Quality Improving, Sepsis Still a Problem, Fist-Bump Not to Replace Handwashing

Since before the Affordable Care Act (ACA) (P.L. 111-148) CMS has been placing on emphasis on paying for the quality of care provided rather than the amount of care provided.  The ACA accelerated that initiative by adding even more quality of care reporting requirements and tying a portion of some payments to the reporting on improvements in quality of care measures.  Those efforts seem to be paying off, according to the 2013 National Healthcare Quality Report  and the National Healthcare Disparities Report from the Agency for Healthcare Research and Quality (ARHQ). This good news, though, has been offset by another study conducted for the American Thoracic Society, which shows that sepsis contributes to as much as 50 percent of all hospital deaths.  In the end, it looks like good old fashioned hand washing will be the most effective way of preventing the spread of infection in the hospital setting as recent studies have shown that patients expect a handshake and not a fist-bump from their physicians.  Fist-bumping became popular after it was studied last year by the University of West Virginia as a way to reduce the spread of infections from medical personnel to patients.

Quality Improving

The ARHQ reported that hospitals had showed significant improvement in 75 percent of the quality indicators that they reported on, while home health and skilled nursing facilities showed improvement in only 60 percent of the quality measure they report on, and ambulatory surgical settings showed improvement in only 50 percent of their quality measures.  “Hospitals are clearly engaged in the efforts to improve health care quality in the United States, ” said AHRQ Director Richard Kronick, Ph.D.  The AHRQ has been reporting on quality improvements and disparities in healthcare every year since 2003.

The public reporting of quality measures seems to be having a positive impact, AHRQ’s report stated.  Fourteen of the 16 quality measures that reached a 95 percent performance level were publicly reported by CMS, and another four measures that CMS reports on were improving at the fastest pace.  The ARHQ report found that the rates of healthcare-associated infections are falling and processes to reduce hospital readmissions are increasing.  The ARHQ noted that this finding is consistent with a number of other national reports, including a May 7 CMS report.

Sepsis Problem

While the quality of care overall is seen as improving, sepsis infections still continue to be a major concern.  A report by the American Thoracic Society found that as many as half of all deaths  in a hospital have sepsis as a contributing factor even though only ten percent of patients have sepsis. According to the Mayo Clinic sepsis occurs when chemicals released into the bloodstream to fight infection trigger inflammation throughout the body which can lead to a number of other complications that result in organ failure. The study prepared for ATS by the Kaiser Permanente Northern California Division of Research examined 6.5 million hospital discharge records and found that mortality rates for patients with sepsis was 10.4 percent compared to only 1.1 percent among non-sepsis patients.  The study’s author said, “we were surprised to find that as many as one in two patients dying in U.S. hospitals had sepsis.”


One novel method studied last year to reduce the rate of infection in hospitals was to replace the patient provider handshake with a fist-bump.  A West Virginia University study found that a fist-bump had one-third as much skin contact as a handshake and that the time the skin of the two people was in contact was 2.7 times greater with a handshake. A number of studies, though, have shown that the handshake is expected by patients. A 2007 study found that 78 percent of patients said they wanted a handshake when being greeted by their physician. Other studies conducted in 2013 and 2009 came to similar conclusions.  The logical conclusion is that proper hand hygiene is necessary and the most effective way to improve care. The lead investigator of the fist-bump study agrees.  “The overall goal of the study was to do one thing: to bring attention to the importance of hand washing. It’s a funny way to raise attention, I know, but my goal wasn’t to get rid of handshaking and supplant it with fist bumping,” said W. Thomas McClellan.