Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines.

Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.

Observation unit economics.

With an aging population, the United States health care delivery system is struggling to handle an onslaught of chronic disease burden. The current process of regulatory oversight and pay-for-performance reimbursement is a reality in today's health care delivery system. To maintain profitability, facilities must be willing to implement new strategies that marry operational redesign, quality care, and cost-effective treatment. As payers increasingly favor outpatient strategies for patient management, inpatient facilities must develop effective strategies to shift inpatient care into ambulatory settings. This article presents a model, based on acute heart failure, that offers a solution that is fixed on process improvement techniques that levy positive economic impact.

Cost effectiveness of chest pain units.

Health care facilities face many challenges in their attempts to provide cost-effective care without sacrificing quality. One key factor in producing quality outcomes while maintaining economic profitability is the establishment of a cost-effective outpatient care environment. Chest Pain Units (CPUs) have evolved to provide a streamlined approach to acute cardiac care that emphasizes optimal efficiency initiated at the point of entry. The Centers for Medicare and Medicaid Services have structured new reimbursement approaches designed to shift care from the inpatient setting and "reward" efficient and appropriate care delivered in the outpatient arena. These new reimbursement strategies have transformed the CPU into an economically viable entity for the acute care facility and also have afforded opportunities to enhance the quality of care delivered to the acute cardiac patient.

Society of chest pain centers: building better value into health care.

With initiation of VBP, acute care hospitals are rewarded based on how closely clinical guidelines and practices are followed and how well hospitals enhance patients' experiences. Thus, the VBP program requires reengineering of acute care processes. Patient-centered care must remain the focus of a rigorous curriculum of goals and metrics for acute care hospitals.

An observation unit may help improve an institution's Press Ganey satisfaction score.

BACKGROUND: : Hospitals measure patient satisfaction through Press Ganey (PG) surveys. The impact of an emergency department observation unit (EDOU) on patient satisfaction has not been reported to date. We hypothesize that an EDOU has a positive impact on patient satisfaction results as measured by PG surveys. METHODS: : This is a retrospective observational analysis of PG scores collected for 8 quarters before the opening of a 13-bed EDOU in January 2002 and compared with 6 quarters post-EDOU opening, starting April 1, 2003, at a tertiary care, academic, urban hospital. The facility, physician staffing, nursing, and wait times all remained the same during this period. Mean values and a 95% confidence interval (CI) are reported and statistical significance is calculated using a t test. Significance is defined as a P < 0.05. RESULTS: : The mean overall PG scores pre-EDOU was 75.2 (95% CI: 74.2-76.2) and post-EDOU was 80.2 (95% CI: 78.9-82.6), which is statistically significant (P = 0.00005). Of 9 scoring categories, 9 increased post-EDOU. Other than the category for physician scores, all other mean values were higher for the EDOU in the subcategories. CONCLUSION: : The introduction of an observation unit appears to be associated with a statistical improvement in patient satisfaction scores as reported by PG, in the setting of same facility, physician staffing, and nursing staffing.