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Tip of the week: Don’t underestimate the power of zero

Medical Staff Leader Connection, August 25, 2011

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Medical staffs might wonder what to do when the number zero shows up on a physician’s ongoing professional practice evaluation (OPPE) report. Is it a red flag? Is the information usable? Is that particular indicator meaningful?

There are indicators on the OPPE report for which the medical staff should expect high numbers, such as admissions, numbers of procedures, and certain core measures. In such cases, zero would raise a red flag. How a medical staff measures certain indicators (i.e., whether it measures the rate of compliance or the rate of noncompliance) may depend on where the information comes from. Medical staffs pull OPPE data from the medical records department, the laboratory, the quality assurance department, the ED, and various other departments throughout the hospital. The ED may measure how many myocardial infarction patients get aspirin on arrival or how many do not receive aspirin on arrival, and the OPPE report will reflect that choice.

Zero can tell you about a physician’s activity as long as two conditions are met, according to “No data is useful data,” an article written by Robert J. Marder, MD, CMSL, vice president of The Greeley Company, a division of HCPro, Inc., in Marblehead, MA. Those two conditions are that a physician had an opportunity to perform a procedure or activity, and while the physician was performing a procedure or activity, there was an opportunity for an event to occur.

The events or activities that may result in a score of zero can be related to a specific privilege or to a physician’s overall participation in patient care, explained Marder.

The example above of emergency physicians giving aspirin to myocardial infarction patients is a privilege-specific indicator because only certain types of physicians treat myocardial infarction patients. This indicator should not appear on the feedback report for physicians who do not treat myocardial infarction patients, and if it does, it should read n/a (not applicable).

Indicators related to a physician’s overall participation in patient care include blood use, medical records completion, history and physical examination completion, and adherence to infection control procedures. These indicators apply to almost all physicians (some specialties don’t order blood), and medical staffs want to see 100% compliance with these protocols (or zero breaches, depending on how the medical staff chooses to measure).

This week's tip is from Medical Staff Briefing.

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