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Top hospitals practice what they preach

What factors increase patients' satisfaction with a hospital? Researchers surveyed key personnel at 52 hospitals rated highly in a national survey designed to measure patient satisfaction. The 138 key personnel who responded to the survey included medical, nursing, and administrative leaders. The hospitals were considered a fair representation of hospitals nationwide, ranging in size from those with over 500 beds to those with less than 200 beds.

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The surveys revealed some common features shared by most top hospitals. For example, 77% of respondents said that commitment to patients and families was part of their culture. On the clinical level, 83% reported the practice of proactive nursing rounds, during which nurses visit patients periodically and ask specific questions related to their care. And 62% of respondents reported leadership rounds, in which hospital executives and other leaders visit patients and staff members to discuss problems or concerns. Many of these highly rated hospitals also promote certain behaviors, such as making eye contact with patients and sitting at the bedside in order to talk to patients at eye level.


Commenting on the importance of a patient-centered hospital culture, lead study author Hanan Aboumatar, MD, MPH, says, "It may seem a simple thing, but if leaders and staff members don't prioritize this commitment [to patients and families] and link it to the greater mission, it becomes easier to lose sight of it in the hectic pace of hospital care."


Sources: Aboumatar HJ, Chang BH, Al Danaf J, et al. Promising practices for achieving patient-centered hospital care: a national study of high-performing US hospitals. Med Care. 2015;53(9):758-767. Survey reveals best practices that lead to high patient ratings of hospital care. Johns Hopkins Medicine. News release. August 10, 2015.



Patients waltz to recovery with favorite music

Mozart, Stevie Wonder, Eminem: whatever a patient's favorite music might be, listening to it can ease recovery after surgery. In a retrospective study, researchers determined that listening to favorite music before, during, or after surgery significantly lowered patients' pain, anxiety, and analgesic use and increased their satisfaction with care.


Researchers reviewed data from 73 randomized controlled trials (RCTs) that involved playing music before, during, or after surgery. The RCTs varied in size from 20 to 458 participants. Choice of music, timing, and duration also varied. Outcomes associated with music therapy were compared to those associated with routine care, headphones with no music, white noise, and undisturbed bed rest.


Analysis revealed that music reduced post-op pain, anxiety, and analgesia use, and increased patient satisfaction. Music was effective even when patients were under general anesthesia. However, music didn't affect length of stay, and the choice and timing of music made little difference.


Researchers recommend offering music to patients to help reduce pain and anxiety during the postoperative period and note that timing and delivery can be adapted to individual clinical settings and medical teams.


Source: Hole J, Hirsch M, Ball E, Meads C. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet. [e-pub Aug. 12, 2015]



Guidelines stress value of patient history

New recommendations from the American College of Obstetricians and Gynecologists regarding assessment for early-onset preeclampsia reject the use of commercial tests and reiterate that the best tool is a detailed patient history. Despite their "modest predictive value," various commercial risk assessment tools are marketed to help clinicians assess a patient's risk of early-onset preeclampsia in the first trimester. The guidelines state that taking a detailed medical history to evaluate risk factors is the only recommended screening approach for preeclampsia, and "it should remain the method of screening for preeclampsia until studies show that aspirin or other interventions reduce the incidence of preeclampsia for women at high risk based on first-trimester predictive tests."

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Source: Committee opinion No. 638: first-trimester risk assessment for early-onset preeclampsia. Obstet Gynecol. 2015;126(3):e25-e27.



Late referrals undermine confidence

Prolonged diagnostic intervals before patients are referred for cancer testing lead to patient dissatisfaction with subsequent cancer treatment, according to a large British study. Researchers analyzed data from more than 73,000 survey responses to determine whether cancer patients with three or more prereferral visits to a general practitioner (GP) were more likely to have negative impressions of subsequent care compared with patients with only one or two prereferral consultations. Of the almost 60,000 survey respondents who received a cancer diagnosis through their GP, nearly 23% had been seen three or more times before being referred for cancer tests.


Thirty-nine percent of patients who experienced referral delays were unhappy with the care they received from their GP and nurses, compared with 28% of those referred for testing after one or two visits.


Patients with delayed referrals were more likely to report dissatisfaction on 10 of 12 aspects of their care. For example, 32% of these patients said they lacked confidence in the hospital nurses who care for them, compared with 28% of early referral patients.


"This research shows that first impressions go a long way," said Dr. Georgios Lyratzopoulos, one of the study's authors. "A negative experience of diagnosis can trigger a loss of confidence in care throughout the cancer journey."


Sources: Mendonca SC, Abel GA, Saunders CL, Wardle J, Lyratzopoulos G. Pre-referral general practitioner consultations and subsequent experience of cancer care: evidence from the English Cancer Patient Experience Survey. Eur J Cancer Care (Engl). [e-pub July 30, 2015] Cancer patients lose faith in healthcare system if referred late by GP. Cancer Research UK. News release. July 31, 2015.



Protection may wane after 6 months

The influenza vaccine offers moderate, sustained protection for up to 6 months, the duration of most flu seasons, but its effectiveness drops sharply after 6 months. This was the preliminary finding of a study involving data on 1,720 Americans of all ages over four flu seasons. However, administering the vaccine early in the fall, before flu season begins, is still a good strategy for decreasing the number of infections overall.


The research was presented at the 2015 International Conference on Emerging and Infectious Diseases in Atlanta, Ga.


Source: Influenza vaccines provide moderate protection throughout the entire flu season. American Society of Microbiology. News release. August 24, 2015.



Staff perception doesn't match reality

In a study of 141 hospitals that treated 48,201 stroke patients in 2009 and 2010, researchers found that staff perceptions of door-to-needle time often failed to match the facility's actual performance. Current guidelines recommend administering tissue plasminogen activator (tPA) to appropriate patients within 60 minutes of arrival at the hospital door. But the study showed that only 29% of hospital staff accurately estimated average door-to-needle times at their facility.


Based on the percentage of time they appropriately administered tPA, hospitals were categorized as low-, middle-, or top-performing. Staff from 42% of middle-performing hospitals and 85% of low-performing hospitals overestimated their facility's door-to-needle performance. In addition, staff from nearly 20% of low-performing hospitals thought their hospitals' performance was above the national average.


"Our findings indicate the need to routinely provide comparative provider performance rates as a key step to improving the quality of acute stroke care," the authors conclude.


Sources: Lin CB, Cox M, Olson DM, et al. Perception versus actual performance in timely tissue plasminogen activation administration in the management of acute ischemic stroke. J Am Heart Assoc. 2015;4(7).



No hard facts about cleaning hard surfaces

Surprisingly, research is lacking on the best methods to disinfect hard surfaces in hospitals, according to investigators who analyzed 76 primary studies and 4 systematic reviews examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci. Of these 80 studies, only 5 were randomized controlled trials; surface contamination was the most commonly assessed outcome. Forty-nine studies examined cleaning methods, 14 studies examined monitoring strategies, and 17 focused on the challenges to implementing them. Studies that compared the effectiveness of disinfecting methods were uncommon.

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Researchers recommend these areas for further inquiry:


* evaluating emerging products and strategies, such as self-disinfecting coatings for surfaces and adenosine triphosphate and UV/fluorescent surface markers for monitoring


* analyzing patient-related outcomes, such as infection rates


* identifying high-touch surfaces that are most likely to transmit pathogens


* developing standard thresholds for defining cleanliness.



Source: Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA. Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief. Ann Intern Med. [e-pub Aug. 11, 2015]



Getting more fit improves outcomes

To determine whether cardiorespiratory fitness improves rhythm control in obese or overweight patients with atrial fibrillation (AF), researchers studied 308 patients with AF and a body mass index of 27 or more. Based on exercise stress testing to determine patients' peak metabolic equivalents (METs), the study participants were placed in one of three fitness groups-low, adequate, and high fitness-and offered a tailored weight loss and exercise program. Rhythm control was determined via 7-day Holter monitoring and an AF severity scale questionnaire. After 4 years, researchers found that 84% of those in the high-fitness group no longer had AF, compared with 76% in the adequate fitness group and only 17% in the low fitness group. They noted that "arrhythmia-free survival with and without rhythm control strategies was greatest in those with METs gain >= 2 compared to those with METs gain < 2 in cardiorespiratory fitness." Improved cardiorespiratory fitness also "augments the beneficial effects of weight loss."

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Sources: Pathak RK, Elliott A, Middeldorp ME, et al. Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol. 2015;66(9):985-996. Exercise may be good medicine for irregular heartbeat. HealthDay News. August 24, 2015.


In November, celebrate


* COPD Awareness Month http://www.lung.org


* National Family Caregivers Month http://www.caregiveraction.org


* National Stomach Cancer Awareness Month http://www.nostomachforcancer.org


* Great American Smokeout (November 19) http://www.cancer.org