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Agency for Healthcare Research Quality

Hospital Care, Cost, and Use

Tools & Resources

AHRQ Quality Indicators™ Toolkit for Hospitals
Becoming a High Reliability Organization: Operational Advice for Hospital Leaders
Central Line Insertion Care Team Checklist
Emergency Department Tools and Resources
Emergency Severity Index, Version 4 and 2012 Edition of the Implementation Handbook
Efforts to Prevent and Reduce Health Care-Associated Infections
The Hospital Built Environment: What Role Might Funders of Health Services Research Play?
Improving Patient Flow and Reducing Emergency Department Crowding: Evaluation of Strategies from the Urgent Matters Learning Network II, Executive Summary
Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals
Patient Safety Culture Surveys
Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for HospitalsNew!
   Hospital Survey on Patient Safety Culture
   Hospital Comparative Database Submission Information
   2012 Comparative Database Report
   2011 Comparative Database Report
   2010 Comparative Database Report
   2009 Comparative Database Report
   2008 Comparative Database Report
   2007 Comparative Database Report
Managing and Evaluating Rapid-Cycle Process Improvements as Vehicles for Hospital System Redesign
Re-Engineered Discharge (RED) Toolkit
Transforming Hospitals: Designing for Safety and Quality
Users of Public Reports of Hospital Quality: Who, What, Why, and How?
Using Workforce Practices To Drive Quality Improvement: A Guide for Hospitals

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Healthcare Cost and Utilization Project (HCUP)

HCUPnet: Interactive Tool for National Hospital Statistics
HCUP Findings and Publications

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Inpatient Quality Indicators

Inpatient Quality Indicators: Fact Sheet
Inpatient Quality Indicators: Software Download

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Research Findings

News and Numbers

Date   Title
9/10/12 AHRQ Patient Safety Project Reduces Bloodstream Infections by 40 Percent
3/7/12 Hospital Readmission Rates Higher for Chronic Conditions
1/25/12 Hospital Stays Involving C. difficile Infections Leveled Off After 300 Percent Increase Since 1993

Research Activities, October 2012:
Label changes, manufacturer's warning letter did not reduce use of propofol for conscious sedation in children
Diagnostic coding formulas underestimate hospitalizations for acute exacerbations of COPD
Electronic medical records reduce negative outcomes and related costs after patient safety events occur
Hospitals vary widely in their use of dopamine and dobutamine in preterm/low birthweight neonates
Two different tools help measure tracheal intubation adverse events and performance in pediatric intensive care units
Noninvasive positive pressure ventilation improves COPD patient outcomes
Extending use of anti-clotting medication following major orthopedic surgery may help prevent post-operative blood clots
New effectiveness review discusses treatment options for inguinal hernia
AHRQ safety project reduces bloodstream infections by 40 percent
More safeguards needed to prevent adverse drug events caused by medication administration errors

Research Activities, September 2012:
Hospital volume does not predict mortality for patients undergoing lung cancer surgery
Studies link adverse drug interactions to elevated risk for hospitalization among the elderly
Study fails to find link between guideline-based emergency treatment for pediatric asthma and patient outcomes
Minority-serving hospitals have problems with quality of care and patient satisfaction

Research Activities, August 2012:
State Medicaid policy changes increasingly driven by evidence
Outcomes of trauma patients depend heavily on whether recommended practices are followed
Patients hospitalized for burn injuries in New York have comparable outcomes at major burn centers
Medicare managed care reduced preventable hospitalizations in 2004 more than fee-for-service Medicare
New study counters the urban legend that insurers won't cover patients who leave the hospital prematurely
Ways to reduce contrast-induced acute kidney injury from imaging procedures in patients with cardiovascular disease
Discharge to skilled nursing facilities after a heart attack or heart failure explains little of variation in hospital readmissions
New tool developed to reduce risks to patients during clinical handoffs
Complications increase mortality of trauma patients
Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life
Benefits and risks of helicopter transport for trauma patients investigated
Adverse drug reactions a major cause of unplanned hospitalizations of elderly veterans
Treatment guideline reduces hypoglycemic events in critically ill children

Research Activities, July 2012:
High-volume hospitals have low rates of adverse events for high-risk surgeries
Complications and in-hospital deaths more frequent among patients who undergo anterior rather than posterior spine fusion
Adjusting hospital admissions by day can help with overcrowding in children's hospitals
Perceived reputation and other factors influence consumers' hospital choices
Market competition has only marginal effect on hospital performance for heart failure
Many surgeons do not discuss advance directives with their patients before surgery
Large vessel occlusion after a mini stroke predicts functional decline
Tumor necrosis factor-antagonists in patients with autoimmune diseases showed no overall increased risk of hospitalizations for serious infections than non-biologic drugs

Research Activities, June 2012:
Vulnerable populations with heart failure less likely to receive early physician followup after discharge
Dual Veterans Administration/Medicare users are not hospitalized more for ambulatory care sensitive conditions
A hospital's ability to rescue patients from complications after high-risk surgery determines mortality rates
Patients recovering in the hospital from total knee or hip replacement have increased risk of falls
Contact isolation of new patients reduces adherence to process-of-care quality measures for pneumonia
Magnet® hospitals offer better work environment for nurses than non-Magnet hospitals
Large variations in Medicare payments for surgery underscore savings potential from bundled payment programs
Remote intensive care monitoring is cost effective for sickest patients
Use of pulmonary artery catheters provides no patient benefit and increases costs
Decision support may aid emergency physicians in interpreting benign from serious eye movement patterns in dizzy patients
Risk of venous thromboembolism low for young trauma patients without a central venous catheter
Risks high for elderly patients receiving angioplasty to fix narrowed heart artery
Men more likely to be readmitted to hospital after discharge

Research Activities, May 2012:
Trauma centers vary in screening for deep vein thrombosis
Leapfrog survey may not accurately report use of safe practices in trauma centers
Lower complications are seen after laparoscopic kidney removal
Health information exchange can save money by reducing admissions from the emergency department
Children's hospitals are pressed to capacity by response to pandemic outbreaks
Kidney-sparing surgery for children with renal tumors has equivalent in-hospital results to kidney removal surgery
Increased child hospitalizations are associated with the mother's mental state and confidence in parenting

Research Activities, April 2012:
Majority of conditions treated in emergency departments are treatable in primary care clinics
Patient surveys are an additional useful tool for identifying adverse events occurring during hospital stays
Public reporting of performance data seems to motivate and energize improvements to hospital performance
Chronic Disease: Heart failure hospitalization and mortality rates drop between 1998 and 2008
Drug-eluting stents appear safe for older patients with chronic kidney disease
Accuracy of ultrasound for ectopic pregnancy in the emergency department is not helped by measuring a key pregnancy hormone
Clinical algorithm can identify and locate serious internal bleeding related to oral anticoagulant use
Hospital readmissions higher for chronic conditions
Midwest hospitals lead in newborn male circumcision rates

Research Activities, March 2012:
Hospital emergency departments get tips from AHRQ on how to reduce crowding and better triage patients
Learning networks can help implement strategies to improve emergency department patient flow
Trauma patients with hospital-acquired infections have poor outcomes, including increased mortality risk
Hawaii's experience shows that a national collaborative effort can reduce central line-associated bloodstream infections
Crisis checklists for the operating room can improve safety and management
Evaluation of TeamSTEPPS® implementation finds improved teamwork and clinical outcomes
Guideline management of inpatient cellulitis and cutaneous abscess reduces antibiotic use
EMS transport is underused by patients with a certain type of heart attack
Study characterizes patients receiving out-of-hospital endotracheal intubation
24-hour intensivist care in ICUs can lead to cost savings for the sickest patients admitted at night
Costs of congenital heart operations vary among hospitals
Pneumococcal disease continues to lead to substantial health care use and costs
ICU nurses show increasing acceptance of electronic health records
Evidence lacking to support surgery for pelvic pain
Study identifies attributes of surgeons more willing to provide charity care
Despite recommendations against it, early discharge of late-preterm newborns remains common
Hospital stays involving C. difficile infections leveled off after 300 percent increase since 1993
AHRQ publishes cancer hospitalization statistics

Research Activities, February 2012:
Superficial surgical site infections are a reliable measure of hospital quality
Patient flow strategies may help to address emergency department crowding
New rule on when to have a trauma surgeon meet a transported trauma patient is found more sensitive than existing criteria
Depending on a woman's age, hysterectomy may be the best option for resolving chronic pelvic pain and heavy bleeding

Research Activities, January 2012:
Bundled payments for heart failure disease management programs can save money while reducing readmissions
Interdisciplinary team training with in-situ simulation helps reduce adverse events in obstetric patients
No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery
Duplicate medication order errors increase after computerized provider order entry is implemented
California nurse staffing mandate did not reduce nursing workforce skill levels
Leg compression devices are not a significant factor in in-hospital falls
A large proportion of hospitalized children receive numerous medications during their hospitalization
Clostridium difficile infection rate has risen among hospitalized children since late 1990s
Pediatric cardiology centers vary in treatment of infants with single ventricle congenital heart disease
Cost of hospitalization highest among the non-elderly
Potential role of physical therapy in ICU patients
Evidence lacking on optimal transition-of-care programs for heart attack and stroke patients following hospitalization

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Research Activities, December 2011:
Evidence-based strategies substantially reduce the incidence of ventilator-associated pneumonia in ICUs
Trauma patients are more likely to die after a major complication in high-mortality hospitals
Hospital boards adopt practices to enhance oversight on quality of care
Fewer than 1 in 5 emergency departments implement recommendations for HIV screening
Increased estradiol levels during critical illness are associated with higher mortality
Hospital lung cancer surgery volume is not correlated with lower mortality
Enrollment in Medicare Advantage managed care plans reduces racial/ethnic disparities in primary care quality in some States
Heart disease, cancer, and trauma-related disorders among the most costly conditions for men
Knee replacements up dramatically among adults 45 to 64 years old
Hospitalizations for eating disorders declined, but big increase seen in pica disorder
Birth defects may be linked to high blood pressure, not use of ACE inhibitors in early pregnancy

Research Activities, November 2011:
Blacks and patients at hospitals with a high percentage of black patients more likely to suffer adverse events
Nurses in hospital units with a higher proportion of short-term patients take longer to respond to patient call lights
Pediatric emergency department visits surged during the 2009 H1N1 flu pandemic, but few children were hospitalized
Recent trends in hospital use by children and youths are a mixed bag—lower for teen pregnancies, much higher for skin infections
Blood infections most costly hospital care in 2009
Updated report highlights hospitals’ progress in reducing bloodstream infections
Hospital readmissions for COPD highest among black patients
Uncertainty surrounds use of terbutaline to prevent preterm birth

Research Activities, October 2011:
MONAHRQ gains momentum
Certain factors increase risk of medication errors in the neonatal intensive care unit (NICU)
Going "smooth" can help relieve weekday crowding at children's hospitals
Minimally invasive heart treatments have reduced bypass surgeries and influenced valve repair and replacement
Heart attack victims should use emergency transport services, not self or family to get to the hospital
Physician recommendations for defibrillator therapy not influenced by race or gender
More research is needed on outcomes after maternal-fetal surgery
A small number of drugs are used most commonly during pediatric hospitalizations
Hospital deaths from heart failure cut by half over 7 years
Hospitalizations for children with influenza and skin infections increased in the last decade
More than 20,000 emergency room visits for air and paintball gun injuries in 2008

Research Activities, September 2011:
Fewer heart bypass surgeries performed
Surgical risk score does not work well for knee and hip replacement operations
Pay-for-performance project showed early gains but tapered in the fourth and fifth years
Leaving the emergency department without being seen more likely at hospitals that serve more low-income patients
Patients with sepsis fare better when admitted via the emergency department rather than directly to the hospital
Blacks who receive heart transplants have poorer survival than other racial groups
Minority status has no effect on patient outcomes in the intensive care unit
The quality of children's asthma care is affected by emergency department crowding
Arizona and Maryland see great drop in in-hospital deaths from pneumonia

Research Activities, August 2011:
Hospital-acquired infections dramatically increase trauma patients' risk of in-hospital death and hospital stay
Trigger tools have potential to detect adverse events following outpatient surgery
Electronic order sets can help treatment conform to guidelines for antibiotic use after surgery
Mental demands of pediatric hospital pharmacy staff have varying effects on likelihood of medication errors and adverse events
Patients with heart failure are older, have more illnesses, and take more medications than earlier
Parents and primary care physicians are satisfied with children's use of nonurgent emergency department services
Primary anterior cervical fusion has lower in-hospital complication rates and deaths than posterior cervical fusion
Six of every 10 rural emergency departments visits made by poor patients
Up to $500 million in Affordable Care Act funding will help health providers improve care

Research Activities, July 2011:
Language barriers related to increased hospital readmissions for Chinese- and Spanish-speaking patients
Delays in reporting medical errors at Japanese hospital nearly triple that of United States hospital
Hospitals with a teamwork culture have better patient safety climates
Quality measures are not used with all patients who suffer heart attacks
Immersive simulation training for CPR shows no benefit over standard training
Patients who suffer strokes and are seen at designated stroke centers fare better in the short and long run
Trauma center patients treated after hours or on weekends have no difference in mortality rates
A high percentage of patients with sickle cell disease self-discharge from hospital care
Two approaches help identify cardiac surgery patients at risk for postoperative kidney failure
Communication problems between hospitalists and primary care providers lead to postdischarge problems for seniors
Some patients hospitalized for stroke more likely to keep taking drugs to prevent another stroke
Sleep apnea and pulmonary hypertension affect in-hospital outcomes of noncardiac surgery
Certain factors linked to risk of early death of intensive care patients after discharge
Physicians more reluctant to deactivate some life-sustaining devices than others
Mandated increases in nurse staffing levels unevenly affect uncompensated care growth rates in California hospitals
Pelvic ultrasound imaging by emergency physicians is highly effective in ruling out ectopic pregnancy
More rural Americans treated in emergency departments for eye injuries
ICUs in Michigan sustain zero bloodstream infections for up to 2 years
Over 3 million look to hospitals for headache relief
Most American women experience complications during delivery
Readmissions in 30 days or less account for 1 in 9 hospital admissions
Connecting local providers to academic medical centers using video improved hepatitis C outcomes

Research Activities, June 2011:
Patient gender does not influence the management or diagnosis of acute abdominal pain in the elderly, but affects outcome
Half of all annual medical expenditures are for chronic diseases
Length of stays in emergency departments varies considerably
Organizational culture distinguishes top-performing hospitals in patient outcomes from heart attack
No consistent association found between volume or quality and outcomes of complex surgeries for cancer
Dilators more cost-effective than surgery for correcting congenital condition in females
Mental status deficits a major factor in elderly falls in the hospital
Medication side effects, injuries up dramatically
Use of episiotomy and forceps during childbirth down, C-section rates up

Research Activities, May 2011:
Emergency department patients and visitors are most interested in education about stress and depression
Systems to detect adverse drug events need buy-in from leaders and staff to become part of hospital routine
Performing cardiac catheterization and heart surgery on different hospital admissions may reduce risk of kidney damage
Surgery and imaging rates for children's kidney stones are stable, but vary greatly from hospital to hospital
Hospital charges surpass the trillion dollar mark
Uninsured hospital stays surged from 2003 to 2008
Low health literacy linked to higher risk of death and more emergency room visits and hospitalizations

Research Activities, April 2011:
Hospital Compare data may not help surgical patients find hospitals with better outcomes
Obese patients with hypertension and diabetes have a greater risk of dying after noncardiac surgery
Certain hospital characteristics influence mortality after complications following high-risk surgery
Physicians cultivate colleagues' esteem differently at low- and high-prestige hospitals
Parents using electronic kiosk provide more accurate clinical information than emergency room providers
Decision support intervention prompts clinicians to update patients' problem lists in their medical records
Adverse drug event surveillance tailored to hospitalized children
Rates of pneumonia dramatically reduced in patients on ventilators in Michigan intensive care units
Patients' income and where they live influence hospitalization for chronic lung disease

Research Activities, March 2011:
Re-engineered discharge project dramatically reduces return trips to the hospital
Hospitals with a high volume of sepsis admissions have lowest mortality rates
Hospitals face dilemmas about disclosure of large-scale adverse events
Most process-of-care events do not harm transplant patients, but they boost costs and lengthen hospital stays
Person-to-person transmission of E. coli resistant to fluoroquinolone drugs is rare among hospital patients
Automated screening of patient electronic medical records is only the first step to identifying a medication problem
Better adherence to diabetes medications means fewer hospitalizations and emergency department visits
Hospitals with more patients who receive angioplasty within 90 minutes of a heart attack have lower mortality rates
Hospitalizations for bacterial pneumonia in Texas towns bordering Mexico three times higher than the national average
Kidney stone rates in children may be on the rise
Better hospital quality of care for the elderly is associated with lower mortality after discharge
Aching back sends more than 3 million to emergency departments
Operating room procedures account for nearly half of hospitals' treatment costs
Growth in Medicaid patient hospital admissions outpace those for privately insured patients

Research Activities, February 2011:
Hospitals vary greatly in the quality of their trauma care
Trauma care costs less at hospitals with lower mortality rates
Routing ambulances to cardiac surgery-equipped hospitals more cost effective than building more such hospitals
Nearly one-third of emergency department visits involve nonideal care events
Emergency departments have increasingly become the health care safety net for adults insured by Medicaid
Routine opt-out HIV emergency department screening only slightly improves identification of patients with HIV infection
Ketorolac, a pain medication, is underused in children operated on for bladder reflux
Higher in-hospital complication rate for primary posterior versus primary anterior cervical fusion
One in 16 women hospitalized for childbirth has diabetes
More than one in five hospital patients in 2008 were born in 1933 or earlier

Research Activities, January 2011:
Most acute-care hospitals follow national guidelines for the prevention and treatment of MRSA infections
Hospitalists modestly improve quality of care
Greater use of preventive measures needed for hospitalized patients with suspected venous thromboembolism
Serious complications from bariatric surgery are fewer when done by high-volume hospitals and surgeons
Treatment for blocked carotid arteries varies depending on where you live
Community hospitals care for psychiatric patients in medical-surgical beds when psychiatric units are full
Patients taking only salmeterol seen in the emergency department for asthma more likely to be hospitalized
Rates of emergency department use greater among women and low-income, older, and rural Americans

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Research Activities, December 2010:
Surgical infection prevention measures reduce postoperative infections when used together, but not singly
Fragmentation of care for complex diabetes patients may be associated with greater use of the emergency department
Uncontrolled asthma events among Massachusetts patients declined between 2002 and 2007
Patients with inherited cancer syndrome need help with decisions and long-term support from their surgeons
Four million hospital admissions potentially unnecessary
Hospitalizations for medication and illicit drug-related conditions on the rise among Americans aged 45 and older
Hospital charges for 1 in 20 hospital stays average $18,000 a day

Research Activities, November 2010:
AHRQ patient safety indicator can be used to identify cases of hospital-acquired collapsed lung
Clopidogrel increases bleeding risk in cardiac patients with drug-eluting stents
Hospital report cards on coronary bypass surgery are more accurate when based on 2-year data
One-fifth of mothers do not receive recommended antenatal corticosteroids before delivery of premature infants
Potentially avoidable hospitalizations high among Medicare and Medicaid patients
Most public hospitals are in rural areas

Research Activities, October 2010:
Health care-associated infections greatly increase the length and cost of hospital stays
Quality improvement initiative successful in sustaining reduction in bloodstream infections caused by catheters
Patients with financial worries or no insurance delay going to the hospital for a heart attack
Rural elderly with dementia are hospitalized more often for conditions that primary care visits might have caught
The role of hospital care in general medical care has declined over time
Risks, benefits of emerging heart valve replacement technique not fully understood
Treating Americans with diabetes cost hospitals $83 billion
Potentially avoidable hospitalizations for heart failure lowest in mountain States
Oregon and Vermont show fewest hospitalizations for children with asthma

Research Activities, September 2010:
Assessment of hospital computerized physician order entry systems finds many medication errors are missed
Certain patients with lupus are more likely to end up in the emergency department three or more times a year
Relative inefficiency of rural critical access hospitals must be balanced against their contributions to care access and quality
Obstetrician malpractice claims lead to small reduction in inpatient deliveries, but not C-section rates
Early followup with a physician reduces readmissions for Medicare patients hospitalized for heart failure
Heart bypass surgery death rates drop sharply
Mental disorders and/or substance abuse related to one of every eight emergency department cases
Blacks hospitalized for high blood pressure five times more often than whites
New study finds rotator cuff injuries treatable, but evidence unclear whether surgery is preferable

Research Activities, August 2010:
Emergency physicians suggest ways to reduce errors in patient handoffs during shift changes
Hospital risk managers more likely than physicians to recommend error disclosure, but less likely to apologize
Patient preferences are important when making clinical decisions for those who can't, but other factors also play a role
Minority patients are less likely to have surgery performed by high-volume surgeons and hospitals
Lower mortality rates after surgery at high-volume hospitals due to fewer complications and other factors
Remote supervision of stroke therapy is safe and effective at smaller hospitals
Studies explore rapid treatment of sepsis and cardiac arrest
Surgical simulation training improves speed and confidence in residents learning endoscopic sinus surgery
Thoracic surgeons can help patients stop smoking with a brief smoking cessation program
Deaths from hospital complications drop, disparities remain
Cost of hospital treatment for blood infection surges

Research Activities, July 2010:
One in four patients experiences revolving-door hospitalizations
Patients at small urban hospitals are more likely to suffer from pressure sores than those at small rural hospitals
Study suggests caution in interpreting impact of nurse staffing levels on postsurgical complication rates
Patient outcomes are better than hospital volume for identifying high-quality bariatric surgery centers
New approach reduces microemboli responsible for neurologic injury following open-heart surgery
Implantable heart defibrillator is effective in reducing deaths among older heart failure patients
Body fat distribution in obese trauma patients is not linked to increased inflammation, infections, or mortality
Performance measures requiring antibiotics for pneumonia have not boosted antibiotic use in nonpneumonia patients
Hospitalization rates have declined over 5 years for patients with HIV infection, but disparities still exist
Nearly 9 percent of children experience agitation during sedation for nonsurgical procedures
Computerized provider order entry significantly reduces medication errors in an ambulatory setting
No additional benefit seen with remote offsite monitoring of ICU patients
Hospital heart attack deaths plummet

Research Activities, June 2010:
Respiratory syncytial virus is more serious than the flu in young children
Nonplatinum chemotherapy agents more likely to lead to hospitalizations for older women with ovarian cancer
Developing community health resources entices more elderly patients to seek hospital care locally
Patients who undergo knee ligament reconstruction do better when the doctor or hospital perform it frequently
Higher nurse-patient ratios result in societal cost benefits for some hospital areas
Medicare Advantage enrollees are admitted to hospitals with higher mortality rates than Medicare fee-for-service enrollees
Paramedics sometimes interrupt CPR to open airway
Study reveals high rates of rehospitalizations and emergency pain treatment for sickle cell disease
Black children are more likely to be hospitalized for a ruptured appendix than white children
For 1 in 10 Medicaid patients, it's back to the hospital in a month

Research Activities, May 2010:
Hospital charges for the uninsured have soared
Adverse events occurring during pediatric sedation are recorded in charts but not always reported
Study provides insights into problems confronting quality improvement educational programs in rural hospitals
Some patients are more satisfied when they are given usually unnecessary antibiotics for upper respiratory infections
Emergency department treatment of asthma with systemic corticosteroids is not always timely
General hospitals are stepping up specialty services in response to competition from single specialty hospitals
Treating blood infections tops annual hospital cost increases
Why women are admitted to the hospital
Patients who take a proton-pump inhibitor with medicine to prevent blood clots are less likely to be hospitalized for bleeding ulcers

Research Activities, April 2010:
Patients admitted to the hospital on weekends wait for major procedures
To reduce hospital deaths, managing surgical complications may be as important as preventing them
FACE cards have a small positive effect on hospital patients' ability to identify their physicians
Rotavirus was culprit in one-fourth of children's diarrhea-related emergency department visits prior to vaccine
Computer display helps reduce the rates of ventilator-associated pneumonia in surgical intensive care units

Research Activities, March 2010:
Venous thromboembolism is rare in young trauma patients, but a better understanding of its risk factors is needed
Simulation training in the operating room improves competency for the entire operating room team
One patient safety indicator may offer a glimpse at a hospital's overall safety record
Pain management in emergency departments has improved but can still be better
Octogenarians fare well after aortic valve replacements
Hospital discharge software slightly boosts patient and outpatient physician satisfaction
More than half of all hospital procedures are outpatient
Medicare pays for nearly half of rural hospital stays

Research Activities, February 2010:
Being overweight prior to transplant surgery slows improvement in the physical functioning of liver transplant patients
COPD drug triad associated with reduced death and hospitalization rates
Children with cerebral palsy who undergo gait assessment before surgery are less likely to need additional surgery later
Primary care doctors often don't know that a child sought care for asthma in the emergency department
ICU scoring system better predicts the risk of death for trauma patients
Trauma triage system tends to overestimate injury severity
Use of bedside ultrasound by hospital emergency departments is not yet common practice in California
Emergency departments treat 3.5 million crash victims a year

Research Activities, January 2010:
Administration of antimicrobials just prior to surgery reduces the risk of surgical site infections
Simulating equipment failures can be useful to hone anesthesia providers' skills
Fewer public psychiatric hospital beds may lead to higher suicide rates
MEPS respondents underreport emergency department and office visits, but accurately report hospital stays
Individuals who seek care for coughs and colds in emergency departments have social support

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Research Activities, December 2009:
Common attention deficit-hyperactivity disorder drugs have similar risk for emergency visits for cardiac problems
Public reporting of hospital antibiotic timing for patients with pneumonia is not linked to antibiotic overuse or overdiagnosis
Telemedicine reduces children's emergency department visits for nonemergency problems
Laptop test in an emergency department can help detect subtle cognitive deficits following concussions
Certain types of hospitals are more likely to use computerized physician order entry
Staff willingness to change and adapt is important when implementing electronic pharmacy systems
Patient deaths in hospitals cost nearly $20 billion

Research Activities, November 2009:
Children are commonly harmed by adverse events in intensive care units
Quality of care may be more important than volume when it comes to heart bypass surgery
Treating aging baby boomers costs hospitals $56 billion
Hospitalizations for coronary artery disease, heart attack, and stroke are down significantly
Blood transfusions have more than doubled
Childbirth and deliveries are becoming more complicated
Falls send more than 2 million seniors to emergency departments

Research Activities, October 2009:
Physician-owned single specialty hospitals may prod nearby hospitals to increase nurse staffing levels
Four in 10 emergency department visits are billed to public insurance
Patients are increasingly leaving hospitals against medical advice

Research Activities, September 2009:
Increasing the number of primary care physicians can reduce the rate of hospitalizations for bacterial pneumonia
Leakage problems following surgery for rectal cancer can be managed with a minimally invasive approach
Hyperdense basilar artery on unenhanced CT scan predicts a clot in the artery and poorer outcome among stroke patients
Air leak test does not accurately predict problems after breathing tube removal in children
Sports-related injuries account for one in five of children's emergency department visits
Osteoporosis-linked fractures rise dramatically

Research Activities, August 2009:
Hospitals with better safety climates have fewer events that can potentially harm patients
Medicare claims data identify hospital-acquired catheter-associated urinary tract infections with limited accuracy
Accurate secondary diagnosis codes improve risk adjustment of inpatient mortality rates
A greater number of different chronic conditions increases hospital readmissions and costs
Hospital system type affects mortality rates
Common definitions and reverse triage can help hospital planners meet surge capacity demands during emergencies
Only a few academic emergency departments have dedicated pharmacists
More education is needed to improve delirium and sedation management in intensive care units
Performance obstacles negatively affect how ICU nurses perceive the quality and safety of care they deliver
Diagnostic codes alone may misclassify bacterial infections among hospitalized patients with rheumatoid arthritis

Research Activities, July 2009:
Better short-term survival of blacks with heart failure is linked to less severe illness at hospital admission
Quality and accessible primary care is linked to fewer emergency department visits by Medicaid-insured children
Children with acute bone infections can be switched from intravenous to oral antibiotics before hospital discharge
The number of hospitalized children on antifungal therapy has increased along with use of newer antifungal agents
Elderly patients on digoxin, recently discharged from the hospital, are at higher risk for drug-related toxicity
Getting patients admitted to a hospital floor reduces length of stay and congestion in emergency departments
Evidence-based practices improve pain management and lower costs for patients hospitalized for hip fracture
Surgical Apgar score can help pinpoint patients at risk for major complications and/or death after surgery
Several practices of hospital governing boards are linked to improved quality of care
Examining processes, not outcomes, improves patient safety in hospitals
Study uncovers factors that determine when rural hospitals convert to critical access hospital designation
Both patient and hospital factors drive discharge costs of coronary artery bypass graft surgery
Hospitalizations for asthma, diabetes, and other conditions are much higher among the poor

Research Activities, June 2009:
Type of beta blocker may affect mortality after hospitalization for heart failure
Caregivers of individuals with Alzheimer's dementia are more likely to visit emergency departments or be hospitalized when depressed
Deaths and rehospitalizations for elderly patients have not decreased despite advances in heart failure therapies
Discharge process reduces hospital use in the 30 days following discharge
Substance abuse is linked to readmissions for mood disorders
Patient safety events make hospital stays longer and more costly
Staff perceptions of hospital patient safety differ by department and position
WalkRounds program enhances the patient safety climate in hospitals
Study outlines the challenges of conducting quality improvement studies at rural and small community hospitals The cost and impact of medical errors continue long after hospital discharge

Research Activities, May 2009:
Hospital reports on patient safety incidents can be useful in identifying the contributing factors, but often need more detail
Eating disorders are sending more Americans to the hospital

Research Activities, April 2009:
Some patients choose safer hospitals when an insurer offers an incentive program
Perception of patient safety climate in hospitals varies by management level and clinical discipline
Quality improvement collaborative fails to improve infection prevention in surgical patients
Focused review is more effective than random review in discovering errors in surgical pathology cases
ICU nurses handle medical errors differently than they say they do on survey
Nearly a fifth of elderly patients are readmitted after a hospital stay for psychiatric care
Depression and substance abuse treatment hospitalizations declined for Medicare beneficiaries over a decade
Care quality disparities exist for children seen in urban versus rural hospitals
Simulation exercise for hospital resuscitation teams pinpoints training and patient safety issues
Antibiotic use and diarrhea are factors in hospital room contamination with vancomycin-resistant organisms
Older males with underlying health conditions are at a high risk of dying from intestinal bleeding in hospitals
Hospitalists and general internists provide similar quality of care for patients with congestive heart failure
The Northeast United States has the most hospitalizations for brain cancer

Research Activities, March 2009:
Educating patients before hospital discharge reduces readmissions, emergency department visits, and saves money
Economic and housing instability are linked to poor access to health care and higher rates of hospitalization
Hospitals spend less for patients in Medicare Advantage than for patients in fee-for-service Medicare
Winter weather hospitalizes thousands and kills hundreds
10-State project to study methods to reduce central line-associated blood stream infections in hospital ICUs

Research Activities, February 2009:
Quality of care and working conditions influence job satisfaction of surgical residents
Multiple approaches are needed to reduce hospital prescribing errors
Veterans Administration hospitals have a generally positive safety climate, but there is room for improvement
Leadership support and fair work distribution keep morale high during quality improvement initiatives
Hospitals' cost for the top six cardiovascular treatments is nearing $60 billion
Hospitalizations are declining for digestive system bleeding
Hospitals spend less for patients in Medicare Advantage than for patients in fee-for-service Medicare

Research Activities, January 2009:
Patients reveal adverse events in the hospital that are not documented in the medical records
More women than men are hospitalized for chest pain with no known cause
Inpatient treatment for elderly nondementia psychiatric illnesses is shifting into less expensive settings
Daily hemodialysis is cost-effective for intensive care patients with acute kidney injury
Pressure ulcers are increasing among hospital patients

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