In our culture of continuous improvement, RML strives to stay on the leading edge of treatment, rehabilitation and research. Constant care is required to ensure we provide the support, training and environment necessary to help patients achieve goals.
We judge our effectiveness by measuring clinical outcomes. We are proud to report our outcomes in key areas associated with excellence in healthcare. They are:
Many lifesaving medical treatments carry some degree of risk to the patient. One of these risks is the risk of infection. According to the Centers for Disease Control (CDC), nosocomial or hospital-acquired infections affect two million people annually.
Safe ways to treat and care for patients are important to the staff at RML. We are committed to reducing the incidence of infection.
Based on the medical complexity of our patients, we closely monitor the occurrence of three major types of infections: catheter-associated urinary tract infections (CAUTIs), central line infections (CLABSIs) and ventilator-associated pneumonias (VAPs).
To gauge patient infection performance, RML uses comparative data from the National Healthcare Safety Network (NHSN), the surveillance system database of the Centers for Disease Control (CDC). The most recent comparative data from NHSN is from 2012.
Currently, there is no mandatory database for long-term acute care hospitals. Data reflected in the NHSN data base is reported on a voluntary basis.
When making comparisons, it should be noted the NHSN data is not risk-adjusted. LTACHs like RML treats very complex patient populations. These complex patients are at much greater risk for developing complications and infections because of the very nature of their illnesses. Hospitals that provide care for these more complex patients may or may not have higher (non risk-adjusted) rates of infections than hospitals that do not care for such complex patients.
Catheter-associated Urinary Tract Infections (CAUTIs)
CAUTIs account for nearly 80 percent of all hospital-acquired infections. RML uses CDC guidelines to assess infection from a urinary catheter. A CAUTI diagnosis requires a positive urine culture plus one of the following:
- Urinary frequency
- Urinary urgency
CAUTI rates are reported as the number of infections per 1000 urinary catheter days. A lower number means fewer infections.
Central Line-Associated Blood Stream Infections (CLABSIs)
CLABSIs are the most severe of all hospital acquired infections. They occur when bacteria enters the bloodstream through a central line. RML carefully monitors and sustains best practices for central line insertion and maintenance.
CLABSI rates are reported as the number of infections per 1000 central-line days. A lower number means fewer infections.
Ventilator-associated Pneumonias (VAP)
Identifying pneumonia in ventilated patients is difficult. Many of the typical symptoms are absent or difficult to obtain since these patients are often sedated and/or unable to communicate. RML uses the nationally recognized CDC definition for pneumonia, which requires a positive chest X-ray (new or progressive infiltrate) plus one of the following:
- New onset of purulent sputum or change in sputum character
- Increased amount of secretion
- Positive culture (from trached aspiration, suction, or bronchoscopy)
VAP rates are expressed as the number of infections per 1000 ventilator days. A lower number means fewer infections.
Our complex patient population is at high risk for falling during hospitalization due to a variety of contributing factors including age, disorientation and dementia, unfamiliarity of surroundings, weakness and frailty, cumbersome lines, tubes and dressings, specialty beds and bed surfaces and mind-and balance-altering medications.
We work diligently to keep our patients safe. To protect patients against falling, we employ fall prevention strategies that target the highest risk areas. Our interventions include thorough assessment of patient risks, frequent patient observation and re-orientation, use of protective equipment, bed and chair exit alarms, beds in low position and placement of call lights within patient reach.
Historically, we compare our outcomes data to the National Association of Long Term Hospitals (NALTH), an advocacy, education and research organization that represents long-term acute care hospitals. The most recent available comparison from NALTH is from 2011.
Patient fall rates are reported as the number of falls per 1000 patient days. A lower number means fewer falls.
A pressure ulcer is a localized injury to the skin and/or underlying tissue due to pressure over a bony area. Factors such as older age, poor circulation, lack of mobility, friction and malnutrition significantly contribute to the risk of developing pressure ulcers.
Patients treated at RML are seriously ill and are at very high risk for developing pressure ulcers. Many of our patients are admitted with pressure ulcers that occurred in during their previous hospitalization.
Pressure ulcers are painful, take a long time to heal and cause other complications such as skin and bone infections. Our goal is to heal the pressure ulcers patients already have at the time of admission and prevent new ones from developing.
Beginning in October 2012, the Centers for Medicare and Medicaid Services (CMS) required LTACHs to report pressure ulcer data as follows:
Using this new definition, RML’s pressure ulcer rate for FY14 was 5.2%. LTACH comparison data from CMS is anticipated in 2014.