Reducing hospital inpatient complications: A four year experience

Ronald  Lagoe; Joseph  Bick

doi:10.4236/abb.2013.41A017

Ronald Lagoe, Joseph Bick

Abstract: This study described the use of administrative data and a computer software algorithm, Potentially Preventable Complications, to support reduction of inpatient hospital complications. The study was carried out between 2008 and2012 inSt. Joseph’s Hospital Health Center in Syracuse, New York. The hospital generates approximately 23,000 inpatient discharges annually. The study employed summary tables for individual inpatient complications and patient specific spreadsheets to evaluate and follow adverse outcomes. The spreadsheets were employed by hospital staff to determine whether patient medical records confirm each complication identified by the software. This process resulted in improvement of the accuracy of administrative data describing inpatient complications. The administrative data and the software were also used in conjunction with medical records to Identify patients who received program interventions and still experienced inpatient complications. This process enabled hospital staff to ensure that interventions were being provided and evaluate their effecttiveness. The study demonstrated that, at the aggregate level, the inpatient complication rate per 1000 discharges declined by 33.4 percent, from 56.11 to 37.37 between 2008 and 2011. The principal drivers of this decline were high volume complications such as pneumonia, where the rate declined by 45.7 percent and urinary tract infection where the rate declined by 23.7 percent. The project provided a means of communicating and managing outcomes data that could be implemented and understood by a wide range of health care providers.

Keywords: Hospital Outcomes; Hospital Complications; Quality of Care

Cite this paper: Lagoe, R. and Bick, J. (2013) Reducing hospital inpatient complications: A four year experience. Advances in Bioscience and Biotechnology, 4, 118-125. doi: 10.4236/abb.2013.41A017.

References

[1] Fuller, R.L., McCullough, E.C., Bao, M.Z. and Averill, R.F. (2009) Estimating the costs of potentially prevent able hospital acquired complications. Health Care Financing Review, 30, 17-32.

[2] Lagoe, R.J., Johnson, P.E. and Murphy, M.P. (2011) In patient hospital complications and lengths of stay: A short report. BMC Research Notes, 4, 135. doi:10.1186/1756-0500-4-135

[3] Hoonhout, L.H., de Bruijne, M.C., Wagner, C., Zegers, M., Waaijman, R., Spreeuwenberg, P., Asscherman, H., vander Wal and G., van Tulder, M.W. (2009) Direct medical costs of adverse events in Dutch hospitals. BMC Health Services Research, 9, 27. doi:10.1186/1472-6963-9-27

[4] Dentzer, S. (2011) Urgent measures for an old problem. Health Affairs, 30, 1626. doi:10.1377/hlthaff.2011.0961

[5] Marcus, A. (2009) Bending the curve: The twists and turns. Health Affairs, 28, 1256-1258. doi:10.1377/hlthaff.28.5.1256

[6] Skinner, J., Chandra, A., Goodman, D. and Fisher, E.S. (2009) The elusive connection between health care spending and quality. Health Affairs, 28, w119-w123. doi:10.1377/hlthaff.28.1.w119

[7] Hughes, J.S., Averill, R.F. and Goldfield, N.J. (2006) Identifying potentially preventable complications using a present on admission indicator. Health Care Financing Review, 27, 63-82.

[8] Lagoe, R.J. and Westert, G.P. (2010) Evaluation of hos pital inpatient complications: A planning approach. BMC Health Services Research, 10, 200. doi:10.1186/1472-6963-10-200

[9] Lagoe, R., Pasinski, T., Kronenberg, P., Quinn, T. and Schaengold, P. (2006) Linking health services at the community level. Canada Healthcare Quarterly, 9, 60-65.

[10] National Center for Health Statistics. (2009) International classification of diseases, tenth revision, clinical modification (ICD-10-CM). 2009. http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.html

[11] Centers for Disease Control and Prevention. (1997) Guidelines for prevention of nosocomial pneumonia. Morbidity and Mortality Weekly Report, 46, 1-79.

[12] Niederman, M.S., Craven, D.E., Bonten M.J., et al. (2005) Guidelines for the management of adults with hospital acquired, ventilator-associated, and healthcare associated— Pneumonia. American Journal of Respiratory Critical Care Medicine, 171, 388-416. doi:10.1164/rccm.200405-644ST

[13] McEachern, R. and Campbell Jr., G.D. (1998) Hospital acquired pneumonia: Epidemiology, etiology, and treat ment. Infectious Disease Clinics of North America, 12, 761-779. doi:10.1016/S0891-5520(05)70209-9

[14] Cohen, S.H., Gerding, D.N., Johnson, S., Kelly, C.P., Loo, V.G., McDonald, L.C. and Wilcox, M.H. (2010) Clinical practice guidelines for clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America and the infectious diseases society of America. Infection Control & Hospital Epidemiology, 31, 431-455. doi:10.1086/651706

[15] Gould, C.V., Umscheid, C.A., Agarwal, R.K., Kuntz, G. and Pegues, D.A. (2009) Guideline for prevention of catheter-associated urinary tract infection. Healthcare Infection Control Practices Advisory Committee, Atlanta.

[16] Grossman, S. and Mager, D. (2010) Clostridium difficile: Implications for nursing. MEDSURG Nursing, 19, 155 158.

[17] Novell, M.J. and Morreale, C.A. (2010) The relationship between inpatient fluoroquinolone use and clostridium difficile-associated diarrhea. Annals of Pharmacotherapy, 44, 826-831. doi:10.1345/aph.1M696

[18] Pépin, J., Saheb, N., Coulombe, M.A., Alary, M.E., Corriveau, M.P., Authier, S. and Lanthier, L. (2005) Emergence of fluoroquinolones as the predominant risk factor for clostridium difficile-associated diarrhea: A cohort study during an epidemic in Quebec. Clinical Infectious Disease, 41, 1254-1260.