Estimated read time: 5-6 minutes
This archived news story is available only for your personal, non-commercial use. Information in the story may be outdated or superseded by additional information. Reading or replaying the story in its archived form does not constitute a republication of the story.
WASHINGTON, Feb 22, 2005 (United Press International via COMTEX) -- Surgical-site infections are costly for patients and hospitals, doubling lengths of stay and the risk of death, while costing the U.S. healthcare system about $1.5 billion each year.
The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention are working together in the Surgical Infection Prevention Project to reduce the number of these infections. At present, about 300,000 patients contract the infections out of 15 million inpatient surgeries performed each year at U.S. hospitals. For major orthopedic or cardiac surgery, the cost of complications from surgical-site infections ranges from $30,000 to $50,000.
"There are substantial opportunities to improve the basic processes of care," Dr. David Hunt of CMS told reporters during a briefing Monday prior to the release of a study on the project, published in Tuesday's Archives of Surgery.
The study -- led by Dr. Dale Bratzler, principal clinical coordinator at the Oklahoma Foundation for Medical Quality and president of the American Health Quality Association -- shows several hundred hospitals around the country are finding success in reducing these infections by properly adhering to specific clinical guidelines. The guidelines call for administering antibiotics to surgical patients within 60 minutes before an incision is made, ensuring the correct antibiotic is given, and ending antibiotics 24 hours after surgery ends.
"Giving antibiotics after the incision is closed doesn't reduce the amount of infection," Bratzler explained.
In the first leg of the study, Bratzler's team analyzed 34,133 Medicare records from 2001 and found only about 55 percent of Medicare surgical patients received antibiotics within that crucial 60-minute timespan, even though that has been the gold standard for care since the 1960s.
In August 2002, hospitals began to work with local CMS Medicare Quality Improvement Organizations in 32 states to redesign procedures to meet the guidelines.
The results -- based on data collected on patients given antibiotics within the critical 60-minute window before the incision -- so far include:
--The 26 hospitals participating in California went from 73.8 percent to 84.3 percent of surgical patients getting antibiotics.
--The 16 hospitals in Colorado in the program improved from 62 percent to 88 percent.
--In Maryland, 16 hospitals posted a gain from 72 percent to 91.9 percent.
--In Texas, 42 hospitals went from 61 percent to 84 percent.
--Leesburg Regional Medical Center in Florida went from 19.3 percent to 92 percent.
--Glen Cove Hospital on Long Island, N.Y., went from 43 percent in July 2003 to 100 percent in early 2004.
--Mercy Health Center in Oklahoma performed 400 surgeries without infections, four times the rate before working with a QIO.
"Surgical site infections are a patient safety issue and a public health problem we can prevent," Dr. Bonnie Zell of the CDC told the briefing.
Bratzler said the surgical site infection project was just a "first step in a number of interventions designed to improve the delivery of surgical care in the United States."
TAKING A BROADER LOOK AT QUALITY OF CARE
The U.S. Agency for Healthcare Research and Quality released two annual reports Tuesday -- one on the state of healthcare quality and the other on disparities in healthcare -- that found some improvements in each area but also a long way to go.
"I think the take-home message is that there is a large gap between the best possible care and the care people actually receive," AHRQ Director Dr. Carolyn Clancy told UPI's Health Biz. "It's clear that healthcare has got to pick up the pace."
The reports found quality is improving but it is going to take time for it to become widespread -- there remains a lot of variation across the country. The AHRQ identified best practices that should help improve quality of care because that is the result wherever they have been adopted.
Overall, comparing results in the 2003 report to the new data, quality has improved by about 3 percent, including a decrease of 37 percent in nursing-home patients who experience moderate or severe pain.
Clancy said that particular improvement tracks with requirements by the Centers for Medicare and Medicaid Services that nursing homes report quality of care data.
She said of public reporting of quality that "by and large, it's been a growing emphasis .. and frankly, it's been a strong stimulus for improvements."
CMS now also is requiring hospitals to report 10 areas of quality care for seniors to receive the full Medicare reimbursement, which Clancy said will help provide more quality data and spur improvements that will show up future annual reports.
For example, the hospitals are required to report on pneumonia care and Clancy said it goes right to the quality issue because only 30 percent of Medicare beneficiaries get all three recommended pneumonia care services.
The 2004 report found some notable quality improvements by state, including Minnesota, which had the largest improvement in rates for mammogram testing. Alabama also was noted for being the only state to significantly increase screening rates for two colorectal cancer tests.
The disparities report also said differences in care based on ethnicity remain pervasive in the United States and there are information gaps for specific conditions and populations.
Blacks, Asians, American Indians, Alaska Natives and Hispanics had a poorer quality of care than whites and lower access to care. The poor also received lower quality of care and had less access to care than did people of higher incomes.
In 1999 the Institute of Medicine released its report that estimated 98,000 people die each year because of medical errors -- a key to quality care. Since then there has been a lot of talk and focus on quality-of-care improvements -- but the United States remains far behind in the goal of reducing error rates by half.
Clancy said one reason it is taking the healthcare industry so long to adopt best practices and improve care is the process is very complex and requires time to install new systems and procedures nationwide.
--
E-mail ebeck@upi.com
Copyright 2005 by United Press International.
