Geriatric Knowledge among Emergency Nurses | Aging In Action

by JOHN DAVY on APRIL 8, 2011

Adults age 65 and older make up at least 15% of emergency department visits, and have longer lengths of emergency department stay, as well as poorer post-discharge outcomes, than the general population. At the same time, most nursing baccalaureate programs do not require coursework in geriatric care. Does this imply a gap between training and practice, or are emergency nurses equipped with the knowledge to work with older adults? The Journal of Emergency Nursing published an article that surveyed nurses at one large California hospital (Roethler et al 2011) on geriatric knowledge and self-perception of nurse ability to work with older adults, which suggests that there may in fact be a knowledge gap.

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Hospitals Building Emergency Rooms for the Elderly - NYTimes.com

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By ALYSON MARTIN and NUSHIN RASHIDIAN

Hospitals nationwide are trying to redefine the E.R. experience for the elderly by building facilities dedicated solely to their needs. St. Joseph Mercy’s parent company, Trinity Health System, opened the nation’s first senior E.R. at Holy Cross Hospital in Silver Spring, Md., in 2008 and plans to put one in 19 other hospitals by 2013. Senior E.R.’s, also called geriatric emergency departments, also have opened in Texas, New Jersey, Missouri and Kansas. By year’s end, Mount Sinai Medical Center plans to open Manhattan’s first such facility.

“We’re going to have an increase in people over the age of 65 who are going to take their medical problems with them to hospital emergency departments,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “The fact that we’re really preparing for that wave, I think, is important.”


The drive to build senior E.R.’s is motivated in part by hospitals’ desire to find an edge in the increasingly competitive health care marketplace.
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Managing the Transition to Post-Acute and Long Term Care | Aging In Action

by John Davy on January 31, 2011

Transitions to long-term care, assisted living, and other supportive living options are often made in difficult conditions, under the financial and time pressure that follows acute care and other crises. A recent article (Kane 2011) in the Journal of the American Medical Association’s “Care of the Aging Patient” series reviews transitional and long-term care options for older adult patients who are transitioning from acute care, and argues that physicians should familiarize themselves with such options and, when possible, be involved in the transition.

The article provides a review of the last two decades of research on transitional (post-acute) care, long-term care, rehabilitation and other assisted living options.
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Health Care Facility Inspections to be Cut if Fees Not Raised - Las Vegas Sun

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If a panel of elected officials in Nevada rejects a proposal to increase health care facility licensing fees today as it did in October some state healthcare facilities inspectors will lose their jobs and the health care facility inspections will be greatly reduced, state officials said. The proposed fee increases are exponential in some cases, which has caused sticker shock for the facilities. Their lobbyist argues that the state, not the businesses, should bear the financial weight of protecting the public. "This amounts to what somebody calls a 'sick tax,'" said Charles Perry, president/CEO of the Nevada Health Care Association, the lobbying group for long-term care facilities.
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CMS National Care Transitions Conference - Registration is Now Open

REGISTRATION IS NOW OPEN for the CMS National Care Transitions Conference on Friday December 3rd at the Baltimore Marriott Waterfront Hotel. This conference will provide a forum for hospitals, community-based organizations (CBOs), Quality Improvement Organizations (QIOs), Administration on Aging (AoA) grantees, and other healthcare providers to receive useful guidance and have questions addressed regarding the upcoming funding opportunity under the Community Based Care Transitions Program (CCTP).

The in person registration deadline is Monday, November 22nd or when available space has been filled. Those who cannot attend the conference in person are encouraged to register for the webinar through 8:00 AM ET on Thursday, December 2nd or when available space has been filled.

The goals under CCTP are; to reduce hospital readmissions, test sustainable funding streams for care transition services, maintain or improve quality of care, and document measurable savings to the Medicare program. The demonstration will be conducted under the authority of section 3026 of the Affordable Care Act of 2010.

To learn more about this conference and to register, please go to
http://www.eventsvc.com/palmettogba/register/e5ac50e8-9691-45d2-a2ed-3a65a1b5f8e1

Fun Hand Hygiene Movements Combined with Dance Moves

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Healthcare-Associated Infection: Not on My Watch - Kimberly-Clark Health Care

Join the community of healthcare professionals concerned with preventing Healthcare-Associated Infections (HAIs), which at any given moment seriously affect 1.4 million hospitalized patients worldwide.

The HAI WATCHDOG* forums are intended to provide a place for health care providers to discuss issues and best practices related to Hospital-Associated Infections (HAIs).

Kimberly-Clark is committed to helping win the battle to prevent HAIs. As part of that effort, we are pleased to sponsor this new community site for healthcare providers to discuss HAI without discussion of product-specific information.

HAI WATCHDOG* Community members can:

• Participate in discussions or start your own
• Post HAI-related videos, photos or links to articles
• Enter the 2010 HAI WATCHDOG* Awards and read and vote on others' entries; this is an excellent way to share initiatives to reduce HAIs and have the opportunity to be recogized with an educational grant
• Spread the word in your facility about your own HAI initiatives by creating customized HAI Commitment posters online; then print or email them to others
• Help this community grow by inviting others to join the HAI WATCHDOG* Community

Healthcare-Associated Infection: Not on My Watch - Kimberly-Clark Health Care

Study: Medical errors cost nation almost $20B each year - The Hill's Healthwatch

By Mike Lillis

Preventable medical errors cost the country $19.5 billion in 2008 — or roughly $13,000 for each avoidable case, according to a report published Monday by the Society of Actuaries (SOA).

And that number is likely low, according to consultants at Milliman, who crunched the data.

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Interruptions Risk Medication Errors by Nurses from MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

When nurses are interrupted while administering medication, the risk of procedural failure and clinical error increases, data from an Australian study showed.

Such interruptions occurred more than half of the time, and three during the same drug administration led to a procedural failure rate of 85% and a clinical error rate of almost 40%, according to a study reported in the April 26 issue of Archives of Internal Medicine.
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• Interrupting a Nurse Makes Medication Errors More Likely (nlm.nih.gov)

Voluntary End-of-Life Measures Banned at Catholic Hospitals - The New Old Age Blog - NYTimes.com

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By PAULA SPAN

In the 600 Catholic hospitals and hundreds of Catholic nursing homes around the country, such issues may grow more contentious in the wake of a new directive adopted by the United States Conference of Catholic Bishops.

As Harris Meyer recently reported in Kaiser Health News, the directive establishes “an obligation to provide patients with food and water, including medically assisted nutrition and hydration” for those who can’t eat or drink, and it specifically includes patients in “chronic and presumably irreversible conditions.”

Patients whose advance directives prohibit feeding tubes if they have terminal illnesses or have entered a persistent vegetative state (as mine does) would either have to accept such treatment or transfer to another facility.
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Perdue's hospital tax strongly opposed | ajc.com

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By Craig Schneider

Several key lawmakers say Gov. Sonny Perdue’s plan for a hospital "bed" tax -- to help fund a $608 million shortfall in Medicaid -- is going nowhere fast. They say they won't support a new tax that could add to the burden of already struggling hospitals and possibly raise medical costs for patients.
But that hardly ends the discussion.

Several proposals are swirling around: the hospital bed tax, a higher tax on tobacco, a Medicaid rate cut, and good old-fashioned spending cuts. For Georgians, the result could mean paying a dollar more for a pack of cigarettes, or seeing a decrease in state services, or seeing their medical costs rise as hospitals and doctors pass on the pain.

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Senior Citizens Do Best in Specialized Orthopedic Surgical Care: Medicare Study

The more specialized a hospital is in orthopedic surgical care, the better the outcomes appear to be for senior citizen patients undergoing hip and knee replacement surgery, University of Iowa researchers report in a new study of Medicare patients.

Among more specialized hospitals, there were fewer serious post-surgical complications such as blood clots, infections and heart problems, as well as fewer deaths.

The findings, which were published online Feb. 11 by the British Medical Journal, were based on data for nearly 1.3 million patients who received hip or knee replacement surgeries between 2001 and 2005 at 3,818 hospitals in the United States.
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• Medicare data reveals differences in orthopedic surgical outcomes (scienceblog.com)

The Health Care Blog: How Maryland “Broke the Curve”: A Solution For Massachusetts?

Massachusetts has succeeded in providing health care insurance for all but 2.6% of its citizens.

Yet the Commonwealth still struggles to make that coverage affordable. Health care inflation is driving Massachusetts’ system toward a cliff. Total outlays for medical services and products are climbing 8 percent faster than the state’s economy. Unless something is done to rein in the cost of care, health care spending in Massachusetts is projected to nearly double over the next 10 years, hitting $123 billion in 2020. State officials know they must find a way to put a lid on spending so that it grows no faster than the state’s gross domestic product. .

But how?

With that question in mind, The Massachusetts Division of Health Care and Policy (DHCFP) contracted with the RAND Corporation to develop a menu of cost containment strategies and options. In September RAND came back with a report that recommended 12 strategies for reducing health care bills.

Near the top of the list (right after “bundling” payments for doctors and hospitals), Rand suggested that Massachusetts set hospital prices by “establishing a regulatory board to determine appropriate rates for hospital inpatient, outpatient, and emergency department care, limiting payment to the minimum amount necessary to cover hospital operating expenses, and requiring all payers (both private insurers and Medicare) to adhere to the rates set.

In other words, Rand recommended that Massachusetts consider the “Maryland solution” (a.k.a. the “all-payer” strategy). Here’s a brief summary: In Maryland prices for all hospital services are set by seven commissioners appointed by the governor to four-year terms. When setting rates for at individual hospitals, the Commission takes into account each hospital's wages, charity care and severity of patient illnesses. Hospitals can appeal only to the commission or take the dispute to court.
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Not on My Watch Campaign To Eliminate Hospital Acquired Infections

Standoff Between Continuum and UnitedHealthcare Over Costs - NYTimes.com

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By ANEMONA HARTOCOLLIS

A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.

The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare, which includes Oxford health plans and has 25 million members across the country, one million of them in New York.

While Congress has been haggling over covering as many as 15 million uninsured Americans, the prestigious hospitals and the major health insurer have been in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half.

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Health Affairs Blog:Healthcare Reform and the Future of Hospitals

Health Affairs Founding Editor John Iglehart recently interviewed American Hospital Association CEO Rich Umbdenstock. The wide-ranging conversation, transcribed below, touched on the ongoing health reform debate, the evolving role of hospitals in community health, the effect of the economy on hospital finances, the evolution of integrated medicine, patient safety, workforce concerns, and other issues.
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How Much Charity Care Do Nonprofit Hospitals Have to Provide? - Health Blog - WSJ

By Jacob Goldstein

Nonprofit hospitals are big businesses. How much charity care do they have to provide to justify their tax exemption? The law is notoriously fuzzy on that question, which it’s being put to the test in arguments today before the Illinois Supreme Court.

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AMNews: Sept. 23, 2009, 2009. Mass. turns spotlight on insurance executives' pay ... American Medical News

The state's attorney general said she is going to be "proactive" in evaluating compensation for executives and directors of health plans and hospitals.

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Health Affairs Blog: The Public Option - Hospital Finances & Private Premiums

by Chris Fleming

One of the main points of dispute in the health reform debate has been whether to include a new public health insurance option. Legislation approved by three House committees and the Senate, Education, Labor, and Pensions Committee includes such a public option, but the proposal unveiled yesterday by Senate Finance Committe Chairman Max Baucus (D-MT) does not.

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