January 2006
Dear Colleague:
Happy New Year! A reminder: we have archives of all past issues and the tools featured in Safety Share since 2002. Also, visit our Guidelines section, where we have downloadable copies of key safety and infection control guidelines, including the new TB Guidelines just released by CDC.
Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute
News
- Key to safe insulin use: Top management commitment, resources, and a link to culture of safety efforts
- Fairview Healthcare Services improves patient and physician satisfaction using Six Sigma
- CDC recommends use of newer antivirals over resistant Rimantadine, Amantadine
- Survey on status of patient safety systems shows mixed results
- CDC updates healthcare TB control guidelines; blood test replaces TB skin test
- SCIP publishes measurement specifications and additional tools
- Lack of communication on patient status at 'hand-off' cited as most common reason for adverse events
- Unplanned post-op admissions to ICU validated as a patient safety indicator
- JCAHO proposes HCW influenza immunization as new IC standard
Safety tools
- Falls injury prevention toolkit for healthcare facilities
- APIC: Community-acquired MRSA resources and more
- AHRQ: Patient guide to surgery
- CV Cath Lab: Infection control guidelines
- JCAHO: Guide for surge hospitals
- HHS: Pandemic influenza planning handbook for families
Key to safe insulin use: Top management commitment, resources, and a link to culture of safety efforts
"Recommendations for Safe Use of Insulin in Hospitals" is the result of a joint effort by the American Society of Health-System Pharmacists and the Hospital and Health-System Association of Pennsylvania. The document is a collection of best practices that experts see as an important tool for preventing hospitalized patients from being harmed by insulin therapy.
Recommendations for leaders and frontline staff address the necessity to have the commitment of top management. This commitment must include the approval of needed resources, authority, and organizational support to make changes to prevent patient harm associated with insulin use. Improving insulin-use safety should be combined with broader efforts associated with implementing a culture of safety, document authors stressed. The recommendations for frontline staff also address the overall medication-use process as well as the use of insulin. These recommendations are applicable to other high-risk medications. Each recommendation is supported by literature and should be reviewed and current practices compared with proposed safe practices. The document also includes many resources that may help provide a "tool kit" for improving the safe use of insulin therapy.
"Safe use of Insulin" (.pdf) (814 KB)
Resources on improving safety culture,
from Premier's Safety Institute.
Fairview Healthcare Services improves patient and physician satisfaction using Six Sigma
The Six Sigma methodology is associated more often with manufacturing companies than healthcare systems and has been used in industry to improve operational efficiency and customer satisfaction. However, Fairview Health Services, a large Minneapolis, Minn.-based integrated health care system has demonstrated dramatic improvements in financial viability, patient and physician satisfaction and stronger employee engagement since successfully deploying the Six Sigma methodology. Six Sigma is a performance improvement method that is a disciplined, data-driven, measurement-based approach to reduce process variation and eliminate errors in organizational processes that require significant improvements.
Fairview began by targeting four clinical projects - Medicare profitability, emergency department cycle time reduction, clinic patient preparation, and medication safety. Yet before completing the analysis of those project outcomes, the system decided to proceed with full deployment in a three-phase, two-year deployment plan.
The Medicare profitability project goal was to look at a specific diagnostic related group (DRG) - joint replacement - where the hospital was losing money and develop a prototype for applying Six Sigma to other DRGs to lower overall length of stay. Fairview reorganized this project into two projects and set up one team focusing on reducing the length of stay for orthopedic patients discharged to home care and another team focused on preoperative patient education, setting physician expectations and developing best practice protocols.
The emergency department cycle time reduction project selected four strategies to focus on: decreasing imaging turnaround time, lab turnaround time, time to get patients to rooms, and improving distribution methodology of patients, staff and physicians.
Clinic patient preparation focused on improving the efficiency of assigning rooms for clinic patients. Six Sigma objectives and measures were incorporated into this already-existing project.
The medication safety initiative project retrofitted Six Sigma methodology onto an already existing pilot pain management project.
The application of Six Sigma to these projects often led teams in new directions. Some lessons learned included:
- It is difficult to successfully graft Six Sigma techniques onto the project if a process improvement project team has begun work on analyses or solutions.
- Six Sigma training provided a menu of improvement methods available for various situations.
- The selection and sequence for implementing strategic improvement projects and the decision to use Six Sigma methods should be guided by an overall system of project portfolio management.
- The Six Sigma language can cause resistance to adopting Six Sigma methods.
Overall team members were supportive of the methodology. They described administrative ownership of each project, noting that the Six Sigma method forced project clarity from the outset. The team also felt the methodology was more reliable because of its rigorous data collection and saw the analyses methods as positive benefits. Three years after the initial six-month project implementation, Fairview continues Six Sigma implementation.
Abstract Six Sigma (.doc) (24 KB)
Full article from Journal of Jt Comm Quality and Safety Nov 2005 (31(11) is available for subscribers at: http://www.jcrinc.com/subscribers/journal.asp?durki=32
CDC recommends use of newer antivirals over resistant Rimantadine, Amantadine
In an unusual weekend media briefing on January 14, CDC Director Julie Gerberding, M.D., advised clinicians against prescribing two common antivirals (amantadine and rimantadine) to treat or prevent influenza during the remaining 2005-2006 influenza season. Laboratory testing by CDC on the predominant strain of influenza (H3N2) currently circulating in the United States showed a dramatic increase in resistance in these standard drugs.
CDC has tested 120 influenza A (H3N2) virus isolates and found that 109 (or 91 percent) were resistant to amantadine and rimantadine. This represents a sharp increase from 2005 when only 11 percent of isolates tested were resistant and 2004 when 1.9 percent were resistant. However, all H3 and H1 influenza viruses tested to date are susceptible to the other two commonly used antivirals (oseltamivir and zanamivir).
Dr. Gerberding noted that the agency has yet to confirm that the dramatic increase in resistance was due to a spontaneous mutation, although such mutations are not unusual. She also noted the resistance affected only the H3N2 strain - a more virulent strain of Influenza A, and stressed that becoming resistant does not mean the strain will be more virulent. Dr. Gerberding strongly urged communicating this information to physicians since it affects patients receiving treatment with either of these antivirals. The CDC director said the media was alerted on a Saturday because this information had just been verified by testing the day before, and in anticipation of a long three-day weekend, the CDC felt it important to alert clinicians immediately so that drug treatment could be changed to oseltamivir (Tamiflu) or zanamivir (Relenza). She emphasized that Tamiflu is not as prone to developing resistance; that the supply well exceeds any current demand, and that if used properly, it will not increase any risk of resistance. CDC followed up the briefing with a MMWR Dispatch on January 17.
Dr. Gerberding said that prevention of influenza infection is best achieved through hand hygiene, respiratory hygiene and most importantly, vaccination. Plenty of influenza vaccine remains and individuals not yet vaccinated are encouraged to get immunized.
MMWR Dispatch 55d117 (.pdf) (77 KB)
Premier's Emergency and Public Health Web site CDC recommendation, January 2006.
Premier Safety Institute's Influenza Web site.
Survey on status of patient safety systems shows mixed results
A recent AHRQ-funded study examined the evolution of patient safety systems from 2002 to 2004. Findings demonstrated only modest improvements in certain areas and variability in others and that the surgical areas and medication processes have the greatest level of patient safety systems.
Recommendations for improvements in patient safety have focused on changes in "systems" of care rather than "individual errors." Longo and colleagues in the December 14, 2005, issue of the Journal of the American Medical Association (JAMA) reported on the results of a survey conducted of all acute care hospitals in Missouri and Utah at two times in 2002 and 2004. The survey used a 91-item comprehensive questionnaire. Seven latent variables were evaluated to represent the most important patient safety constructs studied:
- Computerized physician order entry systems, computerized test results, and assessments of adverse events;
- Specific patient safety policies;
- Use of data in patient safety programs;
- Drug storage, administration, and safety procedures;
- Manner of handling adverse event/error reporting;
- Prevention policies; and
- Root cause analysis.
For each hospital, the seven latent variables were summed to give an overall measure of the patient safety status of the hospital.
Nearly 74 percent of hospitals reported full implementation of a written patient safety plan and more than 95 percent had a patient safety committee. However, fewer than 40 percent reported having a patient safety program budget. Among the hospitals that require a root cause analysis to identify the underlying cause of problems following a near miss, nearly all reported that they ensure that actions are taken based on the findings. However, only 30 percent in the second survey reported using safety assessment results to develop written patient safety plan.
A notable innovation used by some survey respondents is full implementation of "patient safety rounds," which increased from 49 percent to 60 percent during the study period. The majority of hospitals implemented five of the seven items related to surgical policies and procedures; these were identified as vital by the literature and focus groups assisting with the survey development. The five items were pre-anesthesia plan (98 percent), all pre-diagnostic studies included in the chart prior to surgery (97 percent), a policy requiring the surgeon to verbally confirm the side for the operation and mark the limb (95 percent), and a policy requiring pre-surgical discussion of anesthesia options/risks with patient/family (94 percent). However, identification of percentage of equipment failures versus surgical technical performance errors was employed far less often (18 percent) among respondents.
The authors concluded that efforts to improve must be accelerated to meet IOM recommendations.
JAMA Abstract (.doc) (27 KB)
Resources on improving safety culture,
from Premier's Safety Institute.
CDC updates healthcare TB control guidelines; blood test replaces TB skin test
Support for using a blood test for Mycobacterium tuberculosis (MTB) instead of the current tuberculin skin test (TST) was among CDC recommendations in the recently published "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in HealthCare Facilities, 2005."
The newly revised guidelines have been expanded to address a broader definition of a "health-care setting." The term encompasses inpatient and outpatient settings, TB clinics, areas in correctional facilities in which health care is delivered, where home-based health-care and emergency medical services are provided, and in laboratories handling clinical specimens that might contain MTB. The guidelines are intended to minimize exposures to healthcare workers (HCW), a threat primarily from patients or others with unsuspected and undiagnosed infectious TB disease. Administrative, environmental and respiration protection control measures remain the hierarchy of controls to be utilized within a risk assessment process.
N95 respirators. In terms of respiratory protection, CDC recommends the use of N95 respirators, and that N95 fit-testing be done initially and periodically. Although OSHA is referenced (respiratory protection standards require annual fit-testing), CDC appears to give more importance to annual training on respiratory protection, noting there is insufficient evidence to support more than periodic fit-testing. Fit-testing is determined by defined criteria such as weight loss that affects facial features. In a recent "Update," the Association for Professionals in Infection Control and Epidemiology (APIC) noted that the recently signed appropriations bill (H.R. 3010) for the Departments of Labor, Health and Human Services, Education and related agencies contains a provision prohibiting federal funds from being used to implement or enforce annual fit-testing for Fiscal Year 2006 (October 1, 2005-September 30, 2006). This appears to be the same type of provision passed in FY 2005 and addressed in OSHA's 2005 directive.
TB blood test. The 2005 guidelines also include the option of using a new simple, one-step blood test to detect TB infection. The QuantiFERON-TB GOLD (QFT-G) test can be used in all circumstances under which the traditional tuberculin skin test (TST) is used. The CDC recommends that QFT-G be used with contact investigations, evaluation of recent immigrants, and sequential-testing surveillance programs for infection control (e.g., those for healthcare workers). The complete guideline, published in the CDC's December 16 Morbidity and Mortality Weekly Report, states that the sensitivity of QFT-G was statistically similar to that of the tuberculin skin test (TST) for detecting infection in persons with untreated culture-confirmed tuberculosis. QFT-G can detect latent or non-symptomatic TB in individuals while eliminating those who have had BCG vaccinations for TB, a common cause for false-positive readings with the TST. The QFT-G test is highly specific because it measures immune responses to peptides that simulate MTB proteins not present in the BCG vaccine. QFT-G also eliminates the need for multiple visits and any variation in placement, reading and interpretation. Some disadvantages include higher cost, laboratory proficiency issues, and the need for the specimen to be set up within 12 hours. The Centers for Medicare and Medicaid Services also approved QFT-G for reimbursement effective January 1, 2006.
Tuberculosis and Respiratory Protection: prohibition of enforcing annual fit testing requirements during 2005 fiscal year (.doc) (37 KB)
SCIP publishes measurement specifications and additional tools
The Centers for Medicare and Medicaid Services (CMS) Surgical Care Improvement Project (SCIP) specifications (also called "measure information forms" or MIFs) for each SCIP measure are now available on the SCIP Web site. SCIP is collecting information on 21 process or outcome measures in four major areas of surgical complication - infection, cardiac, venous thromboembolism and respiratory.
Each MIF contains information relevant to each measure, such as the definition, rationale, included and excluded populations, and data elements. The specifications also describe references used to support the measure and the algorithm used to determine the numerator and denominator for each measure.
SCIP's site provides many tools shared by participants to address measures and strategies for change to improve processed and outcomes. For example, the "Surgical Preoperative Orders" may be located in the section addressing "Standardizing processes using guidelines and care pathways" (under "Use of standing or preprinted orders"). This standardized order sheet for the surgical preoperative period includes information on preoperative consults, diet, labs, IV fluids, operative permit, surgical site hair removal, appropriate antibiotics by procedure type, and appropriate timing of antibiotics. The surgical site prep listed on the tool is either an iodophor or chlorhexidine (CHG) scrub and clip.
Audio conference on SCIP with Drs. Hunt and Bratzler.
SCIP measurement information forms or specifications.
To join the Surgical Care Improvement Project (SCIP) list serve, send your name, organization and e-mail address to Leigh Anne Baseflug at leighb@qualishealth.org
Surgical Preoperative Orders
(.pdf) (95 KB)
also available at:
http://www.medqic.org/
SCIP information from Premier,
http://www.premierinc.com/quality-safety/tools-services/safety//news/scip-11-11-05.jsp
Lack of communication on patient status at 'hand-off' cited as most common reason for adverse events
A study seeking to analyze communication failures and prevent inefficient or suboptimal care that can lead to patient harm during hospitalization identified "omitted content" as the dominant category of communication failures that occurs when hospitalized patients are being transferred from one physician to another. The "failure to communicate an active medical problem" was the chief sub-category within content omissions.
The study, published in the Quality and Safety in Health Care Journal, interviewed interns to determine which communication failures resulted in adverse events or near misses.
The communication failures reported by the interns included both written and verbal at the time of sign-out from the preceding shift and failures at retrieval of sign-out in the morning. Two major categories of failed communication were observed:
- Omitted content. Failure to report an active medical problem was the most common type of omitted content, in which critical information about medications, active problems, or pending tests was not communicated either verbally or in writing.
- Failure prone communication processes such as a lack of face-to-face discussion. Additional failure-prone communication processes include unclear or illegible hand written notes from "covering" interns and failures from an additional "float" physician covering on the night shift.
Omitted content remained the dominant category and failure to communicate an active medical problem was the chief failure. Another area was failure to communicate the rationale of a treatment decision made by the primary team, such as why antibiotics may not have been started.
The authors categorized their improvement suggestions into two areas - suggested improvements for verbal sign-outs and suggested improvements for written sign-outs. Verbal communication suggestions included detailing any anticipated problems that may occur overnight, as well as including all pertinent medical problems. The interns in the study preferred that verbal sign-outs be given face-to-face. Interns felt that written sign-outs should contain information on code status, baseline mental status, pending tests, consults and procedures. The written sign-outs should also be legible, relevant, accurate and updated, study participants noted. The study authors listed the classifications of an effective sign-out compared to a poor sign-out and noted that this may be important information to use when designing educational or system-based interventions to improve the quality of sign-out.
A December 2005 article in Academic Medicine reinforces similar findings - that precise, unambiguous, face-to-face communication is the best way to ensure effective handoffs of hospitalized patients.
Abstract communication failures (.doc) (25 KB)
Full article at: http://qhc.bmjjournals.com/
Abstract Academic Medicine (.doc) (33 KB)
Unplanned post-op admissions to ICU validated as a patient safety indicator
An unplanned admission to the intensive care unit (UIA) within 24 hours of a procedure is a recommended clinical indicator in surgical patients and is often regarded as a surrogate marker of adverse events. However, researchers have yet to establish its validity as a direct measure of patient safety.
In a recent study by Haller and colleagues in the December 2005 issue of Anesthesiology, UIA was validated as an indicator of safety in surgical patients in a prospective cohort study of 44,130 patients admitted to their hospital. Two hundred and one patients were identified with a UIA and 104 (52.2 percent) had at least one incident or near miss. After adjusting for confounders, these incidents were significantly associated with UIA in all categories of surgical procedures. The 30-day mortality for patients with UIA was 10.9 percent, compared with 1.1 percent in non-UIA patients. After risk adjustment, UIA was associated with excess mortality in several types of surgical procedures. The median length of stay was increased - 16 days versus 2 days - if UIA occurred. For patients with a UIA, the likelihood of discharge from hospital was significantly decreased in most surgical categories analyzed.
Compared with traditional measures such as adverse outcomes, UIA is highly specific to the safety dimensions of patient care and does not depend on the use of complex risk-adjusted models or peer review committees to determine whether an adverse outcome is related to the patient's condition or to a patient's safety issue. These data support the validity of UIA as a measure of patient safety in surgical patients. It can be clearly defined and readily identified in basic hospital information systems.
Anesthesiology abstract, December 2005 (.doc) (23 KB)
JCAHO proposes HCW influenza immunization as new IC standard
A newly proposed infection control (IC) standard that would require offering influenza immunization to caregivers in various healthcare settings has been posted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) on its Web site. The field review of the proposal due February 12, 2006, also seeks information on whether healthcare organizations believe influenza vaccination should be made mandatory, the categories of individuals who should be vaccinated, whether the option to decline vaccination for multiple reasons should be provided, and whether and how organizations can track declination rates.
The proposed standard follows, and may be downloaded. The link for responding to the survey is provided. All statements are new except the #8 Element of Performance.
Standard IC X.X. The risk of influenza infection and transmission is reduced throughout the organization.
Rationale
Transmission of influenza from staff, students, volunteers, and licensed independent practitioners to patients, clients, or residents can create serious health care problems, especially among those who are at high risk for complications related to influenza. In addition, influenza among those in the workforce, especially during an epidemic, can compromise the ability of an organization to provide care for its patients, clients, or residents. Annual vaccination is an important method for preventing influenza and its severe complications. Only 34 -36 percent of staff and Licensed independent practitioners are immunized against influenza each year (unpublished National Health Interview Survey data, Centers for Disease Control and Prevention, 2003).
Elements of Performance
- The organization identifies the kinds of patients, clients, or residents that are at high risk for influenza related complications.
- The organization identifies staff, students, volunteers, and licensed independent practitioners who work with or near these patients, clients, or residents.
- The organization establishes an influenza immunization program for these staff, students, volunteers, and licensed independent practitioners.
- Provides access to influenza immunization at the worksite and at no cost, to these staff, students, volunteers, and licensed independent practitioners;
- Educates these staff, students, volunteers, and licensed independent practitioners about the value of flu vaccination, non-vaccine related control, and the epidemiology, transmission, and diagnosis of influenza;
- Maintains records of staff, students, volunteers, and licensed independent practitioners who have received vaccination;
- Monitors influenza vaccination rates among staff, students, volunteers, and licensed independent practitioners who work with patients, clients, or residents that are at high risk for influenza and:
- Implements enhancements to improve those rates.
This program:
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) currently recommends that all healthcare workers (HCW) be given convenient access to influenza vaccine at the work site, free of charge, as part of employee health programs, a statement recently supported by major professional organizations (see Safety Share, December 2005). The ACIP and CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) are expected to jointly issue recommendations specific to immunizing HCW in the near future.
JCAHO proposed standard. (.pdf) (63 KB)
Comment submission form, JCAHO field survey due February 9, 2006,
http://www.jcaho.org/accredited+organizations/
hospitals/standards/field+reviews/
influenza_immunization_fr.htm
December 2005 Safety Share, "Emphasis on healthcare worker influenza vaccination shifts to patient safety; mandatory versus voluntary."
Premier's influenza resources.
Safety tools
Falls injury prevention toolkit for healthcare facilities
"Minimizing the risk of falls and falls injuries: Guidelines for acute, sub-acute and residential care settings" from the Victorian Quality Council of Australia provides a framework and supporting resources to support falls prevention activities in hospital and residential care settings. This falls reduction guideline packet, or tool kit, contains research, tools, and education materials, including a sample Microsoft® Excel spreadsheet report to track falls data and trends, as well as algorithms for assessing and reassessing an individual's fall risk. The packet includes numerous tips for screening, assessing risk, reducing personal and environmental risk factors, and properly responding to falls. The packet, posters and spreadsheet, and other "fall prevention" resources, are available for download from the Premier Safety Institute's Falls module (under "Sample Procedures").
APIC: Community-acquired MRSA resources and more
New resources on community-acquired MRSA CA-MRSA (.pdf) (123 KB) and a
Template for Gene Vector Guidance (.pdf) (25 KB) have been made available from the Association for Professionals in Infection Control and Epidemiology (APIC) Practice Guidance Council. These resources were developed in collaboration with APIC's Emerging Issues Committee. The CA-MRSA resource identifies key resources available via national, state, and local public health agencies. The Template for Gene Vector Guidance is intended to assist facilities in developing infection control policies to regulate gene vector therapy. APIC recommends any study be reviewed and approved by their Institutional Review Board (IRB) but also include the involvement of an affiliated Biosafety Committee. The reports can also be accessed on APIC's main page under "Practice Guidance Reports" at
http://www.apic.org/Content/NavigationMenu/
PracticeGuidance/Reports/Reports.htm.
AHRQ: Patient guide to surgery
"Having Surgery? What You Need to Know," (.pdf) (489 KB) published by the Agency for Healthcare Research and Quality (AHRQ), is designed to help patients make informed decisions when planning for surgery. The brochure suggests questions to help patients obtain needed information including how and where their operation will be performed, what kind of anesthesia will be used, whether non-surgical medical treatment and watchful waiting are options, possible risks of not having the surgery, potential risks and expected benefits if they have the surgery, and how long recovery is expected to take. Additional questions include cost, insurance and whether a second opinion is required and/or covered. The publication is part of a series of healthcare resources from AHRQ to help people be more active in making informed decisions that can help them obtain high-quality healthcare. A Spanish language version (.pdf) (486 KB) is available.
CV Cath Lab: Infection control guidelines
An updated set of guidelines for infection control in cardiovascular catheterization laboratories has been published by the Society for Cardiovascular Angiography and Interventions (SCAI). Given the increasing complexity and number of interventional cardiology procedures, SCAI identified a need for updated infection-control guidelines and responded with the release of the new guidelines (.pdf) (1.6 MB). The guidelines are published in the January 2006 issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions and update 10-year-old guidelines. New guidelines are designed specifically for the cardiovascular catheterization laboratory and provide information on such issues as the selection of antibacterial soaps, the circumstances under which patients should receive an antibiotic, protective masks and other garb to be worn by catheterization lab staff, and the acceptable level of air circulation in the catheterization lab.
JCAHO: Guide for surge hospitals
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued a guide, "Surge Hospitals: Providing Safe Care in Emergencies" (.pdf) (349 KB). A "surge hospital" is designed to treat a surge in the number of patients needing care, triage, treatment, and even surgical interventions. They are temporary facilities, such as shuttered hospitals, closed wards in existing hospitals, and mobile facilities designed to serve as a stopgap measure to provide medical care until an area's healthcare organizations can reopen. The guide also includes case studies that describe how surge hospitals were established during the recent hurricanes on the Gulf Coast.
HHS: Pandemic influenza planning handbook for families
A new handbook, titled "Pandemic Influenza Planning: A Guide for Individuals and Families," (.pdf) (350 KB) provides information to help Americans understand the threat of pandemic influenza and specific actions they can take to protect themselves and their families and explains topics such as the differences between seasonal and pandemic flu and what to expect in a pandemic. The handbook from the U.S. Department of Health and Human Services (HHS) includes an emergency health sheet for recording personal health information on each family member. A checklist divides actions into three categories: planning for a pandemic, limiting the spread of germs and preventing infection, and items to gather for an extended stay at home. Other important issues include plans for having nonprescription drugs and other health supplies on hand, discussing within a family how care will be given if a member becomes ill, teaching proper hand washing and cough etiquette to children, and having supplies of food and water on hand.
Back to Safety tools | Back to top
Editorial team
- Gina Pugliese, RN, MS editor
- Judene Bartley, MS, MPH, CIC, associate editor
- John Hall, BSJ, contributor
- Judith Luca, RN, BSN, contributor
- Derek Kleckner, BA, Web master
About Premier
Premier, Inc. is a healthcare alliance entirely owned by 200 of the nations leading not-for-profit hospital and healthcare systems. These systems operate or are affiliated with 1,500 hospital facilities and hundreds of other healthcare sites. Premier provides an array of resources supporting health services delivery, including clinical and operational comparative data applications for quality/safety performance improvement, group purchasing and supply chain services, and insurance programs. The Centers for Medicare and Medicaid Services (CMS) has recently partnered with Premier for a three-year quality incentive demonstration project. Participating hospitals using Premier’s Perspective Online ™ database can receive recognition and additional Medicare payment when they meet or exceed specific quality measures.
