weather events, and emerging practices for improving infrastructure resilience. A best practices document and accompanying web-based toolkit are planned for 2015.

HHS considers climate change one of the top public health challenges of our time, and hospitals are an essential part of the country’s responsiveness to the negative impacts of heat waves, floods, wildfires, worsened air pollution, and extreme storms and their aftermath. Damage to hospitals themselves is another key issue, one that was dramatically illustrated by the ravages of Hurricane Katrina in 2005. Climate change is expected to increase the severity of some extreme weather and could alter the range and intensity of infectious diseases, according to the HHS report.

Steps for building a climate-resilient healthcare sector, outlined in the new guide, start with raising awareness among health professionals about climate-related health impacts, particular issues in their regions, and specific resilience strategies. The guide also recommends assessing the vulnerabilities of health facilities, communities, and at-risk populations; building partnerships with energy, transportation, and other sectors of the community; and developing robust communication channels.

On Dec. 15 at a White House Roundtable, the U.S. Department of Health and Human Services (HHS) unveiled its Sustainable and Climate Resilient Health Care Facilities Initiative [PDF], with a new guide to help health facilities enhance their resilience to extreme weather events. Part of the President’s Climate Action Plan, the guide offers a planning framework, case studies of responses to historical extreme weather events, and emerging practices for improving infrastructure resilience. A best practices document and accompanying web-based toolkit are planned for 2015.

HHS considers climate change one of the top public health challenges of our time, and hospitals are an essential part of the country’s responsiveness to the negative impacts of heat waves, floods, wildfires, worsened air pollution, and extreme storms and their aftermath. Damage to hospitals themselves is another key issue, one that was dramatically illustrated by the ravages of Hurricane Katrina in 2005. Climate change is expected to increase the severity of some extreme weather and could alter the range and intensity of infectious diseases, according to the HHS report.

Steps for building a climate-resilient healthcare sector, outlined in the new guide, start with raising awareness among health professionals about climate-related health impacts, particular issues in their regions, and specific resilience strategies. The guide also recommends assessing the vulnerabilities of health facilities, communities, and at-risk populations; building partnerships with energy, transportation, and other sectors of the community; and developing robust communication channels.

Citing a lack of accepted benchmarks for quality improvement in pediatric hospital care, researchers described in Pediatrics their process of establishing benchmarks for the treatment of asthma, bronchiolitis, and pneumonia, three common conditions treated by pediatric hospitalists that together amount to 10% of all pediatric hospital admissions. Despite the existence of evidence-based guidelines for these conditions, there is wide variation in adherence by U.S. hospitals.

The researchers, led by Kavita Parikh, MD, MSHM, a pediatric hospitalist at Children’s National Health System and assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences, both in Washington, D.C., measured 2012 performance in freestanding children’s hospitals using recognized clinical quality indicators and data reported to the Pediatric Health Information System of the Children’s Hospital Association to construct what they call “achievable benchmarks of care,” or ABC. The ABCs are calculated from performance averages at the high-performing children’s hospitals.

“In other words, we identified the best measured performance for each quality indicator, based on actual data reflecting the intricacies of real-world pediatric care,” Dr. Parikh recently told Medscape.

The ABCs also emphasize avoiding the overuse of certain treatments that have a potential risk for adverse events. “High performers did not overutilize nonrecommended services,” Dr. Kavikh says.

Citing a lack of accepted benchmarks for quality improvement in pediatric hospital care, researchers described in Pediatrics their process of establishing benchmarks for the treatment of asthma, bronchiolitis, and pneumonia, three common conditions treated by pediatric hospitalists that together amount to 10% of all pediatric hospital admissions. Despite the existence of evidence-based guidelines for these conditions, there is wide variation in adherence by U.S. hospitals.

The researchers, led by Kavita Parikh, MD, MSHM, a pediatric hospitalist at Children’s National Health System and assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences, both in Washington, D.C., measured 2012 performance in freestanding children’s hospitals using recognized clinical quality indicators and data reported to the Pediatric Health Information System of the Children’s Hospital Association to construct what they call “achievable benchmarks of care,” or ABC. The ABCs are calculated from performance averages at the high-performing children’s hospitals.

“In other words, we identified the best measured performance for each quality indicator, based on actual data reflecting the intricacies of real-world pediatric care,” Dr. Parikh recently told Medscape.

The ABCs also emphasize avoiding the overuse of certain treatments that have a potential risk for adverse events. “High performers did not overutilize nonrecommended services,” Dr. Kavikh says.

Citing a lack of accepted benchmarks for quality improvement in pediatric hospital care, researchers described in Pediatrics their process of establishing benchmarks for the treatment of asthma, bronchiolitis, and pneumonia, three common conditions treated by pediatric hospitalists that together amount to 10% of all pediatric hospital admissions. Despite the existence of evidence-based guidelines for these conditions, there is wide variation in adherence by U.S. hospitals.

The researchers, led by Kavita Parikh, MD, MSHM, a pediatric hospitalist at Children’s National Health System and assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences, both in Washington, D.C., measured 2012 performance in freestanding children’s hospitals using recognized clinical quality indicators and data reported to the Pediatric Health Information System of the Children’s Hospital Association to construct what they call “achievable benchmarks of care,” or ABC. The ABCs are calculated from performance averages at the high-performing children’s hospitals.

“In other words, we identified the best measured performance for each quality indicator, based on actual data reflecting the intricacies of real-world pediatric care,” Dr. Parikh recently told Medscape.

The ABCs also emphasize avoiding the overuse of certain treatments that have a potential risk for adverse events. “High performers did not overutilize nonrecommended services,” Dr. Kavikh says.

Estimated total number of saved lives from 2011 to 2013 as a result of reductions in the incidence of hospital-acquired conditions (HACs) in U.S. hospitals, compared with HAC rates in 2010, according to the U.S. Department of Health and Human Services (HHS). In 1999, the Institute of Medicine estimated that as many as 98,000 deaths per year resulted from avoidable hospital errors, such as central line-associated blood stream infections, adverse drug events, falls, and bedsores. Rates of avoidable medical errors fell by 17% between 2010 and 2013, (HHS) reports, which resulted in 1.3 million fewer HACs than expected and overall savings of $12 billion for the healthcare system.

Estimated total number of saved lives from 2011 to 2013 as a result of reductions in the incidence of hospital-acquired conditions (HACs) in U.S. hospitals, compared with HAC rates in 2010, according to the U.S. Department of Health and Human Services (HHS). In 1999, the Institute of Medicine estimated that as many as 98,000 deaths per year resulted from avoidable hospital errors, such as central line-associated blood stream infections, adverse drug events, falls, and bedsores. Rates of avoidable medical errors fell by 17% between 2010 and 2013, (HHS) reports, which resulted in 1.3 million fewer HACs than expected and overall savings of $12 billion for the healthcare system.

Estimated total number of saved lives from 2011 to 2013 as a result of reductions in the incidence of hospital-acquired conditions (HACs) in U.S. hospitals, compared with HAC rates in 2010, according to the U.S. Department of Health and Human Services (HHS). In 1999, the Institute of Medicine estimated that as many as 98,000 deaths per year resulted from avoidable hospital errors, such as central line-associated blood stream infections, adverse drug events, falls, and bedsores. Rates of avoidable medical errors fell by 17% between 2010 and 2013, (HHS) reports, which resulted in 1.3 million fewer HACs than expected and overall savings of $12 billion for the healthcare system.

Type the name Peter Pronovost into Google and try to make it past the “n” before the word “checklist” pops up. That’s because Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, is the “checklist doctor,” widely known for a five-step checklist designed to reduce the incidence of central-line infections and credited by SHM with saving thousands of lives. He was named one of the 100 Most Influential People in the World by Time magazine, and he co-authored a book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out.”

Dr. Pronovost is one of three keynote speakers slated to offer their wisdom and insights to thousands of hospitalists attending HM15, scheduled for March 29-April 1 at the Gaylord National Resort and Convention Center in National Harbor, Md.

And before you ask—yes, he smiles when people call him the “checklist guy.”

“These catheter infections, just to give you an example, they used to kill as many people as breast or prostate cancer in the U.S. This isn’t some trivial public health problem,” Dr. Pronovost says. “This is a public health problem the size of breast or prostate cancer. And we virtually eliminated it, [which is] pretty remarkable about what the potential of this approach is in healthcare. That is just one harm. We have a lot of other things to go still.”

Dr. Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, has titled his HM15 talk, “Taking Quality to the Next Level.” One of his main beliefs is that intrinsically motivated efforts are much more successful than payment carrots or sticks wielded by the Centers for Medicare and Medicaid Services (CMS).

“Hospitalists have an essential role in improving the quality and safety of care for hospitalized patients and for transitions. I would say that between quality and safety, and the patient experience as a core competency of a hospitalist role, healthcare organizations need to actively engage them, including providing support for their time to lead these efforts.”

—Dr. Pronovost

“We tap into this incredibly rich and passionate juice of improvement work,” he says of intrinsic motivation. “Whether it’s through a church or through a club, all of us have felt that when you connect to a community, the energy and the passion that that unleashes. Hospitalists have the wisdom to know what to do and how to do it right, and it’s just so much more effective when you tap into intrinsic motivation.”

His famed checklist was a great start to that, but he says more needs to be done. That work looked at eliminating a single hospital-acquired condition. Now, Dr. Pronovost has reframed the question: Can we eliminate all harms? What if hospitals listed out all harms and then gave each a checklist?

“It quickly gets to well beyond the potential of human memory, because there are about 150 things we have to do,” he says. “So I’m going to be showcasing a new app that we made that gives you real-time compliance with all those checklists. If I’m missing any one of those 150 things, there’s a red box next to the patient’s name, and all I have to go do is click on the red box and see what I’m missing.”

Dr. Pronovost sees that approach as a fundamental shift in how safety is viewed. It can’t be based on “heroism,” when someone remembers to remember something; rather, it needs to be rooted in properly designed systems that leverage technology to achieve desired results.

To look at it another way, consider a conversation Dr. Pronovost had with friends in engineering who previously worked on missions launching satellites into space.

“They said to me, ‘Peter, you guys are thinking about this backwards in healthcare. If we had to put a mission up…it can blow up for 12 reasons. It didn’t blow up for reason No. 1—call it a bloodstream infection—but it did blow up for reasons 2 through 12, do you think we’d be patting ourselves on the back [because] that No. 1 reason didn’t get us?”

In that vein, Dr. Pronovost believes that hospitalists can be a lynchpin in what he calls “change leadership.”

“Hospitalists have an essential role in improving the quality and safety of care for hospitalized patients and for transitions,” he says. “I would say that between quality and safety, and the patient experience as a core competency of a hospitalist role, healthcare organizations need to actively engage them, including providing support for their time to lead these efforts.”

Richard Quinn is a freelance writer in New Jersey.

Type the name Peter Pronovost into Google and try to make it past the “n” before the word “checklist” pops up. That’s because Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, is the “checklist doctor,” widely known for a five-step checklist designed to reduce the incidence of central-line infections and credited by SHM with saving thousands of lives. He was named one of the 100 Most Influential People in the World by Time magazine, and he co-authored a book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out.”

Dr. Pronovost is one of three keynote speakers slated to offer their wisdom and insights to thousands of hospitalists attending HM15, scheduled for March 29-April 1 at the Gaylord National Resort and Convention Center in National Harbor, Md.

And before you ask—yes, he smiles when people call him the “checklist guy.”

“These catheter infections, just to give you an example, they used to kill as many people as breast or prostate cancer in the U.S. This isn’t some trivial public health problem,” Dr. Pronovost says. “This is a public health problem the size of breast or prostate cancer. And we virtually eliminated it, [which is] pretty remarkable about what the potential of this approach is in healthcare. That is just one harm. We have a lot of other things to go still.”

Dr. Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, has titled his HM15 talk, “Taking Quality to the Next Level.” One of his main beliefs is that intrinsically motivated efforts are much more successful than payment carrots or sticks wielded by the Centers for Medicare and Medicaid Services (CMS).

“Hospitalists have an essential role in improving the quality and safety of care for hospitalized patients and for transitions. I would say that between quality and safety, and the patient experience as a core competency of a hospitalist role, healthcare organizations need to actively engage them, including providing support for their time to lead these efforts.”

—Dr. Pronovost

“We tap into this incredibly rich and passionate juice of improvement work,” he says of intrinsic motivation. “Whether it’s through a church or through a club, all of us have felt that when you connect to a community, the energy and the passion that that unleashes. Hospitalists have the wisdom to know what to do and how to do it right, and it’s just so much more effective when you tap into intrinsic motivation.”

His famed checklist was a great start to that, but he says more needs to be done. That work looked at eliminating a single hospital-acquired condition. Now, Dr. Pronovost has reframed the question: Can we eliminate all harms? What if hospitals listed out all harms and then gave each a checklist?

“It quickly gets to well beyond the potential of human memory, because there are about 150 things we have to do,” he says. “So I’m going to be showcasing a new app that we made that gives you real-time compliance with all those checklists. If I’m missing any one of those 150 things, there’s a red box next to the patient’s name, and all I have to go do is click on the red box and see what I’m missing.”

Dr. Pronovost sees that approach as a fundamental shift in how safety is viewed. It can’t be based on “heroism,” when someone remembers to remember something; rather, it needs to be rooted in properly designed systems that leverage technology to achieve desired results.

To look at it another way, consider a conversation Dr. Pronovost had with friends in engineering who previously worked on missions launching satellites into space.

“They said to me, ‘Peter, you guys are thinking about this backwards in healthcare. If we had to put a mission up…it can blow up for 12 reasons. It didn’t blow up for reason No. 1—call it a bloodstream infection—but it did blow up for reasons 2 through 12, do you think we’d be patting ourselves on the back [because] that No. 1 reason didn’t get us?”

In that vein, Dr. Pronovost believes that hospitalists can be a lynchpin in what he calls “change leadership.”

“Hospitalists have an essential role in improving the quality and safety of care for hospitalized patients and for transitions,” he says. “I would say that between quality and safety, and the patient experience as a core competency of a hospitalist role, healthcare organizations need to actively engage them, including providing support for their time to lead these efforts.”

Richard Quinn is a freelance writer in New Jersey.

Type the name Peter Pronovost into Google and try to make it past the “n” before the word “checklist” pops up. That’s because Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, is the “checklist doctor,” widely known for a five-step checklist designed to reduce the incidence of central-line infections and credited by SHM with saving thousands of lives. He was named one of the 100 Most Influential People in the World by Time magazine, and he co-authored a book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out.”

Dr. Pronovost is one of three keynote speakers slated to offer their wisdom and insights to thousands of hospitalists attending HM15, scheduled for March 29-April 1 at the Gaylord National Resort and Convention Center in National Harbor, Md.

And before you ask—yes, he smiles when people call him the “checklist guy.”

“These catheter infections, just to give you an example, they used to kill as many people as breast or prostate cancer in the U.S. This isn’t some trivial public health problem,” Dr. Pronovost says. “This is a public health problem the size of breast or prostate cancer. And we virtually eliminated it, [which is] pretty remarkable about what the potential of this approach is in healthcare. That is just one harm. We have a lot of other things to go still.”

Dr. Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, has titled his HM15 talk, “Taking Quality to the Next Level.” One of his main beliefs is that intrinsically motivated efforts are much more successful than payment carrots or sticks wielded by the Centers for Medicare and Medicaid Services (CMS).

“Hospitalists have an essential role in improving the quality and safety of care for hospitalized patients and for transitions. I would say that between quality and safety, and the patient experience as a core competency of a hospitalist role, healthcare organizations need to actively engage them, including providing support for their time to lead these efforts.”

—Dr. Pronovost

“We tap into this incredibly rich and passionate juice of improvement work,” he says of intrinsic motivation. “Whether it’s through a church or through a club, all of us have felt that when you connect to a community, the energy and the passion that that unleashes. Hospitalists have the wisdom to know what to do and how to do it right, and it’s just so much more effective when you tap into intrinsic motivation.”

His famed checklist was a great start to that, but he says more needs to be done. That work looked at eliminating a single hospital-acquired condition. Now, Dr. Pronovost has reframed the question: Can we eliminate all harms? What if hospitals listed out all harms and then gave each a checklist?

“It quickly gets to well beyond the potential of human memory, because there are about 150 things we have to do,” he says. “So I’m going to be showcasing a new app that we made that gives you real-time compliance with all those checklists. If I’m missing any one of those 150 things, there’s a red box next to the patient’s name, and all I have to go do is click on the red box and see what I’m missing.”

Dr. Pronovost sees that approach as a fundamental shift in how safety is viewed. It can’t be based on “heroism,” when someone remembers to remember something; rather, it needs to be rooted in properly designed systems that leverage technology to achieve desired results.

To look at it another way, consider a conversation Dr. Pronovost had with friends in engineering who previously worked on missions launching satellites into space.

“They said to me, ‘Peter, you guys are thinking about this backwards in healthcare. If we had to put a mission up…it can blow up for 12 reasons. It didn’t blow up for reason No. 1—call it a bloodstream infection—but it did blow up for reasons 2 through 12, do you think we’d be patting ourselves on the back [because] that No. 1 reason didn’t get us?”

In that vein, Dr. Pronovost believes that hospitalists can be a lynchpin in what he calls “change leadership.”

“Hospitalists have an essential role in improving the quality and safety of care for hospitalized patients and for transitions,” he says. “I would say that between quality and safety, and the patient experience as a core competency of a hospitalist role, healthcare organizations need to actively engage them, including providing support for their time to lead these efforts.”

Richard Quinn is a freelance writer in New Jersey.

As the hysteria about Ebola spreads, hospitalists who have been running most of the country’s ICUs will find themselves at the forefront of treating these patients when more of them present at our different hospitals. It is now time for America to come into the age of Ebola and treat Ebola patients in Ebola centers, in specific prefabricated buildings designed for this specific pestilence. It has been done successfully in Africa—specifically, Nigeria.

Our hospitals in North America are not designed to handle the kind of elaborate decontamination protocols that we now know Ebola requires; we lack the isolation chambers for staff decontamination and the rapid throughput for hazardous material that guarantee minimal environmental exposure before incineration that we are told is required for Ebola waste.

One thing that is clear from the Dallas, Texas Presbyterian Hospital fiasco is not only that the staff was not really prepared to receive its first Ebola patient, despite the false sense of security it was lulled into by numerous drills and reenactments, but also that this lack of preparedness was not solely a staffing or staff-related issue. Ebola was being treated as if it were MRSA, TB, or C. diff. Ebola is none of those. The stories of equipment failure and the pileup of contaminated waste should have come as no surprise. This is a situation like no other. And, not surprisingly, the hospital administration was caught unaware. It could have happened with almost any other hospital.

In Nigeria, where the infection was successfully contained, an Ebola unit was erected in just two weeks. It had a patients’ unit, decontamination unit, and an outside incineration unit. The patients also had to go through elaborate head to toe decontamination before they were released back into the community. I suggest that we look into building such units in a few major cities in this country. It needn’t take more than a few days to erect such prefabricated units in fairly isolated areas with temporary outside incineration units attached for disposal of medical waste.

This effort would afford healthcare workers the ability to don full hazmat gear, including boots, and, after contact with Ebola patients at the end of the day, to go into decontamination chambers, wade with boots through chlorinated pools to reduce contamination, and rinse gloved hands in chlorinated water before commencing ‘directly observed’ degowning. This protocol cannot be effectively performed in our regular U.S. hospitals the way they’re designed now.

The sooner we get on board with this, the better. Ebola is like no other infection we have encountered before in the U.S.

–Ngozi Achebe, MD

Hospitalist, Sunnyside (Wash.) Community Hospital

As the hysteria about Ebola spreads, hospitalists who have been running most of the country’s ICUs will find themselves at the forefront of treating these patients when more of them present at our different hospitals. It is now time for America to come into the age of Ebola and treat Ebola patients in Ebola centers, in specific prefabricated buildings designed for this specific pestilence. It has been done successfully in Africa—specifically, Nigeria.

Our hospitals in North America are not designed to handle the kind of elaborate decontamination protocols that we now know Ebola requires; we lack the isolation chambers for staff decontamination and the rapid throughput for hazardous material that guarantee minimal environmental exposure before incineration that we are told is required for Ebola waste.

One thing that is clear from the Dallas, Texas Presbyterian Hospital fiasco is not only that the staff was not really prepared to receive its first Ebola patient, despite the false sense of security it was lulled into by numerous drills and reenactments, but also that this lack of preparedness was not solely a staffing or staff-related issue. Ebola was being treated as if it were MRSA, TB, or C. diff. Ebola is none of those. The stories of equipment failure and the pileup of contaminated waste should have come as no surprise. This is a situation like no other. And, not surprisingly, the hospital administration was caught unaware. It could have happened with almost any other hospital.

In Nigeria, where the infection was successfully contained, an Ebola unit was erected in just two weeks. It had a patients’ unit, decontamination unit, and an outside incineration unit. The patients also had to go through elaborate head to toe decontamination before they were released back into the community. I suggest that we look into building such units in a few major cities in this country. It needn’t take more than a few days to erect such prefabricated units in fairly isolated areas with temporary outside incineration units attached for disposal of medical waste.

This effort would afford healthcare workers the ability to don full hazmat gear, including boots, and, after contact with Ebola patients at the end of the day, to go into decontamination chambers, wade with boots through chlorinated pools to reduce contamination, and rinse gloved hands in chlorinated water before commencing ‘directly observed’ degowning. This protocol cannot be effectively performed in our regular U.S. hospitals the way they’re designed now.

The sooner we get on board with this, the better. Ebola is like no other infection we have encountered before in the U.S.

–Ngozi Achebe, MD

Hospitalist, Sunnyside (Wash.) Community Hospital

As the hysteria about Ebola spreads, hospitalists who have been running most of the country’s ICUs will find themselves at the forefront of treating these patients when more of them present at our different hospitals. It is now time for America to come into the age of Ebola and treat Ebola patients in Ebola centers, in specific prefabricated buildings designed for this specific pestilence. It has been done successfully in Africa—specifically, Nigeria.

Our hospitals in North America are not designed to handle the kind of elaborate decontamination protocols that we now know Ebola requires; we lack the isolation chambers for staff decontamination and the rapid throughput for hazardous material that guarantee minimal environmental exposure before incineration that we are told is required for Ebola waste.

One thing that is clear from the Dallas, Texas Presbyterian Hospital fiasco is not only that the staff was not really prepared to receive its first Ebola patient, despite the false sense of security it was lulled into by numerous drills and reenactments, but also that this lack of preparedness was not solely a staffing or staff-related issue. Ebola was being treated as if it were MRSA, TB, or C. diff. Ebola is none of those. The stories of equipment failure and the pileup of contaminated waste should have come as no surprise. This is a situation like no other. And, not surprisingly, the hospital administration was caught unaware. It could have happened with almost any other hospital.

In Nigeria, where the infection was successfully contained, an Ebola unit was erected in just two weeks. It had a patients’ unit, decontamination unit, and an outside incineration unit. The patients also had to go through elaborate head to toe decontamination before they were released back into the community. I suggest that we look into building such units in a few major cities in this country. It needn’t take more than a few days to erect such prefabricated units in fairly isolated areas with temporary outside incineration units attached for disposal of medical waste.

This effort would afford healthcare workers the ability to don full hazmat gear, including boots, and, after contact with Ebola patients at the end of the day, to go into decontamination chambers, wade with boots through chlorinated pools to reduce contamination, and rinse gloved hands in chlorinated water before commencing ‘directly observed’ degowning. This protocol cannot be effectively performed in our regular U.S. hospitals the way they’re designed now.

The sooner we get on board with this, the better. Ebola is like no other infection we have encountered before in the U.S.

–Ngozi Achebe, MD

Hospitalist, Sunnyside (Wash.) Community Hospital

69%: the percentage of hospitals that had perfect compliance with the Leapfrog Group employer coalition’s safe practices for hand hygiene in its 2013 annual quality survey of 1,437 U.S. hospitals.

The CDC estimates 2 million patients annually acquire hospital-acquired infections (HAIs), often spread by contaminated hands of healthcare workers.

Urban hospitals performed better than rural hospitals in compliance with Leapfrog’s standard.

69%: the percentage of hospitals that had perfect compliance with the Leapfrog Group employer coalition’s safe practices for hand hygiene in its 2013 annual quality survey of 1,437 U.S. hospitals.

The CDC estimates 2 million patients annually acquire hospital-acquired infections (HAIs), often spread by contaminated hands of healthcare workers.

Urban hospitals performed better than rural hospitals in compliance with Leapfrog’s standard.

69%: the percentage of hospitals that had perfect compliance with the Leapfrog Group employer coalition’s safe practices for hand hygiene in its 2013 annual quality survey of 1,437 U.S. hospitals.

The CDC estimates 2 million patients annually acquire hospital-acquired infections (HAIs), often spread by contaminated hands of healthcare workers.

Urban hospitals performed better than rural hospitals in compliance with Leapfrog’s standard.

UpToDate, a leading clinical decision support resource for physicians, in July added palliative care as the newest of its 22 medical specialties. The palliative care section covers a variety of topics focused on improving symptoms and providing best quality of life for patients with serious illnesses. The new service resulted from two years of extensive collaboration by a team of 100 leading palliative care specialists from around the world, led by Harvard Medical School palliative care physicians J. Andrew Billings, MD, and Susan D. Block, MD, reviewing and grading the body of research and scientific literature on palliative care.

UpToDate, a leading clinical decision support resource for physicians, in July added palliative care as the newest of its 22 medical specialties. The palliative care section covers a variety of topics focused on improving symptoms and providing best quality of life for patients with serious illnesses. The new service resulted from two years of extensive collaboration by a team of 100 leading palliative care specialists from around the world, led by Harvard Medical School palliative care physicians J. Andrew Billings, MD, and Susan D. Block, MD, reviewing and grading the body of research and scientific literature on palliative care.

UpToDate, a leading clinical decision support resource for physicians, in July added palliative care as the newest of its 22 medical specialties. The palliative care section covers a variety of topics focused on improving symptoms and providing best quality of life for patients with serious illnesses. The new service resulted from two years of extensive collaboration by a team of 100 leading palliative care specialists from around the world, led by Harvard Medical School palliative care physicians J. Andrew Billings, MD, and Susan D. Block, MD, reviewing and grading the body of research and scientific literature on palliative care.

When the outbreak first started, and in the months that followed, Ebola virus dominated American headlines. The disease made its way from West Africa, infecting nurses in Spain and the U.S., and questions arose over how to keep healthcare providers and the public safe.

The answers to these questions are not limited to Ebola. Hospitalists and other providers work in the face of infectious disease on a routine basis, particularly in an era of widespread antibiotic resistance and emerging infections caused by such viruses as chikungunya, enterovirus D68, and MERS (Middle East Respiratory Syndrome) coronavirus.

The key to adequate preparation, says Joshua Lenchus, DO, RPh, FACP, SFHM, associate director of the Center for Patient Safety at the University of Miami-Jackson Memorial Hospital, is “information, the ability to implement relevant protocols and procedures when necessary, and, when possible, simulated exercises.”

Hospitalists can play a key role in ensuring their hospitals are prepared.

“I am constantly being reminded by my Society of Hospital Medicine colleagues that many facilities may not have an infectious disease specialist or an infectious disease program,” says Abbigail Tumpey, MPH, CHES, associate director for communications science in the CDC’s Division of Healthcare Quality Promotion.

It starts at the front door of the hospital, Tumpey and Dr. Lenchus say, with appropriate triage, screening, and isolation of potentially infectious patients.

“We diligently draft screening procedures for our frontline staff, clinic personnel, and appointment line phone operators to adequately and quickly evaluate patients so that those affected are provided the appropriate level of care,” says Dr. Lenchus, also a hospitalist and associate professor of clinical medicine and anesthesiology at the University of Miami Miller School of Medicine.

“We diligently draft screening procedures for our frontline staff, clinic personnel, and appointment line phone operators to adequately and quickly evaluate patients so that those affected are provided the appropriate level of care.”–Dr. Lenchus

These screening and management procedures originate with the CDC and state health departments and are often informed by outbreaks occurring in other locales.

“When an outbreak occurs elsewhere in the world, it is simply a matter of time before we may be faced with it in the United States,” Dr. Lenchus says, “so it behooves us to begin the research process and work with our hospital, local, and state personnel.”

The second line of defense, says Tumpey, is having in place the proper administrative controls to ensure that providers have time to don the appropriate personal protective equipment, or PPE. This means not just having access to PPE, but also the ability to put it on and take it off appropriately.

According to The New York Times, European officials investigated whether the Spanish nurse became infected with Ebola by accidentally touching her face while removing her PPE, and officials in the U.S. investigated whether the Dallas nurse who contracted Ebola while treating an infected Liberian patient also breached protocol. In Spain, investigators determined the layout of the hospital’s cramped Ebola ward could lead to accidents. In Dallas, rapidly changing conditions and poor preparation may have played a role, according to some reports. For just these kinds of reasons, Tumpey and Dr. Lenchus suggest hospitals engage in simulations and drills of outbreak events whenever possible.

“The facilities we’ve seen do this have found information they didn’t realize or a way of handling things that was surprising to them,” Tumpey says. “Certainly, there are some things that come up in those drills that highlight potential flaws and show opportunities where you can improve.”

For instance, simulations might reveal problems with the storage or disposal of PPE, lead to changes in hand hygiene locations, or highlight the need for better communication among healthcare workers.

Calm, Cool, Collected

Proper infection control procedures—hand hygiene, injection safety, appropriate cleanup, and careful waste handling—are a third line of defense in preventing the spread of infectious disease, Tumpey says.

Dr. Lenchus says that, particularly in light of diseases like Ebola, hospitalists should present concerned patients with valid information in a “calm, cool, and collected manner” that “helps allay the fear, misconception, and hysteria from generalizations, emotional responses, and anecdotal hearsay.”

These conversations present hospitalists with an opportunity to highlight the protocols, procedures, and patient safety programs in place at their institutions. They also provide a forum to discuss common cold and influenza viruses, which spread more easily than Ebola.

Of course, in the face of new rules for admissions, packed EDs, mounting metrics, and sometimes nonintuitive electronic health records, staying abreast of the latest information and catching every patient with symptoms that may or may not be related to an infectious disease may be easier said than done.

The CDC is redoubling its outreach efforts, Tumpey says, and will offer webinars and trainings for health providers.

“Our hope is that increased awareness can improve triage, early recognition, and appropriate infection control and could help for other things like MRSA, the endemic threats we face every day in U.S. healthcare facilities, even emerging diseases like MERS and carbapenem-resistant Enterobacteriaceae,” says Tumpey. “Awareness of proper infection control could help with many disease threats.”

Kelly April Tyrrell is a freelance writer in Madison, Wis.

When the outbreak first started, and in the months that followed, Ebola virus dominated American headlines. The disease made its way from West Africa, infecting nurses in Spain and the U.S., and questions arose over how to keep healthcare providers and the public safe.

The answers to these questions are not limited to Ebola. Hospitalists and other providers work in the face of infectious disease on a routine basis, particularly in an era of widespread antibiotic resistance and emerging infections caused by such viruses as chikungunya, enterovirus D68, and MERS (Middle East Respiratory Syndrome) coronavirus.

The key to adequate preparation, says Joshua Lenchus, DO, RPh, FACP, SFHM, associate director of the Center for Patient Safety at the University of Miami-Jackson Memorial Hospital, is “information, the ability to implement relevant protocols and procedures when necessary, and, when possible, simulated exercises.”

Hospitalists can play a key role in ensuring their hospitals are prepared.

“I am constantly being reminded by my Society of Hospital Medicine colleagues that many facilities may not have an infectious disease specialist or an infectious disease program,” says Abbigail Tumpey, MPH, CHES, associate director for communications science in the CDC’s Division of Healthcare Quality Promotion.

It starts at the front door of the hospital, Tumpey and Dr. Lenchus say, with appropriate triage, screening, and isolation of potentially infectious patients.

“We diligently draft screening procedures for our frontline staff, clinic personnel, and appointment line phone operators to adequately and quickly evaluate patients so that those affected are provided the appropriate level of care,” says Dr. Lenchus, also a hospitalist and associate professor of clinical medicine and anesthesiology at the University of Miami Miller School of Medicine.

“We diligently draft screening procedures for our frontline staff, clinic personnel, and appointment line phone operators to adequately and quickly evaluate patients so that those affected are provided the appropriate level of care.”–Dr. Lenchus

These screening and management procedures originate with the CDC and state health departments and are often informed by outbreaks occurring in other locales.

“When an outbreak occurs elsewhere in the world, it is simply a matter of time before we may be faced with it in the United States,” Dr. Lenchus says, “so it behooves us to begin the research process and work with our hospital, local, and state personnel.”

The second line of defense, says Tumpey, is having in place the proper administrative controls to ensure that providers have time to don the appropriate personal protective equipment, or PPE. This means not just having access to PPE, but also the ability to put it on and take it off appropriately.

According to The New York Times, European officials investigated whether the Spanish nurse became infected with Ebola by accidentally touching her face while removing her PPE, and officials in the U.S. investigated whether the Dallas nurse who contracted Ebola while treating an infected Liberian patient also breached protocol. In Spain, investigators determined the layout of the hospital’s cramped Ebola ward could lead to accidents. In Dallas, rapidly changing conditions and poor preparation may have played a role, according to some reports. For just these kinds of reasons, Tumpey and Dr. Lenchus suggest hospitals engage in simulations and drills of outbreak events whenever possible.

“The facilities we’ve seen do this have found information they didn’t realize or a way of handling things that was surprising to them,” Tumpey says. “Certainly, there are some things that come up in those drills that highlight potential flaws and show opportunities where you can improve.”

For instance, simulations might reveal problems with the storage or disposal of PPE, lead to changes in hand hygiene locations, or highlight the need for better communication among healthcare workers.

Calm, Cool, Collected

Proper infection control procedures—hand hygiene, injection safety, appropriate cleanup, and careful waste handling—are a third line of defense in preventing the spread of infectious disease, Tumpey says.

Dr. Lenchus says that, particularly in light of diseases like Ebola, hospitalists should present concerned patients with valid information in a “calm, cool, and collected manner” that “helps allay the fear, misconception, and hysteria from generalizations, emotional responses, and anecdotal hearsay.”

These conversations present hospitalists with an opportunity to highlight the protocols, procedures, and patient safety programs in place at their institutions. They also provide a forum to discuss common cold and influenza viruses, which spread more easily than Ebola.

Of course, in the face of new rules for admissions, packed EDs, mounting metrics, and sometimes nonintuitive electronic health records, staying abreast of the latest information and catching every patient with symptoms that may or may not be related to an infectious disease may be easier said than done.

The CDC is redoubling its outreach efforts, Tumpey says, and will offer webinars and trainings for health providers.

“Our hope is that increased awareness can improve triage, early recognition, and appropriate infection control and could help for other things like MRSA, the endemic threats we face every day in U.S. healthcare facilities, even emerging diseases like MERS and carbapenem-resistant Enterobacteriaceae,” says Tumpey. “Awareness of proper infection control could help with many disease threats.”

Kelly April Tyrrell is a freelance writer in Madison, Wis.

When the outbreak first started, and in the months that followed, Ebola virus dominated American headlines. The disease made its way from West Africa, infecting nurses in Spain and the U.S., and questions arose over how to keep healthcare providers and the public safe.

The answers to these questions are not limited to Ebola. Hospitalists and other providers work in the face of infectious disease on a routine basis, particularly in an era of widespread antibiotic resistance and emerging infections caused by such viruses as chikungunya, enterovirus D68, and MERS (Middle East Respiratory Syndrome) coronavirus.

The key to adequate preparation, says Joshua Lenchus, DO, RPh, FACP, SFHM, associate director of the Center for Patient Safety at the University of Miami-Jackson Memorial Hospital, is “information, the ability to implement relevant protocols and procedures when necessary, and, when possible, simulated exercises.”

Hospitalists can play a key role in ensuring their hospitals are prepared.

“I am constantly being reminded by my Society of Hospital Medicine colleagues that many facilities may not have an infectious disease specialist or an infectious disease program,” says Abbigail Tumpey, MPH, CHES, associate director for communications science in the CDC’s Division of Healthcare Quality Promotion.

It starts at the front door of the hospital, Tumpey and Dr. Lenchus say, with appropriate triage, screening, and isolation of potentially infectious patients.

“We diligently draft screening procedures for our frontline staff, clinic personnel, and appointment line phone operators to adequately and quickly evaluate patients so that those affected are provided the appropriate level of care,” says Dr. Lenchus, also a hospitalist and associate professor of clinical medicine and anesthesiology at the University of Miami Miller School of Medicine.

“We diligently draft screening procedures for our frontline staff, clinic personnel, and appointment line phone operators to adequately and quickly evaluate patients so that those affected are provided the appropriate level of care.”–Dr. Lenchus

These screening and management procedures originate with the CDC and state health departments and are often informed by outbreaks occurring in other locales.

“When an outbreak occurs elsewhere in the world, it is simply a matter of time before we may be faced with it in the United States,” Dr. Lenchus says, “so it behooves us to begin the research process and work with our hospital, local, and state personnel.”

The second line of defense, says Tumpey, is having in place the proper administrative controls to ensure that providers have time to don the appropriate personal protective equipment, or PPE. This means not just having access to PPE, but also the ability to put it on and take it off appropriately.

According to The New York Times, European officials investigated whether the Spanish nurse became infected with Ebola by accidentally touching her face while removing her PPE, and officials in the U.S. investigated whether the Dallas nurse who contracted Ebola while treating an infected Liberian patient also breached protocol. In Spain, investigators determined the layout of the hospital’s cramped Ebola ward could lead to accidents. In Dallas, rapidly changing conditions and poor preparation may have played a role, according to some reports. For just these kinds of reasons, Tumpey and Dr. Lenchus suggest hospitals engage in simulations and drills of outbreak events whenever possible.

“The facilities we’ve seen do this have found information they didn’t realize or a way of handling things that was surprising to them,” Tumpey says. “Certainly, there are some things that come up in those drills that highlight potential flaws and show opportunities where you can improve.”

For instance, simulations might reveal problems with the storage or disposal of PPE, lead to changes in hand hygiene locations, or highlight the need for better communication among healthcare workers.

Calm, Cool, Collected

Proper infection control procedures—hand hygiene, injection safety, appropriate cleanup, and careful waste handling—are a third line of defense in preventing the spread of infectious disease, Tumpey says.

Dr. Lenchus says that, particularly in light of diseases like Ebola, hospitalists should present concerned patients with valid information in a “calm, cool, and collected manner” that “helps allay the fear, misconception, and hysteria from generalizations, emotional responses, and anecdotal hearsay.”

These conversations present hospitalists with an opportunity to highlight the protocols, procedures, and patient safety programs in place at their institutions. They also provide a forum to discuss common cold and influenza viruses, which spread more easily than Ebola.

Of course, in the face of new rules for admissions, packed EDs, mounting metrics, and sometimes nonintuitive electronic health records, staying abreast of the latest information and catching every patient with symptoms that may or may not be related to an infectious disease may be easier said than done.

The CDC is redoubling its outreach efforts, Tumpey says, and will offer webinars and trainings for health providers.

“Our hope is that increased awareness can improve triage, early recognition, and appropriate infection control and could help for other things like MRSA, the endemic threats we face every day in U.S. healthcare facilities, even emerging diseases like MERS and carbapenem-resistant Enterobacteriaceae,” says Tumpey. “Awareness of proper infection control could help with many disease threats.”

Kelly April Tyrrell is a freelance writer in Madison, Wis.

Antibiotic overprescription remains a problem in the U.S. and abroad and shows no signs of slowing. A study published in the October 2014 issue of JAMA reports that nearly half of all hospitalized patients receive antibiotics, and the drugs most commonly prescribed are broad-spectrum antibiotics, which have been linked with promoting the spread of antibiotic-resistant bacteria. Based on a one-day prevalence survey of more than 11,000 patients in 183 U.S. hospitals in 2011, the study notes that half of inpatients prescribed antibiotics received two or more of them. The CDC estimates that 20% to 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate, and many of them count adverse drug reactions among their side effects .

While a growing body of evidence suggests that hospital-based antibiotic stewardship programs can optimize treatment, reduce antibacterial side effects, and save money, a study published September 2014 in JAMA says those benefits may be lost post-discharge. Results of a randomized trial of an outpatient antimicrobial stewardship intervention found that an initial 50% reduction in antibiotic prescriptions was lost when their targeted interventions ceased.

“These data suggest that audit and feedback was a vital element of this intervention and that antimicrobial stewardship requires continued, active efforts to sustain initial improvements,” says lead author Jeffrey S. Gerber, MD, PhD, CHCP, attending physician in infectious diseases at the Children’s Hospital of Philadelphia.

The federal government has taken a three-pronged approach to the problem: a report from the President’s Council of Advisors on Science and Technology with recommendations for monitoring superbugs and slowing their spread; an executive order issued by President Obama on September 18, 2014 with a commitment to “accelerate scientific research and facilitate the development of new antibacterial drugs;” and the creation of a national task force charged with designing a national strategy to combat antibiotic overuse by February 2015.

The President’s Council report notes that bacteria are becoming resistant to antibiotics in large part because these drugs are overprescribed to patients and overused in animals raised for food. The report recommends the CDC develop rules by 2017 requiring hospitals and nursing homes to implement best practices for antibiotic use.

Antibiotic overprescription remains a problem in the U.S. and abroad and shows no signs of slowing. A study published in the October 2014 issue of JAMA reports that nearly half of all hospitalized patients receive antibiotics, and the drugs most commonly prescribed are broad-spectrum antibiotics, which have been linked with promoting the spread of antibiotic-resistant bacteria. Based on a one-day prevalence survey of more than 11,000 patients in 183 U.S. hospitals in 2011, the study notes that half of inpatients prescribed antibiotics received two or more of them. The CDC estimates that 20% to 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate, and many of them count adverse drug reactions among their side effects .

While a growing body of evidence suggests that hospital-based antibiotic stewardship programs can optimize treatment, reduce antibacterial side effects, and save money, a study published September 2014 in JAMA says those benefits may be lost post-discharge. Results of a randomized trial of an outpatient antimicrobial stewardship intervention found that an initial 50% reduction in antibiotic prescriptions was lost when their targeted interventions ceased.

“These data suggest that audit and feedback was a vital element of this intervention and that antimicrobial stewardship requires continued, active efforts to sustain initial improvements,” says lead author Jeffrey S. Gerber, MD, PhD, CHCP, attending physician in infectious diseases at the Children’s Hospital of Philadelphia.

The federal government has taken a three-pronged approach to the problem: a report from the President’s Council of Advisors on Science and Technology with recommendations for monitoring superbugs and slowing their spread; an executive order issued by President Obama on September 18, 2014 with a commitment to “accelerate scientific research and facilitate the development of new antibacterial drugs;” and the creation of a national task force charged with designing a national strategy to combat antibiotic overuse by February 2015.

The President’s Council report notes that bacteria are becoming resistant to antibiotics in large part because these drugs are overprescribed to patients and overused in animals raised for food. The report recommends the CDC develop rules by 2017 requiring hospitals and nursing homes to implement best practices for antibiotic use.

Antibiotic overprescription remains a problem in the U.S. and abroad and shows no signs of slowing. A study published in the October 2014 issue of JAMA reports that nearly half of all hospitalized patients receive antibiotics, and the drugs most commonly prescribed are broad-spectrum antibiotics, which have been linked with promoting the spread of antibiotic-resistant bacteria. Based on a one-day prevalence survey of more than 11,000 patients in 183 U.S. hospitals in 2011, the study notes that half of inpatients prescribed antibiotics received two or more of them. The CDC estimates that 20% to 50% of all antibiotics prescribed in U.S. hospitals are either unnecessary or inappropriate, and many of them count adverse drug reactions among their side effects .

While a growing body of evidence suggests that hospital-based antibiotic stewardship programs can optimize treatment, reduce antibacterial side effects, and save money, a study published September 2014 in JAMA says those benefits may be lost post-discharge. Results of a randomized trial of an outpatient antimicrobial stewardship intervention found that an initial 50% reduction in antibiotic prescriptions was lost when their targeted interventions ceased.

“These data suggest that audit and feedback was a vital element of this intervention and that antimicrobial stewardship requires continued, active efforts to sustain initial improvements,” says lead author Jeffrey S. Gerber, MD, PhD, CHCP, attending physician in infectious diseases at the Children’s Hospital of Philadelphia.

The federal government has taken a three-pronged approach to the problem: a report from the President’s Council of Advisors on Science and Technology with recommendations for monitoring superbugs and slowing their spread; an executive order issued by President Obama on September 18, 2014 with a commitment to “accelerate scientific research and facilitate the development of new antibacterial drugs;” and the creation of a national task force charged with designing a national strategy to combat antibiotic overuse by February 2015.

The President’s Council report notes that bacteria are becoming resistant to antibiotics in large part because these drugs are overprescribed to patients and overused in animals raised for food. The report recommends the CDC develop rules by 2017 requiring hospitals and nursing homes to implement best practices for antibiotic use.