ICUs in Michigan Sustain Zero Blood Stream Infections for Up to 2 Years

Electronic Newsletter, Issue 314

May 12, 2011

AHRQ News and Numbers

More than 3 million Americans went to hospital emergency rooms seeking relief from headaches and there were 81,000 hospitals admissions. One-third of the emergency visits and two thirds of the hospital stays were for migraine headaches. [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #111: Headaches in U.S. Hospitals and Emergency Departments, 2008.]

Today's Headlines

  1. ICUs in Michigan sustain zero blood stream infections for up to 2 years
  2. E-prescribing features viewed as cumbersome to physicians
  3. New AHRQ evidence report examines health IT impact on medication management is available
  4. New AHRQ evidence report on safety of probiotics is available
  5. AHRQ data and safety monitoring policy
  6. AHRQ's Health Care Innovations Exchange highlights text messaging services that promote sexual health
  7. Highlights from our most recent monthly newsletter
  8. AHRQ in the professional literature

1. ICUs in Michigan Sustain Zero Blood Stream Infections for Up to 2 Years

Intensive care units (ICUs) in both large and small hospitals stopped central line-associated bloodstream infections for up to 2 years after using a targeted quality improvement initiative funded in part by AHRQ. The initiative, Comprehensive Unit-based Safety Program, was implemented through the Keystone Intensive Care Unit Project in Michigan hospitals. The study, "The Ability of Intensive Care Units to Maintain Zero Central Line-Associated Bloodstream Infections," published in the May 9 issue of the Archives of Internal Medicine found that hospital ICUs eliminated central line-associated bloodstream infections for an extended period of time—up to 2 years or more. The researchers found that 60 percent of the 80 ICUs evaluated went 1 year or more without an infection, and 26 percent achieved 2 years or more. Smaller hospitals sustained zero infections longer than larger hospitals. Select to read our press release and select for more information on the Comprehensive Unit-based Safety Program.

2. E-Prescribing Features Viewed as Cumbersome to Physicians

E-prescribing systems can provide physicians access to important patient information, such as drugs prescribed by physicians in other practices and formulary information that can help reduce insured patients' drug costs, but many physicians are reluctant to use these features because they are viewed as cumbersome and unreliable, according to a new AHRQ-funded report. The report, prepared by researchers at the Center for Studying Health System Change, is a qualitative study of 24 physician practices using e-prescribing systems. Study highlighted two barriers to use:

  • Tools to view and use the patient health information are cumbersome to use in some systems.
  • Data are not always seen as useful enough to expend the extra effort to use them.

Select to access the study, Physician Practices, E-Prescribing and Accessing Information to Improve Prescribing Decisions.

3. New AHRQ Evidence Report Examines Health IT Impact on Medication Management Is Available

AHRQ has released a new evidence report, Enabling Medication Management Through Health Information Technology, that examines the impact—clinical, economic, and effectiveness—of health information technology applications on medication management. The review, conducted by AHRQ's McMaster University Evidence-based Practice Center, Hamilton, Ontario, Canada, found that health IT-enabled applications, especially clinical decision support and computerized physician order entry systems, show evidence of improved care processes. However, the review also showed that few studies examined economic or clinical outcomes, and mixed findings about clinician effectiveness and cost-effectiveness. Select to access the report. A print copy is available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

4. New AHRQ Evidence Report on Safety of Probiotics Is Available

AHRQ has released a new evidence report, Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease, to catalog what is known about the safety of interventions containing organisms from six different genera used as probiotic agents (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and Bacillus), alone or in combination, used to reduce the risk of, prevent, or treat disease. The report, prepared by AHRQ's RAND-Southern California Evidence-based Practice Center, was jointly sponsored by the National Institutes of Health (NIH) Office of Dietary Supplements, the NIH National Center for Complementary and Alternative Medicine, and the Food and Drug Administration Center for Food Safety and Applied Nutrition. Select to access the report. A print copy is available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

5. AHRQ Data and Safety Monitoring Policy

AHRQ issued a policy notice that sets forth the requirements for data and safety monitoring (DSM) for AHRQ-conducted or -supported research involving interventions with human subjects where there is a greater than minimal risk (45 C.F.R. 46.102), to ensure the safety of participants and the validity and integrity of the data. Studies that are exempt under the Department of Health and Human Services human subjects protection regulations 45 C.F.R. Part 46 are not subject to this policy. If research falls under the Food and Drug Administration (FDA) regulatory requirements (21 CFR 50; 21 CFR 56), the researcher must follow both HHS and FDA human subjects protection regulations, as well as this policy. The AHRQ policy specifies that a proposed DSM plan must be submitted as part of the research strategy section in the grant application or the technical approach for a contract application. Further the DSM plan must be approved by the institutional review board prior to the conduct of research involving interventions with human subjects where there is a greater than minimal risk. Effective with its publication, this policy is incorporated as part of the terms and conditions for all new awards. Release of funds for research activities is contingent upon compliance with AHRQ's DSM policy. Select to access AHRQ's policy.

6. AHRQ's Health Care Innovations Exchange Highlights Text Messaging Services That Promote Sexual Health

Three programs featured on AHRQ's Innovations Exchange describe innovative uses of text messaging services to promote sexual health, provide test results, and refer youth to nearby clinics for screening. One example of a text messaging innovation is "Hookup 61827" in California. The statewide program sends weekly text messages on various sexual health topics to more than 4,000 adolescent subscribers. Youth can visit the Hookup 61827 Web site to sign up for the text messaging service and learn more about sexual health. Select to read this issue and for more innovations on AHRQ's Health Care Innovations Exchange Web site.

7. Highlights from Our Most Recent Monthly Newsletter

The May issue of Research Activities is available online. Key articles include:

  • Primary care physicians spend a fifth of their time in patient care activities outside of office visits.

    Internists who serve as primary care physicians spend an average of 1.6 hours (20 percent) of their work day on patient care activities outside of office visits (AOVs), according to a new study. These AOVs may save a median of five office visits per physician day, suggest the researchers. Their findings, based on direct observation of 33 physicians during a work day, are close to those previously found in studies of family physicians (23 percent) and geriatricians at academic institutions (22 percent). This time is generally not reimbursed by payers, but may be useful in coordinating patient care or may substitute for office visits that might otherwise occur. Select to read this article.

Other articles include:

  • Social media use is one of many innovations in care delivery transforming the frontlines of care.
  • Nurse survey identifies important but underused end-of-life care skills.
  • Studies examine black mothers' choices for infant sleep position and location.
  • Inhaler costs contribute to medication nonadherence for Medicare patients with chronic pulmonary disease.

Select to read these articles and others.

8. AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.

Roberts LL, Ward MM, Brokel JM, et al. Impact of health information technology on detection of potential adverse drug events at the ordering stage. Am J Health Syst Pharm 2010 Nov 1; 67(21):1838-46. Select to access the abstract on PubMed®.

Weir RC, Emerson HP, Tseng W, et al. Use of enabling services by Asian American, Native Hawaiian, and other Pacific Islander patients at 4 community health centers. Am J Public Health 2010 Nov; 100(11):2199-205. Select to access the abstract on PubMed®.

Powell ES, Khare RK, Courtney DM, et al. Volume of emergency department admissions for sepsis is related to inpatient mortality: results of a nationwide cross-sectional analysis. Crit Care Med 2010 Nov; 38(11):2161-8. Select to access the abstract on PubMed®.

Wen KY, Gustafson DH, Hawkins RP, et al. Developing and validating a model to predict the success of an IHCS implementation: the Readiness for Implementation Model. J Am Med Inform Assoc 2010 Nov-Dec; 17(6):707-13. Select to access the abstract on PubMed®.

Gierisch JM, Reiter PL, Rimer BK, et al. Standard definitions of adherence for infrequent yet repeated health behaviors. Am J Health Behav 2010 Nov-Dec; 34(6):669-79. Select to access the abstract on PubMed®.

Klabunde CN, Marcus PM, Silvestri GA, et al. U.S. primary care physicians' lung cancer screening beliefs and recommendations. Am J Prev Med 2010 Nov; 39(5):411-20. Select to access the abstract on PubMed®.

Kramer RS, Quinn RD, Groom RC, et al. Same admission cardiac catheterization and cardiac surgery: is there an increased incidence of acute kidney injury? Ann Thorac Surg 2010 Nov; 90(5):1418-1423; discussion 1423-4. Select to access the abstract on PubMed®.

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Current as of May 2011
Internet Citation: ICUs in Michigan Sustain Zero Blood Stream Infections for Up to 2 Years. May 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/314.html