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Craig Newman, the chief strategy officer at HealthChannels for ScribeAmerica, discusses the amount of time that physicians, nurses, and scribes spend on administrative work and how the pandemic has exacerbated the need for things to change.

How much of a physician’s day is spent doing administrative work and how does this time allocation impact the quality of care that patients receive?

As you know, there's about a million active physicians throughout the country working across the care continuum. And that may range depending on which care environment they're in—emergency medicine, the inpatient setting, urgent care, or the clinic-based environment. Or sometimes we think about home care. On average, most physicians are spending, just to give you a sense of the average clinic day—I'm just going to talk about the outpatient clinic—so if you're in clinical practice, you're spending between 9 minutes a clinic hour and 20 minutes of clinic hour, clicking, typing, or moving things around in the EMR [electronic medical records], navigating and working below license.

If you're in the inpatient setting, that may net out to about 3 hours of working below license. So, in a 12-hour shift, imagine 25% of the time we're paying our highest-cost FTEs (full time employees) to do remedial duties. And there's actually a study that came out in 2014, called time driven activity-based cost. And the idea behind this was how do we shift towards value and reduce costs models and think about, not just cost in terms of clinical cost, but also how we think about total costs from a labor spend perspective. And this gets to your point of how much time physicians spend below license.

Imagine they came up with an equation around capacity of a resource cost. And so, essentially, let's say if you make a quarter million dollars a year to $2 a minute. A nurse practitioner, if it's $100,000 a year, it's $1, a minute. A scribe or virtual scribe is the lowest cost, you'd see is like 35 cents a minute. So, on a minute-by-minute basis, you can begin to see and they've tested this up at Boston Children's Hospital, how much cost is going and time is being spent by a physician working below license, and how we can offset that information to a lower-cost resource, whether that's labor or technology, or a bit of both to drive value and improve care delivery models.

It was actually early on how we started thinking about the quadruple aim and really moving towards care-based models that drive high value, clinical care, reduce the cost of care and improve patient satisfaction all at the same time and getting doctors done by dinner. So, that was a long-winded way to say they are spending way too much time on clerical duties, and much less time than they should be on engaging with their patients, whether that's during the encounter or following up with them after the fact.

Again, I think they're it's a multiprong issue. There are challenges, obviously with flow, but physicians get behind because they have to spend so much time with clerical responsibilities that could be offset to a resource like a scribe or a virtual support model or digital assistant. That could be much more effective and if they were able to offload that work, they could actually not just run a much more efficient practice or have an efficient flow but, alternatively, they could potentially see more patients, which would improve the amount of time it would take a patient to get in the door. That's a huge problem we have in healthcare today is the wait times it takes for new patients to get in to see physicians, especially specific specialists where there may be shortages, and that problem is only getting worse for so many organizations across the country. So, those clerical components, we really need to take a hard and fast look at. That's why our company, we serve 3500 hospitals and health systems and over 2000 medical groups, this is exactly the focus. How do we reduce clerical burden from physicians and their care team to improve flow, reduce cost models, and drive value to patients?

How has the pandemic impacted administrative workload for physicians?

I'd say it's only increased. Again, this is a this is a big topic, right? So, hard to cover in a short interview today. But I'd tell you that, physicians, first of all, they're people just like everybody else. And you got to remember they've got family members, they've got other folks. So, they need to protect their time as well and have a work/life balance. The problem is, there's more work being put on them. When we moved forward in the pandemic, obviously, we had a hybrid delivery system. And what I mean by that is we moved from just having in person care to telehealth visits as well.

Well, that's not just a change for them. That's a change for their office staff, as well as for the patients, which means there's more steps that went into the process to make sure that we connected that provider with that patient. That's added burden right off the top. So, I'd say that's problem number one, because if a patient doesn't show up, or maybe a patient's 10 minutes late for that telehealth visit. Well, that backs up everything else throughout the course of the day and there's cascading problems.

But then there's another challenge that we have, which is labor shortages. I've worked with a number of health systems who ranged from having a 10% shortage of medical assistants, to a 30 to 40% shortage of medical assistants. Medical assistants, there weren't enough to go around pre-pandemic. Now, we're competing with, let's say even if we're paying a pretty good salary, they can go down the street to Dunkin Donuts, make $5 an hour more and get a signing bonus, it's a huge challenge. Or maybe they have they're providing home care or childcare for their kids. And so, we're seeing that shift. So, if there aren't medical assistants who can actually help support the provider with flow, or even do some of those additional ancillary duties, it's a huge challenge that backs up the clinician or adds to their day, which means they're spending more time at night on the weekends trying to play catch up with some of those remedial duties like documentation. 

That's actually one of the reasons we have an arm of our company, ScribeAmerica, where we've actually leveraged the scribe as a care team assistant, whether in person or virtually, to actually help with some of those ancillary tests. So, it doesn't bog down the clinician, the care team. So, chart preps, documentation, pending orders, helping organize their time after the event like a personal assistant can really help drive and improve care delivery models and make life a little bit easier for the physician because at the end of the day, again, they're human. They're they're impacted by COVID-19 as well and so are their families and you want them done by dinner feeling refreshed because the last thing we need is to accelerate the burnout curve when we're already facing physician shortages.

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Craig Newman Highlights How Administrative Work Impacts Physicians' Ability to Provide Quality Healthcare

Hospitals and health systems underwent a lot of changes at the outset of the COVID-19 pandemic to deliver care to patients at home, but the momentum is beginning to slow, according to results from the 

sixth annual Kaufman Hall State of Consumerism in Healthcare Survey

The survey fielded responses from more than 110 executives from nearly 95 organizations representing community hospitals, health systems, pediatric hospitals, academic medical centers, rehabilitation hospitals, and rural providers.

These respondents have noted that their organizations are moderating their moves to overhaul aspects of care delivery and pricing strategy to be more consumer friendly. In general, they’ve noted that telehealth use has “dramatically leveled off,” according to the report.

However, their organizations have shown they believe they need to be more proactive when it comes to improving digital capabilities. Less than half have said their organizations were planning for incremental improvements (45%) or are proactively shifting where they deliver care (43%). Only 25% said their organization was making significant investments so they can perform ahead of their competition. The same proportion said their organization was only willing to change to a moderate degree.

Healthcare has notoriously been behind other industries when it comes to digital offerings, but the respondents said that has changed compared with the time before the pandemic. Half said their prepandemic offerings were far behind non-healthcare companies and an additional 26% said slightly behind. When considering their 

 offerings, 28% said they were far behind and 45% said slightly behind.

The majority (80%) of respondents said they are at least somewhat concerned about the long-term impact the COVID-19 pandemic will have on hospital volume with 4% reporting they are “extremely concerned.”

However, things may be turning around. Respondents did indicate “they have seen further movement toward volumes approaching—though not yet reaching—pre-pandemic levels in recent months, as patients grow more comfortable with in-person care or seek treatment they delayed during the heights of the pandemic,” according to the report.

The survey also gauged how executives viewed disruptive threats to their organization. More than half (52%) said they view new primary care models as “strong” or “extreme” threats, and 37% said the same about new insurance providers.

UnitedHealth Group/Optum is viewed as the biggest competitive threat in general with 76% responding that they see it as a strong or extreme threat. CVS/Aetna is the next biggest threat (64%), followed by Walmart (58%) and Amazon (57%).

According to the report, many executives noted that their organizations are in the early stages of exploring partnerships or joint ventures in order to offer new services and reshape their routine care for consumers. Nearly half (46%) said they are planning to implement new models but haven’t fully implemented them yet, and 33% said they have implemented new models but haven’t fully integrated across the system. In addition, 13% aren’t planning for any new models and reported they are “using the same care models that have been used historically.”

While a majority of respondents said they offer telehealth (90%) and walk-in clinics (73%), far fewer offer other innovative primary care services, such as in-home patient monitoring (37%), home-based primary care (22%), or artificial intelligence (12%). Five percent said they offer no innovative primary care services.

“Moving forward, organizations that seek to thrive must be prepared to deliver care when, where, and how consumers want to receive it,” the report noted.

The pandemic has introduced healthcare consumers of all ages to telehealth and other home-based services, including older Americans. The report expects younger generations will demand digital experiences in their healthcare to match their experiences from other industries.

“Organizations that have moved toward more consumer-friendly models for some time may be better positioned to make a more focused, total transformation effort to a consumer-centric model,” the report concludes.

Articles

Hospitals and health systems started to improve digital capabilities as a result of the pandemic, but that momentum is starting to slow, according to new report. 

Healthcare Not Yet Meeting Consumers' Digital Expectations, Execs Say

The COVID-19 pandemic has put pressure on hospitals and health systems throughout the United States and highlighted the need for medical surge preparedness.

, researchers applied the Hospital Medical Surge Preparedness Index (HMSPI) methodology to measure surge capacity in U.S. hospitals. The goal was to quantify hospitals’ ability to respond to mass casualty events.

“As an individual’s health depends on access to and delivery of quality healthcare, mass casualty emergencies require a hospital to ‘medically surge’ to save lives,” the authors explained.

After the 9/11 attacks, there was an increase in federal investments for disaster preparedness, but health systems continue to struggle in this area, they added. Understanding which hospitals can respond to an influx of patients is crucial for response planning and saving lives.

The researchers used 2005 to 2014 data from the American Hospital Association on 6,239 hospitals (3,123 had 82 or fewer beds), as well as data from the Dartmouth Atlas Project. HMSPI is a theoretical framework that reviews 4 metrics of surge capacity: staff, supplies, space, and systems.

Over the course of the study period, there was a steady increase in HMSPI scores. From 2005 to 2014, Montana had the largest increase in scores, followed by Kansas; Nevada had the smallest increase. Just looking at 2013 to 2014, many states had little or no differences, but North Dakota had the greatest increase, and Maine and Arkansas had the greatest decreases.

“From the analysis, and as might be expected, larger hospitals (those with more than 82 beds) had significantly higher surge capacity in terms of the space metric,” the authors noted.

They also reviewed the effect the Affordable Care Act (ACA) might have had on HMSPI scores; however, they did not find any statistically significant difference in scores between the year prior to ACA implementation and after ACA implementation.

There are a number of limitations that the authors highlighted. For instance, since the HMSPI has yet to be validated in relation to hospital performance during actual disasters, it cannot estimate access to care or outcomes. In addition, data until 2014 was analyzed, which only provides one year after the ACA was implemented, and more years of data may provide different results.

They wrote that future studies are needed to refine the score, assess the validity of the index, and evaluate its performance to disasters and policy changes.

“In the future, the HMSPI could serve as an objective and standardized measurement to assess the ability of hospitals, counties, and states to manage public health emergencies, such as the current coronavirus pandemic, and improve planning for mass casualty medical surges,” the authors concluded.

A tool that can accurately measure hospitals’ medical surge preparedness can be beneficial when responding to future crises and large-scale emergencies.

Hospitals Have Improved Capacity to Respond to Mass Casualty Events Since 2004

On this week's episode of Data Book, Chief Healthcare Executive spoke with Steve Wigginton, CEO of Icario, platform that promotes health action to connect everyone to better health. We discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

Podcasts

Steve Wigginton, CEO of Icario, discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

Podcast: Joining Technology and Value-Based Care to Provide More Personal Care

During holiday weekends, like Labor Day, there tends to be an increase in ransomware attacks, the FBI and the Cybersecurity and Infrastructure Security Agency 

. The agencies noted that these attacks have increasingly been taking place during holiday weekends, such as Mother’s Day weekend, Memorial Day weekend, and the Fourth of July weekend.

From January 1 to July 31, 2021, there were 2,084 ransomware complaints, a 62% increase over the same time period a year earlier, and more than $16.8 million in losses, a 20% increase from the previous year.

In general, healthcare data breaches are on the rise, according to the 

. Compared with 2019, healthcare experienced a 51% increase in the total volume of records exposed.

Here is a look at some recent healthcare data breaches:

 In August, the Illinois-based physician group notified 600,000 patients that their personal health information was exposed when the computer network was hacked in July, 

A breach of employee email accounts at the physician group that includes more than 100 infectious disease physicians in the Chicago area may have exposed data for 171,740 patients. The incidence was 

. Patients’ names, birth dates, Social Security numbers, medical data, and more may have been accessed.

 After a ransomware attack on its network, the Indianapolis-based hospital is 

 that some stolen data is being posted online. The attack happened on August 4, although the hospital did not reveal how many patients were affected.

 After an email account of an employee at the Utah-based physician group was breached in June, about 12,000 medical records 

. Medical record numbers, birth dates, procedures, and provider and insurance provider names were all exposed, although they were not shared online.

 in early August that a cyberattack in January had exposed names, Social Security numbers, birth dates, financial account numbers, diagnoses, and more. Since the attack, there have been no reports of fraud or use of the personal health information.

. The Las Vegas-based hospital reported to HHS that 1.3 million people were affected by a cyberattack. Personal data obtained in the attack was 

 that 1.4 million individuals were affected by a data breach that occurred in June. However, while the activity was discovered June 17, the hacker had initially accessed the network as early as December 18, 2020. Names, Social Security numbers, addresses, financial details, and more were exposed.

 The health system, based in Albuquerque, 

 patients that they may have been affected by the attack. The breach was discovered June 4, but the files were accessed May 2. The files contained patient names, addresses, medical record numbers, and more. Some Social Security numbers were exposed.

Ransomware attacks tend to increase around holiday weekends, like Labor Day weekend. Here is a look at some recent healthcare data breaches.

Recent Healthcare Data Breaches as of September 6, 2021

Tim Dowd, MBA, CEO of Accurate Background

It goes without saying that 2021 has seen remarkable shifts within our country. During the first half of the year, as vaccinations became readily available to larger population segments, we saw the country begin to wake up and move again—travel notably increased, businesses resumed full capacity, and more and more offices began reopening. On May 13, the 

 that those who are vaccinated no longer need to wear masks (with a few exceptions). Shortly after on June 15, California, one of the most steadfast states regarding COVID restrictions, officially 

Unfortunately, August painted a different picture. The Delta variant became the dominant strain of COVID within the United States, with statistics showing that the 

, hospitalizations and deaths are from the unvaccinated. The 

 yet again, recommending those fully vaccinated still wear masks in public indoor settings in areas of substantial or high transmission.

As businesses make the choice to reopen amid these latest developments, the responsibility to offer employees both a safe and fair place to work remains paramount, and leads to the inevitable question—what are the legalities surrounding businesses requiring vaccinations in order to return to work? In August we saw 

 begin to require vaccinations, including Google, Facebook, Morgan Stanley and many others. Then the 

 the Pfizer-BioNTech vaccine, which could lead to even more businesses and institutions requiring vaccinations. Case in point: within hours of the FDA approval, 

New York City announced that all Department of Education employees

 must have received at least one dose of a coronavirus vaccine by Sept. 27.

Undoubtedly, the best way to understand the laws surrounding vaccination requirements is to confer with your legal counsel, but also arm yourself with the knowledge of what is allowed based on guidance from the Equal Employment Opportunity Commission (EEOC).

 issued important COVID-19 updates on federal equal employment opportunity (EEO) laws, to assist businesses that were, and are, actively updating safety policies to comply with federal and state guidance. This update included several key points, offering businesses directives on how to maintain a compliant workplace:

Employers may mandate that employees be vaccinated for COVID-19.

 “Federal EEO laws do not prevent an employer from requiring all employees physically entering the workplace to be vaccinated for COVID-19, so long as employers comply with the reasonable accommodation provisions of the [Americans with Disabilities Act] ADA and Title VII of the Civil Rights Act of 1964 and other EEO considerations.” However, note that other laws that do not fall under the EEOC’s jurisdiction may place additional restrictions on employers, which is why it is imperative to confirm with legal counsel. It is also important to note, as the EEOC references, that because “some individuals or demographic groups may face greater barriers to receiving a COVID-19 vaccination than others, some employees may be more likely to be negatively impacted by a vaccination requirement.”

Employers can offer incentives to employees, to confidentiality obtain employees’ vaccine information

. Businesses are allowed to offer incentives to employees who voluntarily confirm vaccination documentation. Additionally, those employers that are administering vaccines to staff are allowed to offer incentives for vaccination; however, employers must ensure that the incentives are not coercive.

Employers can promote the benefits of vaccination.

 “Employers may provide employees and their family members with information to educate them about COVID-19 vaccines and raise awareness about the benefits of vaccination.” Basically, employers who require vaccinations are allowed to tout the benefits of the vaccine within their workplace, to help educate and encourage staff to participate.

This helpful update from the EEOC allows businesses to feel confident in their decisions on whether or not to require vaccinations, knowing they are adhering to the laws dictated by the EEOC. In addition, the EEOC developed a 

for job applicants and employees, detailing the federal laws that protect employees from discrimination as a result of the pandemic, to ensure a workplace free of discrimination. It is vital for employers to understand these laws just as much as those above:

s reported by Bloomberg Law. Thankfully, antidiscrimination laws are in place to protect employees from harassment based on national origin, race, color, religion, age, sex, genetic information, or disability. It is the employer’s responsibility to investigate any allegations of harassment within the workplace, including those triggered by COVID-19.

 If you are reopening your office and requiring employees to return to work, it is required that you respond and take action when dealing with any employee who may have a medical condition that makes him/her considered high risk, including mental health conditions. It is your obligation to provide a “reasonable accommodation” to those employees, including continuing to work from home, assuming the medical disability falls under the ADA.

Employers are not allowed to stop an employee from working during the pandemic, due to conditions such as older age, pregnancy or disability. However, it is legal to keep an employee home if they have COVID-19, or if the employee has a disability that puts him/her in a position of vulnerability and significant risk.

Modifications to COVID-19 Safety Requirements Are Allowed.

 If any employee’s medical condition, or religious belief, practice or observance, requires an alternate accommodation, it is an employer’s responsibility to provide that reasonable accommodation. For example, if an employee does not get vaccinated for religious reasons, the employer may provide an exception and ask the employee to wear a mask, stay socially distant and/or work from home.

As we continue to navigate through the pandemic, it is crucial for employers to create a workplace that is both safe and free of discrimination, and communicate COVID-19 policies to employees clearly and regularly. Understanding both employer and employee rights under the guidance of the EEOC, as well as consulting with legal counsel, will allow employers to more safely reopen the workplace.

The responsibility to offer employees both a safe and fair place to work remains paramount, and leads to the inevitable question—what are the legalities surrounding businesses requiring vaccinations in order to return to work? 

Requiring Vaccinations: Key Legal Considerations Driving Return to Work Policies

Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include 

Louisiana Health Officer Joseph Kanter, MD, MPH, on Saturday ordered the immediate closure of seven nursing homes that evacuated patients to a warehouse on August 27 as Hurricane Ida bore down southeast Louisiana. Conditions deteriorated in the warehouse and seven patients died; five deaths have been declared storm-related, according to a statement from the Louisiana Department of Health (LDH).

The warehouse, located in Independence, La., is located in Tangipahoa Parish, which is north of New Orleans and about 100 miles from where Hurricane Ida made landfall. The nursing homes that evacuated were in Orleans, Jefferson, Lafourche, and Terrebonne parishes, all south of Lake Pontchartrain.

All patients taken to the warehouse have since been relocated, following an inspection that was temporarily blocked by the nursing homes' owner, who also owned the warehouse. Bob Dean, the owner, has previously been cited by state officials for evacuating nursing home patients to a facility he owned that proved to be inadequate. 

LDH Secretary Courtney N. Phillips, PhD, MPA

State officials told the Associated Press that water got into the warehouse and generators failed. Meanwhile, tipsters told officials of patients being left on mattresses on the floor without food or clean clothes. Strong odors of feces permeated the building, and conditions declined rapidly as more patients arrived and owners tried to fit them into an increasingly crowded building. Trash and bags of human waste piled up, according to a nurse 

LDH has now confirmed 7 deaths of nursing home residents evacuated to the Independence facility, 5 of which have been classified as storm-related. State law enforcement officials have called for a criminal investigation, and LDH is reaching out to families of the nursing home residents.

The seven nursing homes that evacuated to the warehouse in Independence include:

River Palms Nursing and Rehab, Orleans Parish

South Lafourche Nursing and Rehab, Lafourche Parish

Maison Orleans Healthcare Center, Orleans Parish

Park Place Healthcare Nursing Home, Jefferson Parish

West Jefferson Health Care Center, Jefferson Parish

Maison DeVille Nursing Home, Terrebonne Parish

Maison DeVille Nursing Home of Harvey, Jefferson Parish

“What happened in Independence is reprehensible, and I know there are many families hurting as a result,” said LDH Secretary Courtney N. Phillips, PhD, MPA. “Today’s action against these facilities is needed. There is more to come. Our department’s mission is to advance the health and wellbeing of our residents—and that includes our vulnerable nursing home residents.”

“The lack of regard for these vulnerable residents' wellbeing is an affront to human dignity,” Kanter said. “We have lost trust in these nursing homes to provide adequate care for their residents. We are taking immediate action today to protect public health.”

Reports of the deteriorating conditions at warehouse after Hurricane Ida made landfall prompted LDH inspectors to visit the site, but they were blocked from making a full inspection August 31 and “subject to intimidation by the owner of the seven nursing facilities,” according to state officials.

LDH and other state and local agencies returned September 1 to evacuate local residents and all had been relocated by September 2.

For several days, Louisiana news outlets have covered the evacuation of the warehouse and history of issues with Dean's nursing homes. He has been described as a previously active political donor who more recently has become isolated among the state's powerful network of nursing home operators. News reports said Dean’s nursing homes received 

 from Medicare before the recent evacuation, which the website nola.com said was a part of a plan on file with the state following the deaths of fragile, elderly patients in floodwaters during Hurricane Katrina in 2005.

 at nursing homes he owned due to poor care. News outlets report attempts to reach Dean have been unsuccesful.

Bob Dean, the nursing homes' owner, has previously been cited by state officials for evacuating patients to a facility he owned that proved to be inadequate.

Louisiana Health Officer Shutters Nursing Homes That Sent Patients to Warehouse, Where 7 Died

Massachusetts General Hospital names president.

David Brown, MD, has been named the president of Massachusetts General Hospital (MGH) and executive vice president of Mass General Brigham. His appointment starts September 8. Brown will succeed Peter Slavin, MD, who had served as president for 18 years.

Brown is the current chair of the Department of Emergency Medicine at MGH, interim president of Cooley Dickinson Health Care and the MGH Trustees Professor of Emergency Medicine at Harvard Medical School.

Cotelingam is Cleveland Clinic’s new chief strategy officer.

Cleveland Clinic announced the Jim Cotelingam is the permanent chief strategy officer. He has been serving as interim chief strategy officer since February and initially joined Cleveland Clinic as the executive director of strategy in 2019. He will lead the team responsible for setting Cleveland Clinic’s growth plans. 

Cotelingam has more than 20 years of experience in nonprofit health care. Prior to joining Cleveland Clinic, he was the senior vice president of strategy at Trinity Health.

Inova Loudoun Hospital has a permanent president.

Susan Carroll, who has been serving as the interim president of Inova Loudoun Hospital since July has been named the permanent president of the Leesburg, Virigina-based hospital. While serving as interim president at Inova Loudoun Hospital, Carroll had also been serving as president of Inova Fair Oaks Hospital. She has a long track record at Inova; Carroll began her career at Inova Loudoun Hospital in 1996. In 2010, she was made chief operating officer.

As the permanent president, Carroll will establish areas of clinical growth, participate in recruitment and retention of physicians and will collaborate with medical staff to pursue opportunities that address community needs.

Omer Sultan has been named the chief financial officer at the University of Texas MD Anderson Cancer Center. His appointment is effective October 4. In the role, Sultan will lead financial matters for the institution and serve as a financial strategist.

He is the current vice president of finance at Northwestern Memorial Healthcare, the parent corporation of a $6.7 billion, 11-hospital academic health system serving the greater Chicago area.

Interim CEO of University of Utah (U of U) Health made permanent.

Dan Lundergan, who has been serving as the interim CEO since February, has been appointed CEO of U of U Health Hospitals and Clinics effective immediately. He will oversee 5 hospitals and 12 community clinics.

Lundergan has spent more than four decades at U of U Health and helped guide the organization through the COVID-19 pandemic and the subsequent vaccination rollout.

Interim executives are made permanent at Cleveland Clinic, Inova Loudoun Hospital, and University of Utah (U of U) Health, while Massachusetts General Hospital (MGH) and MD Anderson announce new hires.

MED MOVES: New Leaders at MGH, Inova Loudon Hospital, U of U Health; Cleveland Clinic, MD Anderson Announce Appointments

In the first year of the COVID-19 pandemic, there was an increase in healthcare-associated infections (HAIs) in hospitals, according to new data from the CDC.

The findings highlight a need to return to the infection prevention and control practices that were standard before the pandemic, as well as a need to build these programs to withstand future pandemics, authors wrote in a study 

Infection Control & Hospital Epidemiology

“The unfortunate reality is that in one year we lost nearly a decade of progress against HAIs like central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant 

 (MRSA), and ventilator-associated events,” Ann Marie Pettis, BSN, RN, CIC, FAPIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC), 

. “We now have an opportunity to use this data and take action to invest in our public health infrastructure, expand our nation’s infection prevention and control workforce, and put infection preventionists—specialists who are trained and certified to prevent infections—at the center of these efforts.”

The pandemic placed a burden on acute care hospitals (ACHs). From 2015 to 2019, there were consistent reductions in the standardized infection ratios for CLABSIs, CAUTIs and 

 infection (CDI) laboratory-identified events, as well as significant decreases in MRSA since 2010.

The researchers utilized data on events in ACHs from 2019 to 2020 reported to the National Healthcare Safety Network Patient Safety Component as of April 1, 2021. They calculated the change in infection ratios in the states with a high number of hospitalized COVID-19 patients.

There was a drop off in ACHs reporting HAI surveillance data between 2019 and the first half of 2020. As many as 88% of hospitals who reported data in 2019 for CLABSI, CAUTI, MRSA or CDI also reported data for the first half of 2020. By the second half of 2020, reporting levels were close to the pre-pandemic period for most HAIs.

Starting in the second quarter of 2020, there were initial increases in the standardized infection ratios for CLABSI and MRSA. Increases in ventilator-associated events (VAEs) started as early as the first quarter. In the third and fourth quarters, there were large and significant increases in the standardized infection ratios for CLABSI, CAUTI, VAE and MRSA.

CLABSI had the greatest increase among all HAIs. In the second half of 2020, CLABSI standardized infection ratios increased up to 47% compared with the previous year. Meanwhile, there were no significant increases for surgical site infections or CDI for any quarter of 2020 compared with 2019.

“The increased focus on hand hygiene, environmental cleaning, patient isolation, and use of [personal protective equipment] during 2020, combined with continued inpatient antimicrobial stewardship programs and a marked decline in outpatient antibiotic prescribing, may have resulted in decreases in the CDI [standardized infection ratios] during 2020 compared to 2019,” the authors suggested.

In addition to calling on healthcare facilities to reassess their own infection prevention programs, APIC highlighted that additional help is needed from the government.

“APIC also calls on federal and state governments to provide funding to help support healthcare facilities across the continuum of care to ensure that there is adequate surge capacity so that infection prevention and control measures will endure when stressed by future pandemics and disease outbreaks,” Pettis said.

The pandemic caused a jump in healthcare-associated infections in hospitals, highlighting a need to return to infection prevention and control practices that were standard before the pandemic.

Healthcare-Associated Infections Increased in Hospitals During COVID-19 Pandemic

Opportunities exist to improve the selection of transfer destinations for patients with emergency general surgery conditions.

The findings of the recent study suggested optimizing transfer destination in the interhospital transfer network may improve such outcomes.

Cindy Y. Teng, M.D., and a team of Pittsburgh-based investigators examined whether patients with emergency surgery conditions were consistently directed to hospitals with more resources and better outcomes. The team analyzed interhospital transfers among adults with emergency general surgery conditions from January 1 to December 31, 2016. They used all-payer claims data from the 2016 Healthcare Cost and Utilization Project state inpatient and emergency department databases in eight states.

More than 700 hospitals were included in the study. Eligible participants were at least 18 years old and had an acute care hospital encounter with a diagnosis of an emergency general surgery condition.

The primary outcome was hospital-level centrality ratio — the normalized number of incoming transfers divided by the number of outgoing transfers. If the ratio was higher, it meant there were more incoming transfers per outgoing transfer. The team hypothesized higher hospitality centrality ratio was associated with more resources, higher volume, and better outcomes.

There were more than 80,000 patients analyzed, of whom, the median age was 63 years old, 52.1% were male, and 78.8% were White. The median number of outgoing transfers per hospital was 106, while incoming transfers was 36.

As the investigators hypothesized, a higher log-transformed centrality was associated with more resources like higher ICU capacity and higher emergency general surgery volume. But such a ratio was not linked with better outcomes, such as lower in-hospital mortality and lower failure to rescue — the occurrence of a complication followed by in-hospital death for emergency general surgery episodes that involved an operation or procedure.

Hospitals with a higher ICU capacity, higher volume, and higher-quality trauma care were associated with better emergency general surgery outcomes.

The findings emphasized the need for further research into the appropriate selection of transfer destinations as a strategy to improve emergency general surgery outcomes.

“Our results raise questions about whether [emergency general surgery] transfers are consistently directed to appropriate hospitals for further care and new concerns regarding how we determine appropriate hospitals in the absence of standardized guidelines,” Teng and the team wrote.

Assessment of Hospital Characteristics and Interhospital Transfer Patterns of Adults With Emergency General Surgery Conditions

Larger hospitals are associated with more resources for emergency general surgery patients.

Improvements Needed for Selection of Transfer Destinations for Emergency General Surgery

Health systems using telemedicine often measure patient satisfaction with the service but are less likely to measure the accuracy of a diagnosis, according to an issue brief from the Society to Improve Diagnosis in Medicine (SIDM).

SIDM conducted a series of interviews with hospitals, health systems, and clinical practices as part of its TeleDx project. The interviews and a literature review identified a gap in the health system’s understanding of telemedicine. Approximately one in 10 diagnoses are incorrect, which affects more than 12 million Americans each year.

As the use of telemedicine drastically increased during the pandemic, it is crucial to understand how telediagnosis impacts diagnostic quality and safety, according to SIDM.

“We found that telediagnosis has potential, although there is still much to learn about how virtual diagnosis can be done most effectively,” Suz Schrandt, JD, senior patient engagement advisor at SIDM and principal investigator on the project, 

. “We found that many patients like the convenience of telemedicine, but we also need more research into who is being left behind in the process, such as small practices or people without access to high-speed internet.”

Before the pandemic, telemedicine was a niche resource, but it has become a mainstay for healthcare delivery. Most research on telemedicine focuses on maintenance of health, according to the report, but telediagnosis at the current scale it’s being used to less researched.

The findings focused on five key aspects of novel implementations: reach, effectiveness, adoption, implementation, and maintenance.

 Both the literature and the interviews clearly showed telemedicine for diagnosis had rapid uptake over the course of a few months. Patients felt like to transition to telemedicine was seamless, but health systems, hospitals, and providers reported it being more stressful.

“Interestingly, in our patient listening sessions, no clear patient ‘prototype’ materialized as the most or least likely to use and benefit from telemedicine; stereotypical assumptions about age and concordant technical savvy did not fully pan out, with some clinicians sharing that many older patients were particularly engaged users,” according to the report.

 The evidence on telediagnosis is mixed and limited, based on the literature review. In the interviews, both patients and providers noted the convenience of telediagnosis, and they also reported a better connection since providers were looking at the computer, and thus at the patient.

“One challenge that emerged within each stakeholder group was the difficulty in measuring or evaluating the true impact of telemedicine on quality and safety, and this remains the key research question that needs to be addressed.”

 There were many accommodations, from state regulations to CMS changes, that led to the uptake and adoption of telemedicine. Even after the pandemic, stakeholders believe there will remain a hybrid model of care, according to the interviews. While hospitals, health systems, and providers largely agreed on adopting telemedicine, resources and capacity differed across the stakeholders.

“Larger systems and clinics with already-dedicated IT teams were able to move more quickly and expansively; smaller clinics and solo practitioners often fended for themselves,” according to the report.

 Policy issues have been the key barriers to implementing telemedicine, and the literature review also found clinicians struggled with pivoting because of the inability to perform a physical exam. In the interviews, some providers explained that they had developed workarounds to not being able to perform the physical, in-person exam.

An important question being considered is when a patient must be seen in person and when they can be seen virtually. Providers had clear examples on either end of the spectrum, but a lot of gray area in the middle, while patients felt familiar symptoms and simple issues could be kept virtual with something new or different prompting an in-person visit.

 There seems to be a desire to continue using telemedicine in some capacity, but questions around the long-term use and sustainability remain, according to the literature. Even clinicians hesitant about the use of telediagnosis said there is a place for virtual care.

“Much, if not all of the future direction of telemedicine rests on the regulatory, legal, and reimbursement landscape,” the report said.

At the beginning of the pandemic, the quick shift to virtual care was necessary. But as the pandemic wears on and people begin to look toward a future after the pandemic, there are questions about the viability of telediagnosis and how to continue utilizing it, according to the report.

“Overall, research priorities regarding the effectiveness of telediagnosis must focus on what symptoms require in-person assessments; what the right mix of in-person and virtual care looks like; who is being left behind in the expansion of virtual care; and what determines success or failure in telediagnosis,” said Mark Graber, MD, FACP, founder and president emeritus of SIDM, and co-author of the issue brief.

Telemedicine for diagnosis scaled up dramatically as a result of the pandemic, but there isn’t much known about the impact on diagnostic quality and safety.

Does Telemedicine for Diagnosis Have a Place in Healthcare?

As the COVID-19 global pandemic continues, access to personal protective equipment (PPE) remains important for both the general public and healthcare workers. However, the vaccines are an important layer of protection against the vaccine. The Biden administration’s 

 that healthcare workers at facilities receiving Medicare and Medicaid get vaccinated has been praised by many in the healthcare industry, but there are worries such a mandate could exacerbate the current workforce shortage.

Chief Healthcare Executive (CHE) recently spoke with Roman Vinfield, chief revenue officer of WeShield about the importance of PPE, vaccine mandates and healthcare workforce shortages all amid the surge of COVID-19 cases due to the Delta variant.

Editor’s note: this interview has been edited for clarity

Roman, tell me a little bit about yourself and the company that you work for?

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