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Two Birds With One Shot: Flu Vaccination Terror Drill

In the event of a natural or intentional infectious disease outbreak, rapidly delivering any available vaccine or prophylaxis to health care workers could be critical to a hospital's chances of keeping its doors open to treat incoming infectious patients. While that may be a stated goal in disaster response plans, an infection control professional decided to take it a step further by setting up a drill to mass immunize 70% of patient care staff in six days.

"The issue was for us was preparedness," said Stephanie Holley, RN, an ICP at the University of Iowa Hospital and Clinics in Iowa City. "Would we be ready and able to mass vaccinate our susceptible health care workers and do it efficiently and rapidly? We thought it would go beyond our typical table top where we would sit around discussing hypothetical situations, and how we might implement those."

While one of the stated goals was to measure the hospital's ability to respond to a bioemergency, Holley killed two birds with one shot by tying the plan to seasonal flu immunization. "My fellow ICPs can attest that we are often challenged to be very resourceful," Holley recently said in Tampa at the annual conference of the Association for Professionals in Infection Control and Epidemiology. "When we are asked to take on a huge project that takes a lot of our time, energy, and resources, we want to get the most bang for our buck. Well, the bang here was maybe we could increase our [influenza] vaccination rates as well."

The hospital's disaster emergency group designed a drill to achieve mass immunization without disrupting patient care. "When we first pitched this idea to hospital leadership, they were not real keen [on it] and were very concerned that we might disrupt normal operating procedures," she said.

However, planners were sufficiently convincing and the drill was approved. The scenario of an influenza pandemic required staff to respond to actual events and to implement decisions in real time, Holley explained. The proposed plan focused on the following components: communication, education and promotion, dispensing strategies, and real-time data collection. Dispensing strategies included using the employee health clinic, a peer vaccination program, and mobile vaccination teams.

From: Bioterrorism Watch

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Increasing ICU Bed Capacity Cuts Diversions

A new study published on-line in the Annals of Emergency Medicine finds that ambulance diversions can result in significant revenue losses for emergency departments and that increasing bed capacity in hospitals can decrease diversion and increase monthly net revenues. Using data collected between Jan.1, 2002, and Dec. 31, 2004, at the Oregon Health and Science University Hospital, Portland, the researchers determined that:

• Every hour of ambulance diversion costs the hospital approximately $1,100 in revenues.
• When the intensive care unit beds were increased from 47 to 67 and ambulance diversion decreased, the hospital gained approximately $175,000 per month in additional revenues generated by ambulance patients.
• Those additional revenues reflected a 10% increase in the hospital's ED revenues.

Oregon Health and Science is a 400-bed, acute care teaching hospital with a Level 1 trauma center in an urban area, which treats approximately 43,000 emergency patients each year. "We took advantage of a natural experiment," explains Chris Richards, MD, chief of acute care and a co-author of the article, who notes that prior to the research, there had been numerous discussions about having trouble getting ED patients up to beds in the hospital.

"We were active in various meetings making this known to administration," Richards adds, but he concedes that surgery needs were probably a more critical factor. "High-margin services always are," he says. "When we have trouble getting our patients admitted, it's not perceived as a high-margin problem, but when cardiac surgeons can't operate because patients don't have beds, that are another story."

Thus, when a new cardiac intensive care unit opened in the hospital, it was an opportunity to show the cost of diversions to the ED and to the hospital as a whole. "We tried to figure out the economics of the situation," Richards says.

This was an empirical simulation, adds K. John McConnell, PhD, lead author, an assistant professor of emergency medicine at Oregon Health and Science University and an economist in the OHSU Center for Policy & Research in Emergency Medicine. "We had two years' data, and we could see what patients were coming in and what the revenues were," he says.

From: ED Management

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Leapfrog Group, NJ Blues Start Recognition Program

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), in collaboration with The Leapfrog Group, has launched the Horizon BCBSNJ Hospital Recognition Program, offering New Jersey hospitals financial and public recognition for high-quality and effective hospital care.

Horizon BCBSNJ, reportedly the first health plan in the nation to implement a statewide hospital recognition program in collaboration with The Leapfrog Group, will offer all of its network hospitals the option of participating either in a program based on the Leapfrog Hospital Rewards Program or in a similar program created by Horizon BCBSNJ.

The Leapfrog program provides a nationally standardized methodology to assess the value of patient care by measuring performance along two dimensions — the quality of the care hospitals provide, and how effectively they deliver it. Its methodology utilizes standardized performance measures developed by the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Medicare & Medicaid Services (CMS), and Leapfrog itself.

However, says William Finck, MBA, the director of physician and ancillary networks at Horizon BCBSNJ, "We recognized that there is a cost to participation in the Leapfrog program, and we did not want to force hospitals to incur a cost in order to participate."

Horizon already had its own recognition program, which included the reporting of compliance with the Joint Commission's National Patient Safety Goals and CMS's 20 core measures for disease states. "We added compliance with the IHI's 100,000 Lives campaign and some patient satisfaction and administrative measures," says Finck.

"We aim to catalyze change, and in Horizon we've found a willing partner," adds Suzanne Delbanco, PhD, chief executive officer of The Leapfrog Group. "The significance of this partnership is that we are working together from the 'buy' side of the market to create a more sustainable and more potent pay-for-performance program than most of what's out there."

Part of the innovation that comes with Hospital Rewards, she continues, is that it is not entirely based on purchasers or payers needing to put all 'new' money on table. "It's not like new funds have to be found to create incentives or rewards," she explains. "Instead, much of it is paid out from the savings that occur as the hospitals improve. That's a shift from what the typical pay-for-performance program is designed to do."

From: From Healthcare Benchmarks & Quality Improvement

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Maryland Facility Begins Discharge By Appointment

This month, St. Joseph's Medical Center in Towson, MD, begins discharging patients by appointment, in the latest phase of a three-year effort toward capacity maximization, says Jackie Connor, RN, MS, CCS, director of case management.

When Connor was hired in April 2005, she was asked to take over the part of the project that included improving the discharge process, "the back end of patient flow," she adds. "Other teams were working on the emergency department, the front end.

"We had an issue with 'boarders' in the ED and as we started collecting data, what came to the surface was that if we could just fix transportation and discharge, 80% of the problem should be fixed."

Connor says her sense of the situation, however, was that a more comprehensive solution was needed. "We put together a multidisciplinary team last June, started working on the problem and, as we moved forward, put together subgroups as issues arose."

When the discharge task force was established in June 2005, one of the main goals was to increase the percentage of patients discharged by noon, Connor adds. But even with that specific intent, several months of data collecting revealed little change.

"What we found was that it was causing what we called 'bolus' discharges," she says. "It was a rapid, concentrated effort, a massive amount of patients, trying to get it all to happen before noon.

"Later in the day we would have 'bolus' admissions as the ED and the catheterization lab would empty out," Connor adds, "so there was not an even workload throughout the day."

That's when the decision was made to move to discharge by appointment, she says. "What we're attempting to do — and I haven't seen this in any of the literature on the subject — is to try to schedule discharge for all patients, not just surgical patients."

The idea has been piloted on the surgical unit with some success, and then with interventional cardiology patients, and is now being expanded to all patients, Connor notes. One group that will not be included is the maternal/child patient population, she adds, because there are no throughput issues there.

From: Hospital Access Management

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