From the July 2016 issue of HealthCare Business News magazine
By: Jill Rathbun
On May 25, the Centers for Medicare and Medicaid Services (CMS) announced the creation of a new network to focus on helping hospitals to advance their efforts in patient safety.
The Hospital Improvement and Innovation Networks (HIINs) will continue the good work started by the Hospital Engagement Networks (HENs) under the Partnership for Patients initiative. These organizations will tap into the deep experience, capabilities and impact of QIOs, hospital associations, hospital systems and national hospital affinity organizations with extensive experience in hospital quality improvement. The HIINs will engage and support the nation’s hospitals, patients and their caregivers in work to implement and spread well-tested, evidence-based best practices in patient safety. CMS has issued a request for proposal to those who would like to apply to operate one of the networks.
After seeing results from its efforts in support of the Partnership for Patients, specifically a reduction of hospital-acquired conditions of 17 percent over a four-year period from 2010 to 2014, CMS is looking to expand these efforts even further with these new networks. The Partnership for Patients aims to engage 100 percent of the nation’s acute care medical centers participating in making hospital care safer, more reliable and less costly through the achievement of two goals:
• Making Care Safer.
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Keep patients from getting injured or sicker. Decrease preventable hospital-acquired conditions by 40 percent compared to 2010.
• Improving Care Transitions.
Help patients heal without complications. Decrease preventable complications during a transition from one care setting to another so that all hospital readmissions would be reduced by 20 percent compared to 2010. One of the hospital-acquired conditions that these HIINs will focus on is a reduction in Central Line-Associated Bloodstream Infections, known as CLABSI, in our nation’s hospitals. The number of CLABSIs a hospital has is a measure of quality in the Hospital Value-based Purchasing Program and in the Hospital-Acquired Conditions Reduction Program.
CLABSIs can be prevented through proper insertion techniques and management of the central line. CDC’s Healthcare Infection Control Practices Advisory Committee has put out guidelines for the prevention of intravascular catheter-related infections. These guidelines can be found at http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf. The Joint Commission has also put out resources for hospitals, including a monograph of various materials regarding the prevention of CLABSIs that can be found at: https://www.jointcommission.org/assets/1/18/CLABSI_Monograph.pdf. Both of these resources talk about the appropriate use of ultrasound in the placement of central lines and how adding this as an element of a hospital’s protocol may help in the reduction of CLABSIs.
So how do hospitals get started with adding the use of ultrasound to guide central line placements? One way is the five-point bundle for the placement of central lines endorsed by the Institute for Healthcare Improvement (IHI) and add a sixth point, ultrasound guidance for line placement. The addition of this sixth point, which the AHRQ and NICE recommend to reduce mechanical complications, is a unique and significant contribution to onsite institutional training programs regarding central line placement. Research has shown that, by using ultrasound guidance for central line placements, the risk for cannulation failure, arterial puncture and other insertion complications is decreased.
About the author: Jill Rathbun is managing partner at Galileo Consulting Group in Arlington, Virginia. She will be commenting for HealthCare Business News on issues of interest to health care professionals.