Thursday, January 17, 2008

Bundling Hospital Processes

A bundle, according to my dictionary, is a collection or group of things tied, wrapped, or held together. A hospital, for example, is a bundle of services held together by a hospital board, its administration, its employees, and a collection of doctors called the medical staff. Processes, of course, are a series of actions with a particular aim.

Bundled Bills

I’ve had experience bundling together hospital and physician fees. In the early 1990s, as chairman of a physician-hospital organization, I helped bundle together fees of independent physicians and a hospital for about 100 common hospital procedures. The idea was to create a collective bundled fee known in advance by insurers and consumers without touching the independence of doctors. If the cost exceeded the bundled fees, we had reinsurance in place to protect everyone involved.

Bundled Safety Procedures

Now I see by the January 16 USA Today “Bundling Hospital Processes May Help Prevent Infection” that hundreds of U.S. hospitals are putting bundles of safety procedures into place. The bundles are recommended by the Institute of Healthcare Improvement in Boston.

The bundle for preventing infection includes:

1. Monitoring antibiotic use before and after surgery

2. Stopping the use of razors at surgery sites to prevent nicks that might serve as portals of entry for bacteria.

3. Keeping patients warm during surgery

4. Monitoring blood sugar after surgery

5. Implementing vigorous hand washing and hygiene

6. Scrubbing skin with bactericidal agents and alcohol to further minimize infection.

The Institute of Healthcare Improvement recommends other bundles as well for preventing pneumonia in respiratory patients, urinary tract and blood borne infections in patient with catheters, confusion in medications and orders when transferring patients from one hospital site to another, protecting patients being resuscitated after a cardiac arrest.

Bundling of safety measures is not rocket science. It entails common sense, collaboration, alertness, and measurements to see how far hospitals are progressing toward the goal of eliminating infections and other safety hazards lurking in hospitals.

As physicians, we know hospitals can be dangerous places. We can help tie together bundles to protect hospital patients. But unfortunately, office-based practicing physicians can’t usually be two places at once. We’re just part of the bundle.

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