CMS issues guidance on emergency care
One month after The New York Times reported that a specialty hospital had to call 911 because no physician was available to care for a patient who had developed breathing problems, CMS issued guidance this week clarifying the responsibility of hospitals to provide emergency services if they participate in the Medicare program.
The guidance makes it clear that nearly all hospitals including specialty hospitals and others without emergency departments must be able to evaluate persons with emergencies, provide initialtreatment, and refer or transfer these individuals when appropriate. The regulation does not apply to critical access hospitals.
In April, The New York Times reported that a 44-year-old man developed breathing problems after spine surgery. No physician was working at the hospital at the time the staff recognized he was in trouble. Staff called 911, and he was taken to a nearby full-service hospital, where he died a short time later. The incident happened at a small hospital that is owned and run by doctors - one of roughly 140 such hospitals around the country, the Times reported.
The CMS guidance was issued in a survey and certification letter. Survey and Certification letters guide state agency surveyors in determining whether hospitals meet all conditions of participation (CoP) required to participate in the Medicare program.
The letter said hospitals must have appropriate policies and procedures in place to address individuals' emergency care needs 24 hours per day,seven days per week.
"Any hospital participating in Medicare, regardless of the type of hospital and apart from whether the hospital has an emergency department must have the capability to provide basic emergency care interventions." Leslie V. Norwalk, acting administrator of CMS said in a press release.
The letter also says that CoPs do not allow a hospital to rely upon 911 services as a substitute for the hospital's own ability to provide these services.
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Pennsylvania pioneers mandatory near-miss reporting for hospitals
Near-miss reporting provides rich information that could potentially reduce adverse events, yet only one state in the country, Pennsylvania, requires it. And even though most hospitals encourage staff to alert them to close calls, many clinicians are loath to do so for fear of reprisal.
"I still think there's a reluctance, because they're saying, 'Well, nothing bad happened, so why do we need to report them?' " says Karen Griffin, RN, MSN, CNAA, a director of the American Academy of Ambulatory Care Nursing.
There are plenty of reasons to report near-misses, according to the Pennsylvania Patient Safety Authority.
"The causes of adverse events are generally the same things that cause near-misses, so ideally, if you're looking at reports of near-misses, you're looking at the causes of those things to prevent adverse events before they actually occur," says Bill Marella, project manager of the Pennsylvania Patient Safety Reporting System. Pennsylvania has required all healthcare organizations to report near-misses since June 2004. The names of the clinicians and patients involved are kept anonymous.
The organization also distributes articles and advisories to Pennsylvania hospitals and ambulatory surgical facilities and makes them available on its Web site. The articles feature serious eventsand incidents (i.e., near-misses) that have actually occurred in Pennsylvania facilities.
Guidelines are offered to help hospitals implement change in their facilities and prevent further occurrences.The authority recently queried patient safety officers about how many changes they had implemented in their facilities as result of reading the advisories. The response: More than 500 policy and process modifications had been made by the patient safety officers after reading the authority's articles.
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WHO unveils solutions to protect patients
The World Health Organization (WHO) this week unveiled nine solutions to prevent healthcare errors that harm millions of people daily throughout the world.
The recommendations of the project, titled Patient Safety Solutions, address the following issues:
* look-alike, sound-alike medication names
* correct patient identification
* handoff communications
* correct procedure at the correct body site
* control of concentrated electrolyte solutions
* medication accuracy
* catheter and tubing misconnections
* needle reuse and injection device safety
* hand hygiene
In 2005, the WHO designated The Joint Commission and Joint Commission International as its collaborating center on Patient Safety Solutions. The Joint Commission International Center for Patient Safety did an extensive field review that garnered feedback from health care providers, practitioners, and other experts from more than 100 countries.
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Hospital offers hotel-style service
As part of its emphasis on patient and family-centered care, a Manhasset, NY, hospital has renovated its medical-surgical unit to offers rooms that are large, and airy, with adjustable beds, comfortable seating areas for family members, and private bathrooms, according to Newsday.
Consumers are demanding state-of-the art care that is more patient-friendly, Michael Dowling, chief executive of North Shore-Long Island Jewish Health System, told the newspaper. "We've got to stay ahead and deliver the kind of care people want," he said.
The health system has also upgraded its cardiothoracic unit to lower the anxiety level of patients: Each patient has a single room with a door and no curtains, Newsday reported. Each room is twice as big as the typical intensive care room so family members can sit with their loved ones.
"It's bringing state-of-the-art care to critical care and enabling families to be a bigger part of things," Carol DiNubila, a cardiothoracic nurse, told the paper. "It's very exciting."
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