Innovations: Quality, patient safety, and technology initiatives

A new infection composite score; Palliative care consultations; The deprescribing trend


Measuring hospital-acquired infection in a new way

Every day, hospitalists struggle with health care–associated infections, which 1 in 25 patients experiences, according to the Centers for Disease Control and Prevention.

These infections are often discussed in terms of the standardized infection ratio (SIR), but that measure may not assess overall performance, according to a study suggesting a new measure that could help large hospital systems better evaluate their infection outcomes by comparing them with those of their peers.

Dr. Mohamad G. Fakih

The researchers piloted an infection composite score (ICS) in 82 hospitals under a single health system. The ICS is a combined score for central line–associated bloodstream infections, catheter-associated urinary tract infections, colon and abdominal hysterectomy surgical site infections, and hospital-onset methicillin-resistant Staphylococcus aureus bacteremia and Clostridium difficile infections. The researchers calculated individual facility ICS scores and compared them with system scores for baseline and performance.

This gives hospitals a more current picture of how they’re doing, compared with the SIR, said Mohamad G. Fakih, MD, MPH, of Ascension Health, Grosse Pointe Woods, Mich., lead author of the study. “The SIR is a ratio based on a baseline that’s usually a few years prior; it’s not the year directly before. So, when we published this paper, some of the infections had a baseline of 2006 through 2008 for the central line infections.”

Another difference is that the ICS gives the six infections the same weight, rather than combining them. “So, if you add them up together and then you divide by six, you get a score that tells you how you’re doing for infection, compared [with] the whole system. If they have a problem that’s related to many infections, then you know the culture of infection prevention in that hospital is much worse. It’s not just one product. There’s something much more worrisome for that hospital.”

This simple score can be adjusted according to a particular hospital’s needs. “Let’s say you want to focus on additional infections that are publicly reported. You can add them to that score,” Dr. Fakih says. “And you can change the weight in a way depending on what you want to focus on, or, if you want to focus on something more than others, you can increase the weight.”


1. Centers for Disease Control and Prevention. Healthcare-associated infections. Accessed April 10, 2017.

2. Fakih MG, Skierczynski B, Bufalino A, et al. Taking advantage of public reporting: An infection composite score to assist evaluating hospital performance for infection prevention efforts. American Journal of Infection Control. (2016);44(12):1578-81.

Hospitalists lead in palliative care

According to a recent report, hospitalists made nearly half (48%) of all palliative care referrals in hospitals in 2015. The report comes from the Center to Advance Palliative Care and the National Palliative Care Research Center.

“The most important finding from this analysis is the near doubling of the number of people receiving palliative care services in U.S. hospital palliative care programs, from an average of 2.7% in 2009 to an average of 4.8% in 2015,” said Diane Meier, MD, director of the Center to Advance Palliative Care. “This suggests increasing recognition of the benefits of palliative care by health professionals and greater likelihood that those living with serious illness will receive state-of-the-art care.”

The report shows that hospitalists are the No. 1 source of referral to palliative care teams. “They see up close the suffering of their patients and families, their need for comprehensive whole-person care, and the beneficial impact of the added layer of support that palliative care provides,” she said.

“Hospitalists should work alongside their palliative care colleagues to develop standardized screening tools so that all patients and families who could benefit have access to the best quality of care during serious and complex illness,” Dr. Meier said. Hospitalists can also gain skills in communicating about prognosis and conducting family meetings, as well as safe and effective symptom management, through the online clinical training curriculum available at


1. National Palliative Care Registry. How We Work: Trends and Insights in Hospital Palliative Care. Accessed April 7, 2017.

Improving outcomes for children with chronic conditions

Cincinnati Children’s Hospital Medical Center improved outcomes for 50% of pediatric patients by redesigning the way it cares for children with active chronic conditions, according to a new study.

The hospital implemented a Condition Outcomes Improvement Initiative, in which specialized clinical teams applied quality improvement principles to improve outcomes for pediatric patients with chronic illnesses.

Each improvement team focused on a specific chronic condition, such as juvenile arthritis, asthma, chronic kidney disease, or sickle cell disease. The improvement processes implemented included reviewing evidence to choose which outcomes to measure, developing condition-specific patient registries and data collection tools, classifying patients into defined risk groups, planning care before and after visits, and providing self-management and caregiver/parent support for patients and their families.

Study lead author Jennifer Lail, MD, FAAP, analyzed data from more than 27,000 pediatric patients from 18 improvement teams. Following implementation of the changes, half of patients had an improved outcome, and 11 of the 18 chronic condition teams achieved the goal of 20% improvement in their chosen clinical outcome, suggesting that clinical teams implementing quality improvement methods with multidisciplinary support can improve outcomes for populations with chronic conditions.

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