"Background and objective: Wearing of gloves reduces transmission of organisms by healthcare workers’ hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when appropriate and whether hand hygiene compliance differed when gloves were worn.

Participants and setting: Healthcare workers in 56 medical or care of the elderly wards and intensive care units in 15 hospitals across England and Wales.

Methods: We observed hand hygiene and glove usage (7,578 moments for hand hygiene) during 249 one-hour sessions. Observers also recorded whether gloves were or were not worn for individual contacts.

Results: Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of 3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was 50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54–0.79]; P ! .0001).

Conclusion: The rate of glove usage is lower than previously reported. Gloves are often worn when not indicated and vice versa. The rate of compliance with hand hygiene was significantly lower when gloves were worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene."

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"Introduction: The role of ICU design and particularly single-patient rooms in decreasing bacterial transmission between ICU patients has been debated. A recent change in our ICU allowed further investigation.

Methods: Pre-move ICU-A and pre-move ICU-B were open-plan units. In March 2007, ICU-A moved to singlepatient rooms (post-move ICU-A). ICU-B remained unchanged (post-move ICU-B). The same physicians cover both ICUs. Cultures of specified resistant organisms in surveillance or clinical cultures from consecutive patients staying >48 hours were compared for the different ICUs and periods to assess the effect of ICU design on acquisition of resistant organisms.

Results: Data were collected for 62, 62, 44 and 39 patients from pre-move ICU-A, post-move ICU-A, pre-move ICUB and post-move ICU-B, respectively. Fewer post-move ICU-A patients acquired resistant organisms (3/62, 5%) compared with post-move ICU-B patients (7/39, 18%; P = 0.043, P = 0.011 using survival analysis) or pre-move ICUA patients (14/62, 23%; P = 0.004, P = 0.012 on survival analysis). Only the admission period was significant for acquisition of resistant organisms comparing pre-move ICU-A with post-move ICU-A (hazard ratio = 5.18, 95% confidence interval = 1.03 to 16.06; P = 0.025). More antibiotic-free days were recorded in post-move ICU-A (median = 3, interquartile range = 0 to 5) versus post-move ICU-B (median = 0, interquartile range = 0 to 4; P = 0.070) or pre-move ICU-A (median = 0, interquartile range = 0 to 4; P = 0.017). Adequate hand hygiene was observed on 140/242 (58%) occasions in post-move ICU-A versus 23/66 (35%) occasions in post-move ICU-B (P < 0.001).

Conclusions: Improved ICU design, and particularly use of single-patient rooms, decreases acquisition of resistant bacteria and antibiotic use. This observation should be considered in future ICU design."

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"An emerging category of hospital quality initiatives, comparable to preventing medical errors and improving quality and patient safety, could be labeled “waste management” or “waste reduction.” "Waste" in this sense refers not to biohazardous substances in need of disposal, but to the overuse of medical resources—such as lab tests and pharmaceuticals—when they are not helpful to a patient's medical management."

"If patients are getting CAT scans they don't really need or an extra day of telemetry because we don't have criteria for who should be on telemetry, that's wasteful, it's costly, and it could be dangerous,” Dr. Wachter explained at the UCSF Management of the Hospitalized Patient meeting last October. "The data are clear that 30% of what we do in American medicine is of no value to patients—and some substantial portion of that is harmful as well. I think we as hospitalists should be identifying what these wasteful things are—and making the hard decisions to stop them."

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Background: Patient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined.

Methods: We conducted a prospective cohort study of adult respondents (N = 51 946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n = 36 428). Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We estimated the adjusted associations between year 1 patient satisfaction and year 2 health care utilization (any emergency department visits and any inpatient admissions), year 2 health care expenditures (total and for prescription drugs), and mortality during a mean follow-up duration of 3.9 years.

Results: Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).

Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

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This TED Talk with Brian Goldman address the some of the issues surrounding the medical culture of denying errors. "Every doctor makes mistakes. 'But,' says physician Brian Goldman, 'medicine's culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve.' Telling stories from his own long practice, he calls on doctors to start talking about being wrong."

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"Ontarians want excellent public services from their government. The Commission on the Reform of Ontario’s Public Services understands and supports this desire. We see no reason why Ontario cannot have the best public services in the world — with the proviso that they must come at a cost Ontarians can afford. With such a goal, we face three overarching tasks. First, we must understand Ontario’s economic challenges and address them directly. Second, we must firmly establish a balanced fiscal position that can be sustained over the long term. And third, we must sharpen the efficiency of literally everything the government does so Ontarians get the greatest value for money from the taxes they pay. This report addresses these issues and offers a road map to a day when Ontarians can count on public services that are both excellent and affordable — the public services Ontarians want and deserve." Read the full post

"Patients need much more than just medication and skilled treatment in order to get well. Attentive care demonstrably accelerates people’s recovery. Hospital architecture and the design of workplaces and patients’ rooms also play an important role – for the patient’s wellbeing, but also an efficient workflow at the hospital.

At the beginning of the year, the staff at the St. Josef Hospital and Pediatric Clinic in Neunkirchen, Germany, faced the difficult task of moving their patients and all of the medical equipment to a new hospital building. Despite all of the cost pressures, this new beginning gave planners the rare opportunity to design and configure the hospital building and wards from the ground up. Upon entering the red-and-white painted hospital facility, visitors arrive in a foyer with a waiting area containing a piano. The corridors are painted in warm shades of yellow, and the patients’ rooms are much friendlier and more comfortable than those in the previous building. The impression of being in a living room is further enhanced by curtains and movable cupboards for the patients. Even such comparatively simple measures seem to have a big effect. “The patients say that they immediately feel as though they’re in a five-star hotel,” reports Dr. Ernst Konrad, Chief Physician of the Clinic for Anesthesiology and Intensive Care Medicine. In the intensive care units, doctors and nurses find it easier to do their work, and here too the rooms are more comfortable and colorful than those in the previous hospital building."

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"The ultimate goal of this study was to help providers of healthcare within Pennsylvania acute care hospitals find solutions to the ever-present problem of the occurrence of medical errors. Scholarly literature states that the majority of medical errors occur due to systems that breakdown and fail healthcare workers. This study sought to provide new knowledge in regard to where one particular system may be breaking down, specifically the error reporting system. The purpose of this study was twofold; 1) to develop two structured interview questionnaires, and 2) to conduct structured interviews as a means to collect data that focused on the occurrence of medical errors; specifically through assessing the error reporting systems within a sample of Pennsylvania acute care hospitals.

This researcher investigates the procedures taken by healthcare administrators within Pennsylvania acute care hospitals with respect to the detection of medical errors in order to provide corrective measures. In response to structured interview questions, the overwhelming majority of research participants stated that the procedures for corrective actions focused upon various training interventions as deemed appropriate by management. However, scholarly literature states that the majority of medical errors do not occur due to the lack of competence, skills, or knowledge of healthcare professionals. Thus, using training interventions to solve non-training problems may not prove effective. The outcome of the study has lead to several important implications for the healthcare industry."

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"If implemented appropriately, health IT can help improve health care providers' performance, better communication between patients and providers, and enhance patient safety, which ultimately may lead to better care for Americans. Health IT is designed to help improve the performance of health professionals, reduce costs, and enhance patient safety. For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. However, poorly designed health IT can create new hazards in the already complex delivery of care.

In the wake of more widespread use of health IT, the Department of Health and Human Services asked the IOM to evaluate health IT safety concerns and to recommend ways that both government and the private sector can make patient care safer using health IT. The IOM finds that safe use of health IT relies on several factors, clinicians and patients among them. Safety analyses should not look for a single cause of problems but should consider the system as a whole when looking for ways to make a safer system. Vendors, users, government, and the private sector all have roles to play. The IOM’s recommendations include improving transparency in the reporting of health IT safety incidents and enhancing monitoring of health IT products."

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"Cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs. A culturally competent health care system is one that acknowledges the importance of culture, incorporates the assessment of cross-cultural relations, recognizes the potential impact of cultural differences, expands cultural knowledge, and adapts services to meet culturally unique needs. Ultimately, cultural competency is recognized as an essential means of reducing racial and ethnic disparities in health care.

This guide explores the concept of cultural competency and builds the case for the enhancement of cultural competency in health care. It offers seven recommendations for improving cultural competency in health care organizations:

1. Collect race, ethnicity and language preference (REAL) data.
2. Identify and report disparities.
3. Provide culturally and linguistically competent care.
4. Develop culturally competent disease management programs.
5. Increase diversity and minority workforce pipelines.
6. Involve the community.
7. Make cultural competency an institutional priority."

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