CMS Hospital Inpatient Quality Reporting Program for FY2025

Sharing key takeaways on the refined HCAHPS measure per the CMS Quality Reporting Center: -> The number of questions in the HCAHPS survey is increased from 29 to 32, with 8 questions added and 5 deleted. -> The new survey will be administered beginning with January 1, 2025, patient discharges -> The crosswalk between current survey and new survey is available here: https://lnkd.in/ej9rub_S -> There are pronounced differences in response rates by mode of survey administration for some patient characteristics. o Black, Hispanic, Spanish language-preferring, younger, and maternity patients are more likely to respond to a telephone survey. o Older patients are more likely to respond to a mail survey My editorial comment: If we don't get feedback from all or at least the majority of our patients, we are only going to hear from the very upset or the very happy patients, with the very upset ones more likely to fill out the survey. Efforts to mobilize response rates are key to improving HCAHPS score.

REDUCE HOSPITAL READMISSIONS Readmissions are costly for both healthcare providers and patients, often resulting from poor care coordination, inadequate patient education, or insufficient discharge planning. To combat this issue, the Centers for Medicare and Medicaid Services (CMS) introduced the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with high readmission rates by reducing their Medicare reimbursements by up to 3%. In response, hospitals and skilled nursing facilities (SNFs) are focusing on improving care transitions and post-acute care to avoid these penalties. Windy City Wound Care plays a vital role in supporting these efforts by providing advanced, compassionate wound care directly in patients' homes. Their team of MDs, NPs, and podiatrists specializes in post-acute, minimally invasive treatments that protect wounds from infection, promote healing, and prevent further complications. By collaborating with hospitals and SNFs, Windy City Wound Care ensures that patients transition smoothly from facility to home, receiving personalized, ongoing care that empowers them to manage their recovery safely. With a strong focus on patient education, infection prevention, and proactive monitoring, their at-home services significantly reduce the likelihood of unnecessary hospital readmissions. This compassionate, home-based approach not only improves patient outcomes but also helps healthcare providers avoid financial penalties under the HRRP, offering a holistic solution to both patient care and healthcare sustainability.

#Dialysis patients are at significant risk of developing a range of lesser-known and potentially deadly #infections that are often missed due to inadequate patient-doctor interactions during clinic visits. These infections, if left undiagnosed, can lead to severe sepsis and other life-threatening conditions 1. Strongyloides stercoralis: This parasitic nematode can cause chronic infections and hyperinfection syndrome, especially in immunocompromised patients. It is often misdiagnosed as a simple gastrointestinal issue, leading to severe outcomes such as respiratory failure and disseminated infection if untreated 2. Schistosomiasis: This parasitic infection can be particularly insidious in dialysis patients, leading to chronic complications if not identified and treated early. It is often underdiagnosed due to nonspecific symptoms 3. Cryptosporidiosis: Caused by the Cryptosporidium parasite, this infection can lead to severe gastrointestinal symptoms and dehydration in dialysis patients, often mistaken for less severe conditions 4. Giardiasis: Another parasitic infection, caused by Giardia lamblia, can cause prolonged diarrhea and weight loss. It often goes undiagnosed due to its subtle onset and nonspecific symptoms 5. Echinococcosis: This infection, caused by Echinococcus tapeworms, can result in cyst formation in various organs, often misdiagnosed as tumors or abscesses 6. Toxoplasmosis: Caused by Toxoplasma gondii, this infection can cause severe complications in immunocompromised patients, including encephalitis and retinitis 7. Leishmaniasis: This parasitic disease can cause visceral and cutaneous manifestations, frequently misdiagnosed as other dermatological or gastrointestinal conditions 8. Microsporidiosis: This infection, caused by microsporidia, can lead to chronic diarrhea and is often undiagnosed in immunocompromised patients 9. Cyclospora infection: This causes severe gastrointestinal symptoms and is often misdiagnosed as a bacterial gastroenteritis 10. Amebiasis: Caused by Entamoeba histolytica, this infection can cause severe colitis and liver abscesses Infections among dialysis patients are often missed by nephrologists primarily due to the brief and insufficient patient interactions during "wave rounds" in dialysis centers, where the focus is predominantly on immediate dialysis-related issues rather than comprehensive health assessments. This limited interaction can result in overlooked symptoms and delayed diagnosis of infections. Additionally, in-center dialysis patients face higher risks of infections because of their frequent exposure to healthcare environments and the potential for cross-contamination. The surveillance for chronic infections is often less rigorous in in-center settings compared to home dialysis, where patients typically receive more thorough education on self-monitoring, enabling earlier detection and treatment of infections #InfectionPrevention #Nephrology #PatientSafety #HealthcareReform

A comprehensive guideline by Dr. David Provenzano and colleagues, published in Regional Anesthesia and Pain Medicine, establishes consensus infection control practices for regional anesthesia and chronic pain medicine. These guidelines aim to reduce infectious complications, enhance diagnosis, and improve treatment outcomes in procedural and surgical settings. The publication highlights the clinical and economic burden of surgical site infections (SSIs), detailing their prevalence and associated pathogens. It provides recommendations on managing preoperative patient risk, sterile techniques, and postoperative care. Specific measures include the use of styletted needles for intradiscal procedures and avoiding corticosteroid injections near planned surgeries. This work emphasizes the importance of evidence-based, multidisciplinary approaches to infection control, ensuring better safety and outcomes for patients undergoing acute and chronic pain management interventions. 📖 Learn more: https://lnkd.in/dKNiBj-j

When a patient has symptoms of a severe infection, how do we approach treatment? Suppose the patient is already hospitalized for other reasons. As soon as we (nurses) see a temperature spike with increased heart rate or decreased blood pressure, we notify the providers, who immediately order labs (blood culture, urine culture, wound culture, lactate level, metabolic panel, etc.). If there is a reason to suspect a new or worsening infection, the provider will order a broad-spectrum antibiotic and fluids, maybe a vasopressor to increase blood pressure, followed by a recheck of the lactate level when the fluids are completed. Ideally, the patient will get antibiotics within the first hour of noticing symptoms and be closely monitored throughout. The type of antibiotic will change later when the blood or urine culture narrows down the pathogen causing the infection. On the other hand, if a patient is feeling these symptoms at home, they may feel sick, have a fever, feel dizzy, and be nauseated, but they may not know what is causing these symptoms or associate them with an infection. They may not realize how sick they actually are. If they present to the emergency department, the treatment modality is the same: labs, antibiotics, fluids, close monitoring, and recheck of labs. Patients who are at high risk for infections (e.g., cancer patients with a compromised immune system) are educated to monitor their temperature at home and to present to the emergency room immediately when they notice any abnormalities. In any case, the success of treatment lies in how quickly the patient gets treated for the infection. When we discharge a patient after surgery, we include education about monitoring for local and systemic signs of infection as part of the discharge teaching. Every hour of delayed treatment increases the odds of poor outcomes by about 10%. Please don't hesitate to reach out if you have questions. #sepsis #sepsisbundle #medicalmalpractice #wrongfuldeath #legalnurse

Why Are We Still Ignoring Fistula Health? ⛔ For dialysis patients, arteriovenous fistulas (#AVFs) are more than just a treatment option—they are a lifeline. Yet, despite their crucial role in sustaining the lives of those with kidney disease, fistula health is shockingly under-prioritized in the broader conversation about renal care. It’s time to ask why we are not focusing on AVF health with the urgency it deserves. 🩸For patients on #hemodialysis, a well-functioning fistula allows for effective treatment, reducing reliance on temporary catheters with higher infection risks. But when AVF issues arise patients face delays in their treatment and life-threatening complications. 👩⚕️ Where Are the Vascular Surgeons? One of the most pressing questions is why there isn’t a stronger emphasis on vascular surgeons stepping in to improve fistula care. These experts are key to successful AVF placements and minimizing complications like infections or blood flow issues. But in too many cases, patients receive suboptimal care due to lack of access to specialized, experienced surgeons. The renal care community must urgently focus on addressing the following overlooked issues: 🛠 Maturation Failure: Without proper attention to preoperative assessments and vessel quality, fistulas often fail to mature, forcing patients to rely on riskier dialysis options. 🦠 Infection rates from fistulas are alarmingly high when preventive measures aren’t prioritized. Where are the updated protocols and training to keep fistulas free from infection risks? 💔 Inconsistent Follow-Up Care: Not all patients receive the same level of postoperative monitoring, leading to complications like stenosis or thrombosis. Disparities in healthcare access mean that some patients face a higher risk of fistula failure simply because they cannot get the follow-up care they need. ⌛ Delayed Maturation: For many, fistula maturation can take 6-9 months, delaying dialysis and increasing the risk of catheter-related infections. Without regular monitoring, these delays can become deadly. By continuously neglecting these issues, we are putting patients' lives at risk. It’s not just about providing dialysis—it’s about ensuring the quality of the treatment, starting with the fistula. 🔍 We must push for greater education around fistula health. Patients need to know how to care for their AVFs. Families must be informed about the importance of early intervention when issues arise. And the entire healthcare system has to place a higher priority on AVF maintenance to prevent the cascade of complications that come from neglect. 👩🔬 Innovation Is Urgently Needed We need to explore innovative solutions such as far-infrared therapy for faster fistula maturation, wearable monitoring devices for real-time AVF health checks, and more accessible mobile care units to reach underserved populations. Tim Fitzpatrick

#SEPSIS ⏬⏬⏬ Sepsis is a life-threatening condition that arises when the body's response to an infection becomes uncontrolled and causes widespread inflammation. Clinical indicators for diagnosing sepsis include: 1. Systemic Inflammatory Response Syndrome (SIRS) criteria: - Body temperature >38°C (100.4°F) or <36°C (96.8°F) - Heart rate >90 beats per minute - Respiratory rate >20 breaths per minute or PaCO2 <32 mmHg - White blood cell count >12,000 cells/μL or <4,000 cells/μL 2. Organ dysfunction indicators: - Cardiovascular: Hypotension (SBP <90 mmHg), vasopressor requirement - Respiratory: Hypoxemia (PaO2/FiO2 <300), mechanical ventilation - Renal: Oliguria (<0.5 mL/kg/h), creatinine increase - Hepatic: Bilirubin increase, coagulopathy - Neurological: Altered mental status, Glasgow Coma Scale <13 3. Other indicators: - Suspected or documented infection - Increased lactate levels (>2 mmol/L) - Coagulation abnormalities (e.g., thrombocytopenia, DIC) The quickSOFA (qSOFA) score is a simplified tool for identifying sepsis outside of the ICU: 1. Respiratory rate ≥22 breaths per minute 2. Altered mentation (Glasgow Coma Scale <15) 3. Systolic blood pressure ≤65 mmHg Keep in mind that sepsis diagnosis requires a combination of these indicators and clinical judgment. Here are some additional details on sepsis diagnosis and management: *Diagnosis:* - Clinical suspicion: Recognize signs and symptoms, such as fever, tachycardia, tachypnea, and altered mental status. - Laboratory tests: - Blood cultures - Complete Blood Count (CBC) - Blood chemistry (e.g., lactate, creatinine) - Inflammatory markers (e.g., CRP, procalcitonin) - Imaging studies: Chest X-ray, CT scans, or other imaging as needed to identify sources of infection. *Management:* 1. *Early recognition and intervention*: Identify sepsis promptly and initiate treatment within the first hour (the "golden hour"). 2. *Fluid resuscitation*: Administer IV fluids (e.g., crystalloids, colloids) to restore blood pressure and perfusion. 3. *Antibiotics*: Start broad-spectrum antibiotics as soon as possible, then narrow the spectrum based on culture results. 4. *Vasopressor support*: Use vasopressors (e.g., norepinephrine, vasopressin) to maintain blood pressure if needed. 5. *Source control*: Identify and address the source of infection (e.g., abscess drainage, surgical intervention). 6. *Supportive care*: Manage organ dysfunction, provide oxygen, and monitor for complications. - Sepsis-3 defines three stages: 1. Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection. 2. Severe sepsis: Sepsis with organ dysfunction (e.g., hypotension, respiratory failure). 3. Septic shock: Sepsis with persistent hypotension despite fluid resuscitation. #sepsis #medicalcoder #interview #jobs #codingtips #coders #healthcare #diagnosis #clinicalindicaters #dubai #cfbr #followformoreupdates

MolecuLight 's Profound Impact on Wound Healing Highlighted in Breaking Clinical Research Pittsburgh, PA, USA – August 6th, 2024 – MolecuLight Corp., the global leader in fluorescence imaging technology for real-time detection of harmful bacteria in wound care, announces the publication of peer-reviewed clinical research highlighting the transformative power of MolecuLight in healing more pressure injuries with fewer infection complications among 167 Medicare beneficiaries across 55 US-based Long Term Care and Skilled Nursing Facilities.   Published by Martha R Kelso, RN, CHWS, HBOT and colleagues, the article entitled “Improving Wound Healing and Infection Control in Long-term Care with Bacterial Fluorescence Imaging” is featured in the latest edition of Advances in Skin & Wound Care journal. The authors report an impressive improvement in pressure injury outcomes among incredibly complex and healing-challenged patients. This is a testament to the power of MolecuLight technology, which continues to prove its effectiveness even in the most challenging patient base.   When comparing the outcomes of patients that were treated per standard of care approach alone with those in which MolecuLight real-time fluorescence was integrated into that care, those in the MolecuLight-imaged group saw 71% more wounds healed by 12 weeks, healed 28% faster, and were 1.8 times more likely to heal their wound by 12-weeks. The researchers also investigated the incidence of severe infection complications including cellulitis, osteomyelitis, gangrene, sepsis, and wound-related hospitalization, reporting a 75% decrease in infection complications when patient care was guided with the help of MolecuLight.   “We are very excited to share with the world through concrete findings what we have been experiencing firsthand with our LTC/SNF patients,” remarks Martha R. Kelso, lead author of this study “The positive effects that the MolecuLight technology has on all patients, even those who are severely sick and compromised, is outstanding. Increasing healing rates, shortening healing times, and avoiding complications IS how you make a difference. All patients deserve the best! I hope that as these remarkable outcomes are shared with our wound care colleagues, they too can be part of this much needed disruption to wound care.”   Full press release here: https://lnkd.in/gz_psD52

Does the use of cefepime or piperacillin-tazobactam affect the risks of AKI or neurologic dysfunction in adults hospitalized with acute infection? Find out more at https://loom.ly/t7YICyI #doctors #disease #medicine #foamed #infection #paitents

📃Scientific paper: Impact of congenital heart disease on outcomes among pediatric patients hospitalized for influenza infection Abstract: BACKGROUND: Young children and those with chronic medical conditions are at risk for complications of influenza including cardiopulmonary compromise. Here we aim to examine risks of mortality, clinical complications in children with congenital heart disease (CHD) hospitalized for influenza. METHODS: We analyzed data from in-hospital pediatric patients from 2003, 2006, 2009, 2012 and 2016 using the nationally representative Kids Inpatient Database (KID). We included children 1 year and older and used weighted data to compare the incidence of in-hospital mortality and rates of complications such as respiratory failure, acute kidney injury, need for mechanical ventilation, arrhythmias and myocarditis. RESULTS: Data from the KID estimated 125,470 children who were admitted with a diagnosis of influenza infection. Out of those, 2174(1.73%) patients had discharge diagnosis of CHD. Children with CHD who required hospitalization for influenza had higher in-hospital mortality (2.0% vs 0.5%), with an adjusted OR (aOR) of 2.8 (95% CI: 1.7–4.5). Additionally, acute respiratory failure and acute kidney failure were more likely among patients with CHD, with aOR of 1.8 (95% CI: 1.5–2.2) and aOR of 2.2 (95% CI: 1.5–3.1), respectively. Similarly, the rate of mechanical ventilatory support was higher in patients with CHD compared to those without, 14.1% vs 5.6%, aOR of 1.9 (95% CI: 1.6–2.3). Median length of hospital stay in children with CHD was longer than those without CHD [4 (IQ... Continued on ES/IODE ➡️ https://etcse.fr/ijFI ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.