[Kelly_the_Great]

Have y'all heard?

CMS made an announcement April 14th to propose an expansion to the “Never Events” list, which include the following:

· Surgical site infections following certain elective procedures
· Legionnaires’ disease (a type of pneumonia caused by a specific bacterium)
· Extreme blood sugar derangement
· Iatrogenic pneumothorax (collapse of the lung)
· Delirium
· Ventilator-associated pneumonia
· Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
· Staphylococcus aureus septicemia (bloodstream infection)
· Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

If adopted, decrease in reimbursement would take effect as of October 1, 2008 (less than 7 months away). This is of great concern! "Present on Admission" has been a real challenge for us.

Two of the items that I see right off the bat that seem pretty arbitrary to me are: extreme blood sugar derangement and delirium. While regrettable when they occur and hopefully soon corrected, they are relatively common events when persons are seriously ill.

Additionally, c-diff is a significant issue. Two cases I only recently reviewed whereby patients had negative stool samples and yet had positive findings with sigmoidoscopy (not a cheap procedure to perform). Thus, rarely performed first, thus making it hard to determine time of onset.

CMS will be accepting comments on the proposed rule through June 13th and will respond to comments in a final rule to be issued on or before August 1, 2008.

I urge everyone to write them with your thoughts and suggestions.

P.S. Here are a couple of links for more information: hcPro and CMS

[cstolle]

This makes analyzing our data for quality improvment all the more important. I don't know about the rest of you, but like most hospitals we collect a lot of data but don't really analyze it - like a Six Sigma project - for quality improvement. I believe that we can not continue in this manner with the stakes for quality improvement getting higher. We must begin to use our data more intelligently to guide quality improvement.