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Friday, November 17, 2017
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Health Care Rules
Patients Say Should Be Broken

Healthcare organizations can take specific action to mitigate the burden of unnecessary regulations without sparking political battles or slogging through policy changes, according to a viewpoint published in JAMA.

Written by three leaders from the Institute for Healthcare Improvement — Donald Berwick, MD, president emeritus, senior fellow and former CMS administrator; Saranya Loehrer, MD, head of the North America region; and Christina Gunther-Murphy, executive director — the viewpoint details an initiative to identify and eliminate unnecessary rules. Some were originally well-intended, but outdated; some were misinterpreted and their application no longer provided value; while others were simply obstructive regulations.

To identify rules perceived as unnecessary, 24 healthcare organizations from the IHI's Leadership Alliance tapped staff and patients for their feedback during a "Breaking Rules for Better Care Week" in January 2016. They asked, "If you could break or change any rule in service of a better care experience for patients or staff, what would it be?" Across the organizations, 342 rules were identified — and a few common themes emerged.

Here are the 10 most common rules, norms and/or habits staff and patients say hospitals should break.
1.Visiting hours and policies that restrict visitors' time with patients — 15 mentions
2.CMS' three-day rule, which requires three consecutive days of inpatient stay for Medicare to cover skilled nursing facility care — 13 mentions
3.Licensure rules that prohibit clinicians from working to the top of their license — 13 mentions
4.Limited same-day appointments and direct access to physicians over the phone —10 mentions
5.Long wait times for appointments, surgeries and discharges (i.e. no double booking, providing discharge schedules, etc.) —10 mentions
6.HIPAA regulations and misunderstandings that lead to delays and communication issues — 8 mentions
7.Lack of engagement with family members and loved ones — 6 mentions
8.Unnecessary interruptions to patient sleep throughout the night — 5 mentions
9.Duplicative paperwork — 5 mentions
10.Infrequent patient ambulation — 5 mentions

After the exercise, many of the organizations took action to ensure rules were interpreted correctly and true to their original intent through staff education, clarification from regulatory agencies, changing local policies and lobbying policy makers, according to the viewpoint.

"Healthcare leaders may be well advised to ask their clinicians, staffs and patients which habits and rules appear to be harming care without commensurate benefits and, with prudence and circumspection, to change them," the authors concluded.

Investigating The Unusual Death of a Man
At a New York Hospital

The New York State Department of Health opened an investigation into Ithaca, N.Y.-based Cayuga Medical Center following the death of an unnamed patient in the medical center's emergency department waiting room last month, according to the Ithaca Journal.

According to CMC officials, the 52-year-old man arrived at the ED at 6:07 p.m. Jan. 19 after a witness discovered him asleep on the floor of a convenience store. He was reportedly conscious and fully alert upon arrival at the medical center, according to the article. However, he was found dead in the waiting room at 8:32 p.m.

After conducting an internal investigation, officials discovered one of the contract nurses on duty at the time of the incident "falsified her triage documentation," David Evelyn, MD, CMC's vice president of medical affairs, told the Ithaca Journal. Dr. Evelyn said the medical center discovered video evidence that shows the nurse did not ask the patient routine questions and did not measure the patient's vital signs she later reported in her records.

"She said [triage] was done in the waiting room," Dr. Evelyn said. "We see [the patient] in the waiting room, but the two hours he's in the waiting room, the nurse doesn't approach him at all. Vital signs are logged when he's already in the room, and she was at a desk."

Dr. Evelyn said the nurse, a contract travel nurse who was not new to the hospital, was terminated after video review and interviews.

Following the incident, CMC officials contacted the DOH and the medical examiner. The results of the autopsy have not yet been disclosed, according to the article.

Officials said the medical center made several changes to protocol following the incident, including assigning a triage nurse to cover the waiting room at all times. CMC also instituted safety briefings for all shifts.

"Obviously this is a serious event, and we view it as a defining moment for us to say how do we look at our processes and how do we change processes so something like this will never happen again," Deb Raupers, RN, the hospital's vice president of patient services, told the Ithaca Journal.

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