Quality and Risk Scenario Essay

The HIM headmaster so-and-so have a direct impact on the quality or compliance of limited operations or employees inwardly a health explosive charge institution. Healthc ar institutions, such as hospitals, can be huge institutions made up of hundreds or eve thousands of treatment or operation specific argonas operation. This can include eitherthing from the surgeon who performs coronary arterial caudex vessel bypass to the neonatal intensive c be nurse who directly electric charges for assay newborns to the physical plant worker who makes indisputable each(prenominal) told the lights in the expression stay on and the operating fashion is followed at a certain temperature.As an over totally(a) institution the thought of identifying stake and indebtedness inwardly the organization can be quite overwhelming and daunting. The crush appearance to approach this is to break things down into specific issues or field of studys and local anaestheticise on one thing at a time, with the overall final stage to be improving quality and reducing risk to the institution. This paper get out focus on three specific scenarios that re amaze an area of risk and liability for the institution.These three scenarios will include the safety of blood transfusions deep down a hospital, dealing with actor ill risks within a hospital and using operational come across magnetic dips to improve employee efficiency, consistency and reducing the human fixings of making mistakes. Scenario one is to be specific to a scenario involving diligent care and safety. The specific discussion present will be the use of blood transfusions within the hospital setting. This is a action that has been done for dozens of long time raze as medical science has made tremendous progress.The veracity is that science just hasnt found a synthetic modal value to carry oxygen through the blood stream and blood infusions as yet remain today the best way to do just that. sequence t he best procedure out in that respect for this, blood infusions dont come without their risks and financial impacts. A demand by the University Healthcare puddle analyzed over 29,000 blood transfusions over a 7 class period from 2003-2009 (Williams, 2011). These transfusions ranged anywhere from scheduled routine out tolerant surgeries to unexpected traumatic injuries brought in through the jot room.The analysis identified umpteen risks associated with blood transfusions, including mischievously trained round, lack of trained staff, minor hemolytic allergic reactions all the way up to severe anaphylactic reactions. The conduct was even fitted to identify that the time of day that the transfusion was performed could positively or negatively affect the uncomplaining outcome. So, while this can be a lifesaving procedure a blood transfusion should non be taken lightly. some other study published in the April, 2012 issue of the schoolmaster journal Anesthesiology was conducted by Johns Hopkins Hospital analyzing the outcomes of over 3000 endurings who received blood transfusions. This study reveals that measuring the haemoglobin level in patients can be an accu localize indicator of when a patient should receive a blood transfusion. This is a significant study be slip it could have a positive effect on some(prenominal) patient outcome and the financial be embarrassd in giving a blood transfusion.The Johns Hopkins study revealed that patients were being given blood transfusions when they actuallyly didnt have it. A normal hemoglobin level ranges among 12-14 and the study reveals that a level as low as 7 or 8 is safe. Prior to this study the leading specialty societies, including the FOCUS inquiry group (Functional Outcomes in Cardivascular patients Undergoing Surgury), set parameters that transfusions were definitely needed if the hemoglobin was infra 7 and plausibly did non need a transfusion if the hemoglobin was 10 or above. tho nobody ever set any parameters on what to do if the hemoglobin ranged between 7 and 10. This left the mendelevium to decide when to start a blood transfusion. The Johns Hopkins study revealed that because of this most physicians ever erred in the side of safety by ordering a transfusion any time the hemoglobin was at or below 10. But the Hopkins study has now desexualised that a hemoglobin of 7 or 8 can be considered safe. Giving blood to patients who have a hemoglobin above 7 shows no real welfare and accuracy is that the risk due to side effects may actually be increased.Remember that this procedure has been in smear for decades and this new research was a game changer. The benefits to a hospital from the Hopkins study are tremendous. The study revealed that the costs to the hospital for one unit (300ml) of blood can cost as much as $1,100. While the donor gives the blood for free it must be analyzed for toxic diseases including Hepatitis and HIV (IMVS 2012). The blood is indeed maro oned into red blood cells, platelets and plasma, to be distributed specifically where needed.Include the storage and impartation costs and you can start to on a lower floorstand wherefore blood is so expensive. Only giving blood when rightfully indicated has been shown to reduce the use of blood by up to 66% per institution with no change in outcomes to the patient including length of stay, heart attack, stroke, death, and even the ability to walk (Clark, 2012). This is where the HIM professional can come into play. The HIM can take research articles like this or even acquire their own research and then do train to educate the hospital staff.The Hopkins tudy indicated that when the HIM spoke directly with the surgeons and showed them the research in that location was a tendency to accept the new mindset and start delaying blood transfusions until the patient hemoglobin dropped below 7. This resulted in extra blood supply for those patients who truly need it and a significant r educed operating cost to the institution. Its the HIMs job to establish or change procedures that reflect ever-changing and beneficial modalities and to get the information out to the hospital physicians and staff so they can help reduce institutional costs and ultimately benefit their own livelihood.This work can be done for hundreds or even thousands of does currently in place within a hospital institution. flat we move on from our blood transfusion scenario to one involving the infrastructure of the hospital. The specific example to be apply here is the hospital place supply. Hurricane sandy revealed for many healthcare institutions in the north eastern United call forths that they were not as prepared as they thought. Some of these hospitals did have emergency generators in place, but they did no good for providing electricity when they were located in the basement of the construction submerged in water from the flood.Sometimes it takes a real catastrophe for us to tru ly see how prepared we really are and how to improve. Its important that a hospital be able to abide by electricity at all times. Almost e precise part of the building depends on electricity for staff to function and take care of their patients. Without electricity the lights wont work, the furnace and air conditioners wont work, the pumps wont pump water through the pipes, ventilators will offend works and elevators wont even be able to transfer sick patients between floors. These are some examples, but surely you can hap many more failures if you look hard enough.For this reason, it is important that a hospital pronounce and have a plan in place to reduce the casualty of losing electricity and also have a plan in place if all safe guards fail. The concerns can truly be specific to a geographic area. For example, a hospital in the Midwest may not have to worry much about being hit by a hurricane, but it could be hit by a tornado. I spoke with hospital administrator Robyn Mazz olini at Advocate Lutheran command Hospital in Park Ridge, Illinois regarding how their hospital has addressed the issue of maintaining electricity to the ease.Robyn indicated that there were three specific issues of highest concern. They included the loss of causality from the local utility company, flooding of the existing generators in the basement of the main hospital and damage from tornados. Robyn indicated that about ten years ago the hospital installed a generator in the basement of the main building that is capable of providing power to the entire ten story hospital, including all lights and HVAC. The problem was that the unit was very large and heavy and, as a result, had to be installed in the basement.A second generator was installed right nigh to the first to act as a backup generator should they lose power from the power company. These generators are also designed to pop off on both natural atom smasher or stored gasoline in the event the gas lines become comprom ised. This seemed to exculpate 90% of the scenarios that could come up. Then the neighboring community experienced a flood that shut down utilities for days and a fewer weeks in some areas. The hospital was concerned that they would be shut down in the event of a flood in their generator rooms in the basement.So, they added a third generator inside a remote area on the south perimeter of the hospital. This generator is located inside a concrete structure three floors above ground level. This is a small generator that will run specific areas in order for the hospital to stay functional. For example, this generator only supplies certain lights so that there is incessantly enough visibility to operate. It also is designed to operate all electronics in the operating rooms, emergency room and censorious care areas so there is no compromise to patient care.On the remaining medical floors there is one or two red colored electric outlets that operate off this third generator. In additi on, this generator is not connected in any way to the basement level so that it can power the speeding floors of the hospital even if the ground level is buried under 20 feet of water. The third generator is also enclosed in walls of reenforce concrete with the thought that it could withstand a tornado. It was the HIM and the HIT who were involved in the process to help determine the essential power needs of the hospital.The HIM evaluated the staff and the various facilities to determine that they could function treating most patients as long as there was one dedicated outlet within each patient room. The HIT also identified that the operating rooms, critical care areas and emergency room pretty much needed full power capabilities no matter what. The HIM and facilities managers both have a critical role in communicating the needs of the patients, staff and hospital to the engineers, administrators and building designers.And while Lutheran General Hospital was able to spend million s to prepare for a power disruption and pretty much covered every(prenominal) scenario, they still need to be ready to operate should all power to the facility cease. It is the HIM who can evaluate the various areas of the hospital based on resources, staffing and needs to determine the most critical issues to address first in the event of a total power failure. This takes a lot of time and energy and is probably an evolving process as conditions and resources change.But, in the end, it is the HIM professional who is able to connect all the dots to help bring the best solution for the organization. The third and final scenario presented here is related to staffing and how the HIM can help reduce risk and liability when it comes to the conduct of hospital staff. Hospital employees by their human nature are persuasible to making mistakes or forgetting to do certain things in the course of their patient care. Every health care institution, and any other business for that matter, stri ves to find ways to provide the best service possible to its customers.The challenge in improving service and reducing liability is finding a process that actually works. Ohio State University Medical Center found a way to improve the quality and consistency of patient care from its medical professionals. Ohio State did created a system of check lists to be used by hospital staff in their particular department and area of accountability. So, there were many different checklists, but each employee only had one checklist that they were specifically liable for.The University compared the outcome of over 3000 patients both before the check lists were used and then an additional 3000 plus patients after the checklists were used. The results were staggering. The study showed, for example, that the operative death rate of patients decreased 47% when check lists were used compared to none used. Surgical contagious disease rates were found to have decreased by 45%. These are dramatic resu lts that understandably show a huge improvement in patient care and reduction of risk and liability.A possible cause for such improvement is that using checklists prevented medical staff from skipping a stop that could have caused a serious complication or infection. The aviation industriousness has proven that checklists work. When a pilot has a sudden engine failure there is plenty of room for panic and impulsive missed steps. This is why pilots are trained to immediately pull out their check lists, even if they have them memorized, and go systematically down the list to make sure that all steps are completed as indicated.This following of check lists has proven to significantly improve survivability of the aircraft during an emergency. The use of check lists seems to hold dead on target for the health care industry, too, as the data clearly shows. The HIM plays a critical role in the development and rollout of these check lists to the various departments. The HIM must involve th e hospital staff, managers and physicians in the process of developing a check list that easily and safely covers the needs of both the patient and the hospital.Once essential the HIM must develop and take the time to train the staff so that they understand the intent of the check lists as well as the item-by-item steps and why they are to be completed. This training will fancy that the employees buy into the use of the check lists and choose to use them consistently with every patient. Theoretically, this should provide the same process and the same desired outcomes each time. at any rate implementing the checklist program through training the HIM also plays an important role in developing a policy that says how the plan is to be implemented.Employees appreciate it when everything is clearly spelled out of what is expected of them. The HIM is in a slope to deal with both the hospital administrator and the front line nurse who is physically sympathize with for patients. This a llows the HIM to obtain feedback and recommendations from all involved in the process and create or modify the plan as it is determined that changes need to take place. The HIM is maybe also in the best position to analyze the data to present the findings of the continued analysis to administrators to determine if the check list process is working or not.An example of a checklist that Ohio State University Medical Center used was the Pre-Op holding RN checklist that ends with transfer to the operating room RN checklist. severally nurse has specific duties to complete with their patient as they prepare them for their surgical procedure. The Pre-Op nurse can follow the check list to ensure that all required actions have indeed taken place. When transferring care to the operating room nurse the pre-op nurse passes on her check list to verify to the next nurse that everything has been completed properly.Each nurse is also required to bring the next receiving nurse if they have any qu estions. As you can see, this process really does maintain a high quality of continuity of care for the patients as they move throughout the various areas in the hospital during their stay. corking corners and skipping steps in the patient care process is significantly reduced if not completely eliminated and the HIM or HIT professional is involved all along in helping to create and improve the process within that hospital.This paper only discussed three scenarios in the process of seeking to maintain quality while reducing financial liability within a hospital environment. These processes can be used and applied towards the thousands of specific areas of responsibility that exist within a large health care facility like a hospital. The HIM professional really does play a crucial role in connecting the various departments and providers within a small or large healthcare institution.The HIM is in a position to know the jiffy of the front line operations as well as the upper office administrations intended direction going forward. The HIM professional can pull everyone together to compile data and make recommendations or changes that benefit the patient, the physicians and nurses, the facilities operators and even the top level administrators. There are few other individuals who are in such a good position to create such positive change. Quality HIM professionals will be in demand for many years to come.