patient safety quality healthcare

CMS Outlines The Methodology Behind Its Five-Star Hospital Ratings

CMS held a webinar on May 12 explaining the methodology and upcoming changes to its controversial five-star hospital ranking system. Under the ranking system, hospitals would receive more stars for better compliance with a set of measures that focus on mortality, safety, hospital readmissions, and the timeliness and effectiveness of care. Prior to the webinar, several groups have argued that the star ranking system is too simplified to show true quality and reported difficultly replicating CMS’s methodology in testing the five-star rating system.

Some of the changes include the elimination of 14 voluntary measures falling under the “effectiveness of care” and “timeliness of care” categories. Measures for 20-day mortality and readmission coronary bypass grafting were added in April, with two colonoscopy measures to be added in July.

One of the webinar’s speakers was Arjun Venkatesh, MD, director of quality and safety research and strategy at the Yale University School of Medicine. He said that the five guiding principles behind the hospital star ratings simplicity/accessibility, inclusivity, scientific rigor, stakeholder engagement and consistency. The ratings methodology itself comprises of five steps:

1.    CMS select measures
2.    Measures are grouped into respective categories, such as safety, mortality or patient experience
3.    Group scores are calculated based on latent variable models
4.    A weighted summary score is generated for each hospital
5.    A final star rating is awarded

In addition to the Hospital Compare data, CMS will also start providing hospital-specific reports with additional details, such as individual standardized measure scores. The release of the star system has been postponed until July.

Click here to see the CMS webinar slides.


Two Frequently Cited Joint Commission Standards Are “Catchall” for Patient Safety


EC.02.06.01 and IC.02.02.01 were the two most challenging standards for hospitals in 2015, both of which have significant patient safety implications.

The top two most frequently cited Joint Commission standards in 2015 are not necessarily surprising. Both are widely recognized as catchall standards that encapsulate a wide variety of survey violations.

However, both standards have clear patient safety implications that reveal ongoing concerns about scope reprocessing, infection prevention best practices, and managing behavioral health patients in the ED.

According to The Joint Commission, the top two most frequently cited standards for hospitals in 2015 were:

  • EC.02.06.01 - Maintaining an environment that is safe and functional (62% noncompliance)
  • IC.02.02.01 - Reducing infection risks from medical devices, equipment, and supplies (59% noncompliance)

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Wanted: Evidence That Improving Quality Cuts Costs

By Tinker Ready, HealthLeaders Media

There's hope. And there's reality. On close inspection, the link between cost and quality is actually pretty fuzzy: We just don't know.

One of the incentives for improving the quality of healthcare is the notion that it will also lower costs.

Ideally, patients will have a medical home to go to instead of an emergency room.

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Major HAIs Decline, but Antibiotic Resistance Remains Problematic

Updated infection control guidelines released by the CDC in February indicate hospitals are making strides to prevent common infections.

According to updated statistics from the CDC, central- line bloodstream infections (CLABSI) saw an 8% decline from 2013 to 2014, 50% below the national baseline. Hospital-acquired MRSA infections saw a 4% decline from 2013 to 2014, 13% below the national baseline.

Although several other infections fluctuated between 2013 and 2014, many were still well below the national baseline. C. difficile infections, for example, increased 4% between 2013 and 2014, but remained 8% below baseline. Reductions in surgical site infections (SSI) were statistically insignificant over the course of a year, but still remained 17% below baseline.

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Medical Errors Unseat Respiratory Disease as Third Leading Cause of Death

A study conducted by Johns Hopkins researchers estimates that 250,000 Americans die annually due to medical errors, nearly 100,000 more than those who die of respiratory disease. The Centers for Disease Control and Prevention (CDC) states that respiratory disease is the third leading cause of death in the nation.

The CDC uses the cause of death listed in a person’s death certificate to calculate the leading causes of mortality each year. The John Hopkins team says that since medical errors aren’t listed separately on death certificates, the CDC has been vastly underestimating their impact.

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Identifying Best Practices for Suicide Prevention

Over the last decade, suicide rates in the United States have been creepily skyward. In some states, the suicide rate is nearly twice the national average.

Suicide is the 10th leading cause of death, according to statistics from the CDC, and in certain populations it is even more pervasive. From 2005 to 2014, the national suicide rate increased from 10.90 per 100,000 people to 12.93 per 100,000, and states like Montana and Alaska have rates of 23.8 and 21.97 respectively.

Among adolescents and young adults, suicide is a shockingly prevalent cause of death. In 2014, suicide was featured as the second leading cause of death in three different age groups (10-14, 15-24, and 25-34). For those ages 35-44 and 45-54, suicide was the fourth leading cause of death.

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CMS Releases Guide to Preventing Readmissions for Racially, Ethnically Diverse Beneficiaries

Patients who are members of racial and ethnic minority groups may be more likely than others to be readmitted after discharge—particularly if they have chronic conditions, such as pneumonia or heart failure or have suffered a heart attack. Many times, it’s social, cultural, or linguistic barriers that lead to those readmissions, according to the CMS Office of Minority Health (CMS OMH).

To help healthcare practitioners combat these issues and help minority patients improve their health, CMS OMH released the “Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries.” It’s designed to help hospitals identify the reasons why readmissions occur among this group of patients and to find solutions to help prevent them.

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CMS adopts 2012 Life Safety Code®

In a highly-anticipated move expected to significantly affect the regulatory rules that hospitals and other healthcare facilities are held to, the Centers for Medicare & Medicaid Services (CMS) has officially adopted the 2012 edition of the Life Safety Code® (LSC).

CMS has confirmed that the final rule adopts updated provisions of the National Fire Protection Association’s (NFPA) 2012 edition of the LSC as well as provisions of the NFPA’s 2012 edition of the Health Care Facilities Code.

Healthcare providers affected by this rule must comply with all regulations by July 4—60 days from the publication date of the rule in the Federal Register.

The adoption of the rule has long been anticipated, as the LSC, which governs fire safety regulations in U.S. hospitals, is updated every three years, and CMS has not formally adopted a new update since 2003, when it adopted the 2000 edition. As a result, CMS surveyors have been holding healthcare facilities to different standards to other regulatory agencies that have gradually adopted provisions of the new LSC in their survey requirements.

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GAO Report Highlights Three Key Patient Safety Challenges


Agency finds that hospitals struggle with data collection, identifying evidence-based practices, and implementation strategies.


A recent report from a federal watchdog agency offers new insight into the barriers hospitals still face when it comes to addressing patient safety concerns, offering a concise distillation of the key gaps that remain in ongoing efforts to prevent patient harm.

Officials at the Government Accountability Office (GAO) interviewed patient safety experts at six hospitals and six insurers, as well as officials at CMS and the Agency for Healthcare Research and Quality (AHRQ). The six hospitals were selected according to their performance in certain patient safety quality measures.

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NPSF Announces DAISY Award 2016 Honorees

The National Patient Safety Foundation along with The Daisy Foundation have announced the winners of the 2016 National Patient Safety Foundation DAISY Awards for Extraordinary Nurses. The award, a derivative of The DAISY Award for Extraordinary Nurses, places special emphasis on patient and workforce safety.

Now in its second year, this award is a derivative of The DAISY Foundations’ signature program, The DAISY Award for Extraordinary Nurses which is given to nurses in more than 2,200 healthcare facilities throughout the U.S. as well as 14 other countries. Nurses who received the DAISY award from their organizations between January 2014 and June 2015 were eligible for this 2016 international award.

“The National Patient Safety Foundation DAISY Award for Extraordinary Nurses is a way to formally recognize and celebrate exceptional contributions to patient safety by nurses,” said Tejal K. Gandhi, MD, MPH, CPPS, president and CEO, NPSF.

Rachel Whittaker, BSN, RN, CPN, of Children’s Hospital Colorado in Aurora, the recipient of the individual award, was chosen for her leadership, compassion, and practice of patient-and family-centered care, particularly during end-of-life decisions.

The Clinical Informatics Council of the University of New Mexico Hospitals in Albuquerque, will receive the team award for their efforts to address safety issues including an alert designed to prevent complications from ventilator use, a Pediatric Early Warning Score to predict a deteriorating patient, and a streamlined method for documenting wounds. Sheena Ferguson, MSN, RN, CNS, CCRN, chief nursing officer, noted this as a “huge improvement” in patient safety, because it allows multiple disciplines to document wounds in the same place and with consistent terminology.

“Choosing the final honorees for this international award was difficult because we had so many inspiring stories of truly compassionate nurses making a difference in patient and workplace safety,” said Bonnie Barnes, FAAN, co-founder and president of The Daisy Foundation.

The awards will be presented during the 18th Annual NPSF Patient Safety Congress in Scottsdale, Arizona at the end of May.

For more information about The DAISY Foundation, visit For updates about the award and the NPSF Patient Safety Congress, visit

Joint Commission Finalizes New Requirements for CAUTI NPSG

Proposed Joint Commission NPSG focuses on risks of pediatric CT scans

Radiology experts are split on whether the focus on head and chest scan is a valuable use of resources

A proposed National Patient Safety Goal (NPSG) released by The Joint Commission in February takes aim at judicious use of computed tomography (CT) imaging among pediatric patients, requiring hospitals to follow evidence-based guidelines when considering CTs for minor head trauma.

The proposed standard, released as NPSG.17.01.01, would apply to hospitals, ambulatory care facilities, and critical access hospitals. The Joint Commission accepted comments on the proposed requirement through the end of March.

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ABQAURP American Society for Quality American Society for Quality Healthcare Division Consumers Advancing Patient Safety
EMPSF Institute for Safe Medical Practices
Medically Induced Trauma Support Services (MITSS) Medication Safety Officers Society NPSF Partnership for Patient Safety Society to Improve Diagnosis in Medicine