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Digital Issues

ASA Issues Road Map for Anesthesia Information Management

Electronic medical records that transfer digital data to printed charts are behind the times, says the American Society of Anesthesiologists.

Anesthesia information management systems (AIMS) can collect vital-signs data and collate patient information faster, better and more comprehensively than any provider could hope to do using paper records, write the authors of an ASA-issued white paper aimed at guiding providers who want to add the technology to their practices.

The white paper points out that AIMS result in reduced anesthetic-related drug costs, improved staff scheduling (and reduced staffing costs), increased anesthesia billing and capture of drug-related charges, and increased reimbursement through improved coding.

Regardless of how individual anesthesiologists feel about adopting the technology, notes the paper, the reality is that the government has stepped in and required its use by eligible professionals and hospitals within the next 5 years.

ASA President-Elect Jerry Cohen, MD, believes the healthcare industry is "near the convergence of capacity, technology, and necessity to mandate the widespread adoption of meaningful electronic records, including AIMS."

He suggests AIMS can become the foundation for data-based decision-making that drives quality improvement, better outcomes, greater efficiency, science-based practice guidelines, public policy and cost containment. "It is time to move forward," he says, "while our future is still in our hands."

Daniel Cook

Nevada's Safety Proposals Reviewed

Spurred on by hepatitis outbreaks, safety violations and press coverage of sentinel events in the state's surgical facilities, the Nevada legislature has considered numerous bills promoting healthcare transparency during its 2011 session, which adjourned for a between-session interim period last week.

The Las Vegas Sun recently reviewed the status of the state Senate bills that had passed or which were deemed likely to once the lawmakers reconvene.

  • S.B. 209, which requires the state's Health Division to post annual sentinel event reports for hospitals in Clark and Washoe Counties on its website has been signed into law.

  • S.B. 340 would require hospitals and ASCs to provide the names of their physicians and information on procedures in order to track adverse events. It has passed the Senate and awaits a vote in the Assembly.

  • S.B. 338, which would require any medical facility with 25 or more patients to report sentinel events to the CDC for eventual publication by the state, is still under consideration by the Senate.

  • S.B. 339 requires physicians to notify patients or their caregivers of healthcare-acquired infections within 5 days. It awaits the governor's signature.

  • S.B. 264 mandates the reporting of preventable re-admissions related to the previous admission. It is presently under review by Senate and Assembly committees.

    Each bill has been backed by the Nevada State Medical Association and the Nevada Hospital Association. Patient safety advocates say that breaking down sentinel event reports by facility, as opposed to the current system of reporting statewide totals, will arm healthcare consumers with the information they need to choose the safest options, while creating an incentive for providers to improve their safety records.

    David Bernard

  • Spinal Fusion's Cost Variables Examined

    How much can a hospital expect to charge for one of the most commonly performed spinal surgeries these days? The answer varies widely, depending on the surgeon performing the single-level anterior cervical discectomy/fusion (1-ADF) and the supplies and instrumentation that surgeon chooses to use, according to a retrospective analysis of 102 surgeries performed at a single hospital.

    Total surgical charges, which include operative, instrumentation and supply charges, varied from $11,540 to $53,533 per case among the 15 surgeons who performed the spinal fusion surgery at the hospital in 2008, the study shows. The difference in total hospital charges was even greater at more than $100,000, due in large part to wide variations in inpatient lengths of stay.

    "Both the surgeons' choice of instrumentation and the choice of surgeons contributed to the large variations in total hospital charges" for the 102 patients studied, writes lead author Nancy Epstein, MD, of the Albert Einstein College of Medicine in New York and her colleagues in the journal Spine.

    Actual charges for the instrumentation used in performing 1-ADF ranged from $4,062 to $40,409. The authors note that "the number of combinations of instrumentation and supplies" from which spine surgeons can choose is "enormous," creating a wide range of associated costs. You must take the rate of complications and outcome measures associated with different equipment into account when performing a cost/benefit analysis of instruments and supplies, they write, but "the published data suggests that using more expensive combinations... would not necessarily reduce costs."

    Hospital charges also vary widely from surgeon to surgeon, with one of the 6 higher volume surgeons studied far outpacing the other 5 in total hospital charges for his 1-ADF patients. Based on these findings, the researchers conclude that "spine surgeons can take proactive steps to reduce the total hospital charges associated with 1-ADF."

    Irene Tsikitas

    InstaPoll: How Many Surgeons Are Affiliated With Your Facility?

    In recent years the number of surgical facilties has skyrocketed, while the number of surgeons has remained relatively stable. Given those facts, you could easily imagine that the ratio of surgeons to surgical facilities would be shrinking. Help us find out. Tell us how many surgeons are credentialed at your facility in this week's InstaPoll. Check back here next week for the results.

    How do you ensure hand hygiene compliance? For nearly three-fourths (73%) of the 106 respondents to last week's poll, it's direct observation. Another 16% use a combination of measures, including observation, tallying used bottles of hand gel and employing hand hygiene monitoring equipment. But 8% don't measure compliance.

    Dan O'Connor

    News & Notes

  • Tip of the week Cancelled cases are expensive and frustrating for everyone involved. Reviewing charts 1 or 2 days before a procedure doesn't allow enough time to make sure all the pre-op testing results are there and giving the go-ahead, writes Diana McDaniel, MSN, CASC. So her staff starts the review earlier, at least 9 days ahead, and enjoys fewer cancelled cases.

  • Battling the old boys' club Remember the 2 West Texas nurses who faced criminal charges for reporting the bad behavior (including performing surgery without privileges) of a doctor with ties to local authorities? On a recent episode of public radio's This American Life, the nurses, Anne Mitchell, RN, and Vickilyn Galle, RN, recount the bizarre tale of their firing and arrest at the hands of a small group of powerful men, including a hospital administrator, sheriff and county prosecutor determined to silence their criticism of the physician at a time when few were willing to practice in their rural community.

  • C. diff surveillance needed Hospitals should institute mandatory hand-washing standards in order to prevent C. difficile outbreaks, says Irena L. Kenneley, PhD, APRN-BC, CIC, an infection prevention and control expert and assistant professor of nursing at the Frances Payne Bolton School of Nursing in Cleveland. She suggests hospitals create "hand-washing squads" to oversee staff hand-hygiene practices, likening the monitoring to federal intelligence agents who watch for terrorists threatening to attack the U.S. "If there is an outbreak, it clearly points to the fact that healthcare workers are not washing their hands at appropriate times that are critical for infection prevention," says Dr. Kenneley, who based her claims on a recent survey of hospital infection control practices conducted by the Association for Professionals in Infection Control.
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