Financial Incentives to Reduce Hospital-Acquired Infections Under Alternative Payment Arrangements

Behavioral Strategies in Diagnostic Stewardship

Diagnostic stewardship refers to the responsible and judicious use of diagnostic tests to reduce low value care and improve patient outcomes. This article provides an overview of behavioral strategies, their relevance to diagnostic stewardship and highlights behavioral determinants that drive diagnostic testing behavior, drawing on theoretic frameworks. Additionally, we provide concrete examples of evidence-based behavioral strategies for promoting appropriate diagnostic testing while acknowledging associated challenges. Finally, we highlight the significance of evaluating these strategies and provide an overview of evaluation frameworks and methods.

Implementation of Kangaroo Care in a Pediatric Cardiac Intensive Care Unit

With supporting the best neurodevelopmental outcomes possible, the doctor of nursing practice project was constructed. An educational program was created for nursing staff discussing the importance of kangaroo care and how to safely facilitate it in the intensive care setting. Following the education completion, kangaroo care was implemented. Data were collected exploring barriers to implementation, discharge on maternal breast milk, and parental feedback.

Hospital, Catheter, Peritoneal Dialysis Acquired Infections: Visible Light as a New Solution to Reduce Risk and Incidence

Healthcare-associated infections, often identified as hospital-acquired infections (HAIs), are typically not present during patient contact or admission. Healthcare-associated infections cause longer lengths of stay, increasing costs and mortality. HAI occurring in trauma patients increases the risk for length of stay and higher inpatient costs. Many HAIs are preventable. Antibiotic resistance has increased to a high level making proper treatment increasingly difficult due to organisms resistant to common antibiotics. Therefore, there is a need for alternate forms of attack against these pathogens. Currently, the application of light for the treatment of topical infections has been used. Ultraviolet (UV) light has well-documented antimicrobial properties. UV is damaging to DNA and causes the degradation of plastics, etc., so its use for medical purposes is limited. Using visible light may be more promising. 405-nm light sterilization has been shown to be highly efficacious in reducing bacteria. Light Line Medical, Inc.'s (LLM) patented visible-light platform technology for infection prevention may create a global shift in the prevention of healthcare-associated infections. LLM has developed a proprietary method of delivering light to prevent catheter-associated infections. This technology uses non-UV visible light and can kill both bacteria and prevent biofilm inside and outside a luminal catheter. This is significant as prevention is key. Independent analysis of the prototype system showed the application of the device met the acceptance criterion of 4 x 109-10 reduction in Candida albicans, Staphylococcus aureus, Pseudomonas aeruginosa, and other bacteria and fungal species. Further design evolution for this technology continues, and the FDA submission process is underway.

Healthcare Associated Infections, Nurse Staffing, and Financial Performance

Healthcare associated infections (HAIs) are a concern to patients, hospital administrators and policymakers. For over than a decade, efforts have been made to hold hospitals accountable for the costs of HAIs. This study uses contingency theory as a framework to examine the association between HAIs and hospital financial performance. We use publicly available data on 2059 hospitals in 2014 to 2016 that include HAIs, staffing financial performance, and hospital and hospital market characteristics. The key independent variables are available infection rates and nurse staffing. The dependent variables are indicators of financial performance: operating margin, total margin, and days cash on hand. We find nearly identical negative direct associations between infections and operating margins and total margins (-0.07%), and positive associations between the interaction of infections and nurse staffing (0.05%). A 10% higher infection rate would be predicted to be associated with only a 0.2% lower profit margin. The associations between HAIs, nurse staffing and days cash on hand were insignificantly different from zero.

Management practices for leaders to promote infection prevention: Lessons from a qualitative study

BACKGROUND

Prevention of healthcare-associated infections (HAIs) is critical to reduce preventable deaths and healthcare costs. Variable success with HAI prevention efforts has suggested that management practices are critical to support clinical infection prevention practices. This study examined hospital leaders' management practices around the prevention of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) to identify actions that leaders can take to promote HAI prevention efforts.

METHODS

We conducted interviews with 420 key informants, including managers and frontline staff, in 18 hospitals across the United States. Interviewees were asked about management practices supporting HAI prevention. We analyzed interview transcripts using rigorous qualitative methods to understand how management practices were operationalized in infection prevention efforts.

RESULTS

Across hospitals and interviewees, three management practices were characterized as important facilitators of HAI prevention: (1) engagement of executive leadership; (2) information sharing; and (3) manager coaching. We found that visible executive leadership, efficient communication, and frequent opportunities to provide and promote learning from feedback were perceived to promote and sustain HAI prevention efforts.

CONCLUSIONS

Our findings provide insight into management practices for leaders that support successful HAI prevention. In practice, these tactics may need to be adjusted to accommodate the current restrictions caused by the COVID-19 pandemic, in order to maintain HAI prevention efforts as a priority.