Hospital Process of Care Measures

Surgical Care Improvement Project Process of Care Measures

Hospitals can prevent surgical wound infections. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections.

The timing is important: getting an antibiotic earlier, or after surgery begins, is not as effective. Hospital staff should make sure patients get antibiotics at the right time.

Higher numbers are better.

Hospitals can prevent surgical wound infections. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery.

Hospital staff should make sure patients get the antibiotic that works best for their type of surgery.

Higher numbers are better.

It is often standard procedure to stop patients' usual medications for awhile before and after their surgery. But if patients who have been taking beta blockers suddenly stop taking them, they can have heart problems such as a fast heart beat. For these patients, staying on beta blockers before and after surgery makes it less likely that they will have heart problems.

Higher numbers are better.

Surgical wound infections can be prevented. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections. Getting an antibiotic earlier, or after surgery begins, is not as effective. Hospital staff should make sure surgery patients get antibiotics at the right time.

Higher numbers are better.

Surgical wound infections can be prevented. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery. Hospital staff should make sure patients get the antibiotic that works best for their type of surgery.

Higher numbers are better.

Antibiotics are often given to patients before surgery to prevent infection. Taking these antibiotics for more than 24 hours after routine surgery is usually not necessary. Continuing the medication longer than necessary can increase the risk of side effects such as stomach aches and serious types of diarrhea. Also, when antibiotics are used for too long, patients can develop resistance to them and the antibiotics won't work as well.

Higher numbers are better.

Sometimes surgical patients need to have a urinary catheter, or thin tube, inserted into their bladder to help drain the urine. Catheters are usually attached to a bag that collects the urine.

Surgery patients can develop infections when urinary catheters are left in place too long after surgery. Infections are dangerous for patients, cause longer hospital stays, and increase costs.

This shows the percent of surgery patients whose urinary catheters were removed on the first or second day after surgery. Research shows that most surgery patients should have their urinary catheters removed within 2 days after surgery to help prevent infection.

Higher numbers are better.

Certain surgeries increase the risk that the patient will develop a blood clot (venous thromboembolism). When patients stay still for a long time after some types of surgery, they are more likely to develop a blood clot in the veins of the legs, thighs, or pelvis. A blood clot slows down the flow of blood, causing swelling, redness, and pain. A blood clot can also break off and travel to other parts of the body. If the blood clot gets into the lung, it is a serious problem that can cause death.

To help prevent blood clots from forming after surgery, doctors can order treatments to be used just before or after the surgery. These include blood-thinning medications, elastic support stockings, or mechanical air stockings that help with blood flow in the legs.

Higher numbers are better.

Many factors influence a surgery patient's risk of developing a blood clot, including the type of surgery. When patients stay still for a long time after some types of surgery, they are more likely to develop a blood clot in the veins of the legs, thighs, or pelvis. A blood clot slows down the flow of blood, causing swelling, redness, and pain. A blood clot can also break off and travel to other parts of the body. If the blood clot gets into the lung, it is a serious problem that can sometimes cause death.

 

Treatments to help prevent blood clots from forming after surgery include blood-thinning medications, elastic support stockings, or mechanical air stockings that help with blood flow in the legs. These treatments need to be started at the right time, which is typically during the period that begins 24 hours before surgery and ends 24 hours after surgery.

Higher numbers are better.

Heart Attack/Chest Pain Process of Care Measures

• "ECG" (sometimes called EKG) stands for electrocardiogram. An ECG is a test that can help doctors know whether patients are having a heart attack.
• Standards of care say that patients with chest pain or a possible heart attack should have an ECG upon arrival, preferably within 10 minutes.
• This measure tells the average (median) number of minutes it takes before patients got an ECG.
• Sometimes patients get an ECG done before they get to the hospital (for example, by the ambulance staff). This is counted as "0 minutes."

• Blood clots can cause heart attacks. Certain patients having a heart attack should get a "clot busting" medication to help break up the blood clots and improve blood flow to the heart.
• Standards for care say that a clot busting medication should be given within 30 minutes of arrival at the hospital.
• This measure tells the percent of patients who received a clot busting medication within 30 minutes of arrival.

• Blood clots can cause heart attacks. For many patients having a heart attack, taking aspirin soon after symptoms of a heart attack begin may help break up a clot and make the heart attack less severe. If patients have not taken aspirin themselves before going to the hospital, they should get aspirin when they arrive.
• Standards for care say patients should get aspirin within 24 hours of arrival at the hospital. This measure tells what percent of patients got aspirin within this time period.

Blood clots can block blood vessels. Aspirin can help prevent blood clots from forming. Following a heart attack, continued use of aspirin may help reduce the risk of another heart attack. Aspirin can have side effects like stomach inflammation, bleeding, or allergic reactions. Talk to your health care provider before using aspirin on a regular basis to make sure it's safe for you.

Higher percentages are better.

The heart is a muscle that gets oxygen through blood vessels. Sometimes blood clots can block these blood vessels and the heart can't get enough oxygen. This can cause a heart attack. Fibrinolytic medications are medicines that can help dissolve blood clots in blood vessels and improve blood flow to your heart. You should get them within 30 minutes of arrival at the hospital.

Higher percentages are better.

Pneumonia Process of Care Measures

Different types of bacteria can cause pneumonia. A blood culture is a test that can help your health care provider identify which bacteria may have caused your pneumonia, and which antibiotic should be prescribed. A blood culture is not always needed, but for patients who are first seen in the hospital emergency department, it is important for the accuracy of the test that blood culture be conducted before any antibiotics are started. It is also important to start antibiotics as soon as possible.

Higher percentages are better.

Pneumonia is a lung infection that is usually caused by bacteria or a virus. If pneumonia is caused by bacteria, hospitals will treat the infection with antibiotics. Different bacteria are treated with different antibiotics. To learn about how hospitals use a blood test to choose the most effective treatment for pneumonia patients, refer to the Process of Care measure named Percent of Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics.

Higher percentages are better.

Immunization Process of Care Measures

Pneumococcal infections result in increased hospitalizations and death. The pneumococcal vaccine may help prevent, or lower the risk of complications of pneumonia caused by bacteria. It may also help prevent future infections. Hospitalization is an opportunity to screen and provide the vaccination.

About 1 in 5 people in the United States get influenza every season. Flu shots reduce the risk of influenza, a serious and sometimes deadly lung infection that can spread quickly in a community. Vaccination is associated with reduction in influenza among all age groups and is the most effective method for prevention of influenza and its severe complications. Hospitalization is an opportunity to screen and provide the vaccination.

Heart Failure Process of Care Measures

Heart failure is a chronic condition. It results in symptoms such as shortness of breath, dizziness, and fatigue. Before you leave the hospital, the staff at the hospital should provide you with information to help you manage the symptoms after you get home. The information should include your

• activity level (what you can and can't do)
• diet (what you should, and shouldn't eat or drink)
• medications
• follow-up appointment
• watching your daily weight
• what to do if your symptoms get worse

Higher percentages are better.

The proper treatment for heart failure depends on what area of your heart is affected. An important test is to check how your heart is pumping, called an "evaluation of the left ventricular systolic function." It can tell your health care provider whether the left side of your heart is pumping properly. Other ways to check on how your heart is pumping include:

• your medical history
• a physical examination
• listening to your heart sounds
• other tests as ordered by a physician (like an ECG (electrocardiogram), chest x-ray, blood work, and an echocardiogram)

Higher percentages are better.

ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are medicines used to treat patients with heart failure and are particularly beneficial in those patients with heart failure and decreased function of the left side of the heart. Early treatment with ACE inhibitors and ARBs in patients who have heart failure symptoms or decreased heart function after a heart attack can also reduce their risk of death from future heart attacks. ACE inhibitors and ARBs work by limiting the effects of a hormone that narrows blood vessels, and may thus lower blood pressure and reduce the work the heart has to perform. Since the ways in which these two kinds of medications work are different, your doctor will decide which medication is most appropriate for you. If you have a heart attack and/or heart failure, you should get a prescription for ACE inhibitors or ARBs if you have decreased heart function before you leave the hospital.

Emergency Department Care Measures

Emergency departments that provide prompt, condition-specific patient care typically have an increased ability to respond to urgent situations and have reduced wait times. Direct condition-specific treatment tends to decrease time spent with patients and increase the access to additional treatment, which potentially improve outcomes and the overall quality of patient care. Prolonged care may impede the administration of medications or the ordering/reading of tests, which may cause complications.

Less time is better.

Emergency departments that provide prompt, condition-specific patient care typically have an increased ability to respond to urgent situations and have reduced wait times. Direct condition-specific treatment tends to decrease time spent with patients and increase the access to additional treatment, which potentially improve outcomes and the overall quality of patient care. Prolonged care may impede the administration of medications or the ordering/reading of tests, which may cause complications.

Less time is better.

Emergency departments that provide prompt, condition-specific patient care typically have an increased ability to respond to urgent situations and have reduced wait times. Direct condition-specific treatment tends to decrease time spent with patients and increase the access to additional treatment, which potentially improve outcomes and the overall quality of patient care. Prolonged care may impede the administration of medications or the ordering/reading of tests, which may cause complications.

Less time is better.

Emergency departments that provide prompt, condition-specific patient care typically have an increased ability to respond to urgent situations and have reduced wait times. Direct condition-specific treatment tends to decrease time spent with patients and increase the access to additional treatment, which potentially improve outcomes and the overall quality of patient care. Prolonged care may impede the administration of medications or the ordering/reading of tests, which may cause complications.

Less time is better.

Emergency departments that provide prompt, condition-specific patient care typically have an increased ability to respond to urgent situations and have reduced wait times. Direct condition-specific treatment tends to decrease time spent with patients and increase the access to additional treatment, which potentially improve outcomes and the overall quality of patient care. Prolonged care may impede the administration of medications or the ordering/reading of tests, which may cause complications.

Less time is better.

Emergency departments that provide prompt, condition-specific patient care typically have an increased ability to respond to urgent situations and have reduced wait times. Direct condition-specific treatment tends to decrease time spent with patients and increase the access to additional treatment, which potentially improve outcomes and the overall quality of patient care. Prolonged care may impede the administration of medications or the ordering/reading of tests, which may cause complications.

Higher percentage is better.