At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.

This Big Brother-ish approach is one of a panoply of efforts to promote a basic tenet of infection prevention, hand-washing, or as it is more clinically known in the hospital industry, hand-hygiene. With drug-resistant superbugs on the rise, according to a recent report by the federal Centers for Disease Control and Prevention, and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission.

Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients. So in addition to the video snooping, hospitals across the country are training hand-washing coaches, handing out rewards like free pizza and coffee coupons, and admonishing with “red cards.” They are using radio-frequency ID chips that note when a doctor has passed by a sink, and undercover monitors, who blend in with the other white coats, to watch whether their colleagues are washing their hands for the requisite 15 seconds, as long as it takes to sing the “Happy Birthday” song.

All this effort is to coax workers into using more soap and water, or alcohol-based sanitizers like Purell.

“This is not a quick fix; this is a war,” said Dr. Bruce Farber, chief of infectious disease at North Shore.

But the incentive to do something is strong: under new federal rules, hospitals will lose Medicare money when patients get preventable infections.

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A simulated teaching package that focuses on helping undergraduate medical students to improve their ability to conduct arterial blood gas (ABG) testing has been developed by a team at the Bath Academy in the U.K. This simulated teaching package is expected to advance the competence and confidence levels of Bristol university medical school undergrads to perform these important blood tests.

Arterial blood gases (ABGs) testing is often required in testing sick patients to help diagnose the severity of a condition and assist in assessing treatment. We've learned in highschool that as blood passes through our lungs, oxygen moves into the blood and carbon dioxide moves out of the blood and into the lungs. What an ABG test does is check how well the lungs are able to carry oxygen into the blood and remove carbon dioxide from the blood. The test uses blood drawn from an artery to measure its oxygen and carbon dioxide levels before they enter body tissue.

The Bath Academy, which trains the medical students at the Royal United Hospital, hopes the simulated teaching package will help to improve positive patient outcomes and gain valuable experience for the medical students. For more information, click here>>

A study released today by George Washington University School of Public Health and Health Services (SPHHS) researchers offers an in-depth look at hospitals nationwide and admissions to intensive care units (ICU). The study, published in the journal Academic Emergency Medicine, finds a sharp increase—nearly 50 percent—in ICU admissions coming from U.S. emergency departments.

"These findings suggest that emergency physicians are sending more patients on to the ICU," said SPHHS researcher and lead author Peter Mullins. "The increase might be the result of an older, sicker population that needs more care." The larger question, one that this study couldn't answer, is whether there will be enough ICU capacity in the future to accommodate the growing number of patients, particularly the oldest of the old, the authors said.

Mullins and his colleagues conducted the study by using data from the National Hospital Ambulatory Care Survey, a sample of U.S. hospital-based emergency departments during a seven-year period. They found that ICU admissions jumped from 2.79 million in 2002-2003 to 4.14 million in 2008-2009. The study also shows that during the same time frame overall emergency department admissions grew by only 5.8 percent.

Other key findings of the study:
- ICU admissions grew the most among patients aged 85 and older—increasing 25 percent every two years.
- Utilization of tests and services provided to emergency department patients on their way to the ICU also jumped during the study period, with the largest rise occurring in computerized tomography (CT) or magnetic resonance imaging (MRI) tests. In fact, CT and MRI tests provided while still in the emergency department increased from 16.8 percent to 37.4 percent.
- The most common reasons for ICU admissions were symptoms such as chest pain or shortness of breath that can signal life-threatening conditions like heart attacks.
- On average, patients had to wait five hours in the emergency department before getting into the ICU.

Additional research must be done to find ways to keep critically ill patients from facing long waits in crowded emergency departments, said co-author Jesse Pines, MD, MBA, MSCE, a practicing emergency physician and an associate professor of emergency medicine and health policy at SPHHS.

"Studies have shown that the longer ICU patients stay in the emergency department, the more likely they are to die in the hospital," Pines said. "Better coordination between the emergency department and ICU staff might help speed transfers and prevent complications caused by long emergency department waits," he said.

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Giving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research shows that’s not the case. What’s going on?

Since 2011, new regulations restricting the number of continuous hours first-year residents spend on-call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

And there were tragic examples of the high cost of this exhausting schedule. In 1984, 18-year old Libby Zion, who was admitted to a New York City hospital with a fever and convulsions, was treated by residents who ordered opiates and restraints when she became agitated and uncooperative. Busy overseeing other patients, the residents didn’t evaluate Zion again until hours later, by which time her fever has soared to 107 degrees and she went into cardiac arrest, and died. The case highlighted the enormous pressures on doctors-in-training, and the need for reform in the way residents were taught. In 1987, a New York state commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100 hour a week shifts with 36 hour “call” times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

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Introducing a fleet of social robots in a hospital, so that they can interact with children affected by cancer, will be the final outcome of a new international research project that Universidad Carlos III of Madrid is participating in. The objective is to design and build these devices and to advance the study of societies in which humans and robots mix.

The MOnarCH project (Multi-Robot Cognitive Systems Operating in Hospitals), which involves researchers from approximately ten European companies and research centers, intends to introduce a set of robots that collaborate with medical personnel, relating with the children who are patients in the pediatric ward of the hospital of the Instituto Portugués de Oncología de Lisboa (Portuguese Oncological Institute of Lisbon).

There are several cases that have shown that interacting with robots can be beneficial for certain patients. In the United Kingdom, for example, studies have explored the possibility of using social robots with autistic children. And in Japan, the robot known as Paro (which is shaped like a baby seal, with white fur and black eyes) has been successfully used to improve the state of mind of elderly people and to reduce stress among patients and their caregivers. In fact, it was used in some cases to treat the depression suffered by survivors of the earthquake and subsequent tsunami that devastated the northeast coast of Japan in March of 2011.

The objective of the MonarCH project is to further advance in this direction, making a significant qualitative leap forward. Rather than using a single robot, they will use several formats simultaneously. And instead of attending to a single patient, the fleet of robots will relate with all of the patients on the floor. "In addition, we intend to move forward in the development of robots that can carry on autonomously for long periods of time without the aid of their operators, which is something that at this point has not been achieved in such complex situations," comments the head of the project at UC3M, Miguel Ángel Salichs, a full professor in the University's Systems Engineering and Automation Department.

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What if someone told you that your learners could interact in an environment where safety threats can be eliminated prior to actual patient care? What if, faculty and learners together, could evaluate latent safety threats (LST) in new clinical settings? Would you take the leap into a dynamic simulation healthcare environment? Texas Children’s Hospital (TCH) did. And the results were both beneficial and constructive.

TCH’s long history of quality care and cutting-edge training led to the opening of their Pediatric Simulation Center in late 2009. Equipped with the most advanced technology, learners at TCH can develop their clinical skills when responding to high risk pediatric and obstetrical emergencies and LST in new simulation healthcare environments.

Jennifer Arnold, MD, Pediatric Simulation Center Medical Director, and Kelly Wallin, MS, RN, Assistant Director, determined how the use of simulation might reduce LST in new clinical environments through an intensive learning experience. Arnold concluded that “In Situ simulation prior to implementation can test the environment, staff, and the interaction of both in the delivery of patient care. This can identify and address overt and/or latent threats to patient safety and weaknesses in complex systems involving the interaction of people and the physical environment.”

With the perspective and understanding that future situations must be taken as a unique experience packed with case-specific elements, Arnold developed a five-step program for preparing and implementing a work environment simulation healthcare exercise.

First, Arnold wanted to be sure that everyone’s specific goals were determined to optimize desired outcomes. Then, meetings would be held to plan for the success of the exercise. Deciding on the types of simulation that will be of greatest benefit for operational readiness was next, followed by developing tools, such as checklists, to help guide evaluation during a simulation healthcare procedure. Lastly, preparation was necessary for the day of the event, with both participants and observers oriented to their specific roles.

With the use of this exercise, both Arnold and Wallin discovered unexpected benefits in the work environment simulation process. “Our leadership had a rare opportunity to view their various contributions to the final outcome of patient care delivery. It was very fulfilling to see all components come together and function,” remarks Arnold.

We had a great response to the webinar (Feb 6) "Is Calculating an ROI Impossible?" - presented by Amar P. Patel, MS, NREMT-P, CFC, Director, Center for Innovative Learning, WakeMed Health & Hospitals.

Abstract: There are variables that must be considered when determining if simulation will impact patient safety, make changes in our students' ability to understand and apply the knowledge they gain, and determine if it is a cost-effective way of providing education. Simply put, is calculating an ROI impossible? This webinar will focus on how simulation programs can generate an ROI without using complex calculations. In the end, you will be able to show a return on investment simply by using student feedback, faculty buy-in, and program metrics.

Here’s your chance to continue the conversation. Post your questions/comments here and get a response.

If you missed the webinar and would like a link to the recording, click on the "Contact Us" tab at the top of this page.

Some people believe that being admitted to a teaching hospital in July, when the new medical residents have just arrived, is a guarantee of poor care, and some research supports that view. But a new study suggests that fear of the “July effect” may be exaggerated.

Researchers studied 528,057 admissions to teaching hospitals for spinal surgery. After adjusting for patient characteristics (race, age, number of diagnoses, type of admission and others), patients admitted to teaching hospitals in July fared as well as those admitted in other months by such criteria as in-hospital mortality rates and negative reactions to implanted devices. But there was a slightly higher likelihood of postoperative infection and discharge to long-term care facilities among July admissions, compared with patients admitted in other months.

The study, published online last week in The Journal of Neurosurgery: Spine, found that among sicker, high-risk patients who had more illnesses and higher rates of mortality, there was no difference in any outcome between patients admitted in July and those admitted at other times.

“If there really was a July effect, we would expect it to manifest in these patients, and we didn’t see it,” said the lead author, Jennifer S. McDonald, a researcher in the radiology department at the Mayo Clinic. “We want to reassure patients not to worry, to have their surgery when it’s needed and not to worry about any possible July effect.”

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Healthgrades, an online resource that helps consumers evaluate and compare hospitals, released its list of hospitals that have won its award for clinical excellence.

The honor was given to 262 hospitals, out of more than 4,500 evaluated, that scored in the top 5 percent for clinical outcomes determined by an objective evaluation of government data on 27 different clinical measures.

The Philadelphia-area medical centers recognized by Denver-based Healthgrades with its Distinguished Hospital Award for Clinical Excellence were:

• Thomas Jefferson University Hospital, Philadelphia.
• Methodist Hospital, Philadelphia.
• Penn Presbyterian Medical Center, Philadelphia.
• Grand View Hospital, Sellersville, Pa.
• Lankenau Hospital, Wynnewood, Pa.
• Our Lady of Lourdes Medical Center, Camden, N.J.

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