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The prevention and management of hospital-acquired pressure ulcers, or HAPUs, varies greatly, according to new research. Ask any patient who has ever had one: a bedsore hurts a lot. And if it doesn’t heal, that sore can last for years, eating away at the flesh and leading to infections, sepsis, or even death. That’s why hospitals have worked for years to reduce the chance that patients will develop such sores—also called pressure ulcers or pressure injuries—and to treat new ones quickly. It’s also why Medicare pays less to hospitals with the highest hospital-acquired complication scores, which include HAPUs. But a new study shows important differences between two sources of data used to track the rates and progress of HAPUs. The hospital billing data used to calculate Medicare payment rates and penalties for hospitals may miss many of the HAPUs that patients are actually getting, the study finds. And hospitals’ progress in reducing HAPUs is almost entirely because they prevented less-costly and less dangerous early-stage HAPUs, and not the more severe kind, according to billing data. Read More
Dr. Basil Pruitt returned to San Antonio from Vietnam as commander and director of the U.S. Army Institute of Surgical Research, (the Burn Center) at Brooke Army Medical Center, a position he held for 27 years. When Dr. Basil Pruitt became commander of the U.S. Army Institute of Surgical Research at Fort Sam Houston in 1968, he began a tradition that fellow physicians, nurses and laboratory researchers came to dread — Saturday “grand rounds.” Pruitt went patient to patient at Brooke Army Medical Center with a team that included laboratory section chiefs — pathology, bacteriology, hematology and others. Until Pruitt ran ISR’s burn center, the visits were on weekdays. Lab chiefs were not involved. “When I retired, the next Saturday there were no grand rounds,” he laughed. Pruitt, 88, is considered the father of burn medicine because of the advances he helped pioneer. One of his most important contributions at the ISR, where he spent 27 years, was to discover why burn wounds get infected. He teamed up with the late Arthur D. Mason Jr., chief of the laboratory division, who developed and tested a burn cream on animals. Their work led to a reduction in patient mortality and other important clinical-laboratory collaborations. Read More
The addition of new quality measures for nursing homes receiving federal funds could soon upset the pecking order of Philadelphia’s best — and worst — nursing homes, according to the latest government data. Roughly once every quarter, the federal government updates its quality rankings for nursing homes that receive funds from Medicare and Medicaid. Each facility receives an overall star rating — from one to five — based on its most recent health inspections, staff-to-patient ratios, and quality of care. But this month, the results included something new — stats tracking pressure ulcers, patient-treatment plans, and fall-related injuries. The new measures could offer key insights into the quality of staff responsiveness and care, said David Hoffman, president of a national health care consulting firm based in Philadelphia. “I think staffing is the most important issue in long-term care,” Hoffman said. “And it’s not just numbers — it’s competence.” Read More
Compression therapy is a clinical intervention and high compression therapy produces better healing rates than no compression;4 compression therapy delivers results when a high sub-bandage pressure is delivered to the limb accompanied by a high static stiffness index.5 Unfortunately, despite nearly 30 years of education, there remains a lack of understanding about the role of this important therapeutic intervention and the art required in enabling patients to tolerate the regime. To the untrained ear, reduced or light compression sounds friendly—a kind response to a challenging situation. What would happen if we changed our language and called these reduced regimes weak, ineffectual or sub-optimal? A change in terminology may make all of us wake up to what is happening, and the subsequent harm to patients’ lives. Read More