Hospitals' surgical directors earned an average of $223,711 (including bonus and overtime pay) in 2008, while their administrator counterparts at ASCs averaged only $97,119, according to Outpatient Surgery Magazine's sixth annual salary survey.

The survey results, published in January's issue alongside "How to Get the Raise You Deserve," a guide for negotiating your salary in uncertain economic times, polled 575 respondents - 423 from ASCs and 152 from hospitals - on their views of the surgery employment market.

The survey also found that:

The U.S. Department of Health and Human Services has issued a set of five-year national targets for the prevention of healthcare-associated infections which, despite being largely preventable, remain one of the nation's 10 leading causes of death, it says.

The Action Plan to Prevent Healthcare-Associated Infections targets six categories of infections, including surgical site infections, Clostridium difficile and methicillin-resistant Staphylococcus aureus.

In devising the plan, the authors identified seven metrics associated with each type of HAI and a corresponding five-year target for each metric. For example, one target for SSI prevention calls for a 95 percent adherence rate to Surgical Care Improvement Project / National Quality Forum infection process measures, including perioperative antibiotics, hair removal and normothermia.

In addition to the five-year targets, the plan calls for the development of national benchmarks, recommended clinical practices and an electronic reporting system for healthcare facilities. It also recommends ways of improving "regulatory oversight of hospitals and CMS oversight of the hospital accreditation program."

The HHS maintains that "a systemic approach to reducing the transmission of disease can be more effective than disease-specific approaches," and that "the education of best practices for providers and other healthcare personnel is critical to prevent HAIs."

The agency is accepting comments on the plan via e-mail until Feb. 6, 2009, and plans to hold public meetings to discuss it this spring.

Irene Tsikitas

Nurses are often excluded when physicians disclose serious errors in care to patients, even though they want to be included in the conversations, claims a Joint Commission study.

The study, which appears in the Jan. 9 issue of The Joint Commission Journal on Quality and Patient Safety, reports that nurses discuss mistakes with patients that are within their control, like missed medications, but hesitate to broach errors that lead to serious harm or involve other members of the clinical care team. While physicians are often charged with communicating directly to patients when serious errors occur, the researchers report that nurses want to be included in the disclosure process in order to convey nursing's role in adverse events and to avoid being blamed for them.

"Improving the quality of error disclosure to patients is a top priority in health care," says Sarah E. Shannon, PhD, RN, vice associate dean for academic services in the University of Washington School of Nursing, associate professor of behavioral nursing and health systems at the University of Washington and lead author of the study.

She says clinical teams need to continue to work as a unit throughout the error disclosure process by quickly assessing why the errors occurred, what can be done to prevent future errors and reviewing what the patient has been told, will be told and when they'll be told it. Her research team suggests that nurses should receive training on how to discuss clinical mishaps with patients and that facilities should develop policies to include nurses in the error disclosure process, which would help improve nurses' job satisfaction and retention rates, the researchers say.

Daniel Cook