In the News

Recession hurting hospitals' bottom lines, and more.

Recession hurting hospitals' bottom lines

Hospitals' median profit margin fell to 0% in the third quarter of 2008, according to an analysis by Thomson Reuters.

The health care surveying firm based the findings on proprietary and public data gathered from 439 hospitals in the U.S. About 50% of the studied hospitals were unprofitable, and the median profit margin of zero was a historic low. Growth in payments from private and public payers had slowed toward the end of the year as well.

The credit crunch also had an impact on hospitals, the report found. The median cash-on-hand held by hospitals fell to an unprecedented low—110 days in the third quarter of last year. There was also significant variability in the median cash-on-hand, from 57 days in the lowest quartile of hospitals to 203 in the highest. However, it is difficult to attribute all of the economic decrease to the recession since the downward trend started well before late 2007.

Blood cultures a faulty quality measure in pneumonia

Blood cultures rarely affect care in patients with community-associated pneumonia (CAP) and should not be used as a quality measure, a recent study asserted.

Although blood cultures in patients with CAP have been recommended as a quality measure, evidence of their utility has been lacking. Researchers performed a meta-analysis of existing trials to determine whether and how obtaining blood cultures affects the management of patients with CAP. The results appeared in the February Journal of Hospital Medicine.

Thirteen observational cohort trials were examined in the primary analysis. The authors found that blood cultures yielded true-positive results in only 0% to 14% of cases and affected antibiotic use in just 0% to 3%. Physicians broadened antibiotic use because of a resistant organism in 0% to 1% of cases.

The authors acknowledged their study's limitations, including the possibility of missed studies and the lack of high-risk patients. However, they concluded that blood cultures are not useful in the management of CAP and that their inclusion as CAP quality measures should be reconsidered.

Comprehensive hospital discharges can reduce re-hospitalization

A comprehensive approach to hospital discharges can help decrease the chances of rehospitalization, according to a recent study.< /p>

Researchers followed 749 hospitalized adults for 30 days to test the effects of an intervention designed to minimize hospital use after discharge. Half of the patients received normal care, while the other half worked with a nurse discharge advocate during their hospital stay to arrange follow-up appointments, confirm medications and receive patient education. A clinical pharmacist called patients soon after discharge to reinforce the discharge plan and review medications. The results appeared in the February 3 Annals of Internal Medicine.

The intervention resulted in a 30% reduction in hospital use, improved patient self-perceived preparation for discharge, and increased primary care physician follow-up, even among participants who frequently used hospital services. Although it involved only one hospital and relied on some self-reported data, the authors concluded that this comprehensive discharge program successfully reduced hospital use up to 30 days after discharge.

Some MRSA infections decreasing in U.S. ICUs, study reports

Methicillin-resistant Staphylococcus aureus (MRSA) central line-associated bloodstream infections (BSIs) have been decreasing in the U.S., according to a recent study.< /p>

Researchers from the CDC used data reported to the agency as part of the National Nosocomial Infections Surveillance system to examine trends in MRSA and methicillin-susceptible S. aureus (MSSA) in seven types of U.S. ICUs from 1997 to 2007. The main outcome measures were the incidence of central line-associated BSIs per 1,000 central line days and the percentage of S. aureus BSIs caused by MRSA. The study results appeared in the February 18 Journal of the American Medical Association.

Of 33,587 central line-associated BSIs reported from 1,684 ICUs, 2,498 (7.4%) were MRSA and 1,590 (4.7%) were MSSA. From 1997 to 2001, rates of MRSA central line-associated BSIs increased in surgical, nonteaching-affiliated medical-surgical, cardiothoracic and coronary ICUs, but did not change significantly in medical, teaching-affiliated medical-surgical and pediatric ICUs. Central line-associated BSIs caused by MSSA decreased in all ICU types from 1997 to 2007, and rates of MRSA central line-associated BSIs decreased significantly in all types of ICUs except pediatric ICUs from 2001 through 2007. From 1997 to 2007, the overall percentage of S. aureus central line-associated BSIs caused by MRSA increased by 25.8% while overall MRSA central line-associated BSIs decreased by 49.6%.

The authors concluded that the observed decrease in MRSA incidence could be related to improved infection prevention, implementation of standardized protocols for insertion of central line catheters, and development and use of targeted prevention guidelines. They noted, “The overall decline in [MRSA] incidence stands in sharp contrast to trends in percent MRSA, which give an incomplete picture of changes in the magnitude of the MRSA problem over time and may have led to a misperception that the MRSA central line-associated BSI problem in ICUs has been increasing.” They called for future studies to examine incidence of MRSA infection in other populations and settings and to evaluate the effects of infection control measures.

n the News is a product of ACP HospitalistWeekly, an e-newsletter provided every Wednesday by ACP Hospitalist. If you're not already receiving ACP HospitalistWeekly, contact Customer Service at 800-523-1546, ext. 2600, or directly at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or send an email.< /em>