Quality and safety metrics that will specifically affect neurologists/neurohospitalists are coming in the next few years, and neurohospitalists need to be involved in the discussion of what those metrics are, warned S. Andrew Josephson of USCF during a neurohospitalists session at the Stroke 2010 conference yesterday.
He urged the audience to consider the current metric of “time to antibiotics administration for pneumonia,” which seems like a reasonable quality metric on the surface. To get compliance rates up, many hospitals give antibiotics to anyone with a little sputum, a cough, a fever, etc., as soon as he/she arrives at the ED. Thus, resistance rates have risen along with administration rates, because people are getting the drugs when they have things like bronchitis, not just pneumonia.
Why did this happen? Because subspecialists like pulmonologists and infectious disease specialists didn’t play much of a role in making the quality metrics, Dr. Josephson said. “We neurologists need to be at the table when these quality measures that are soon going to affect our practice are made. Because if we aren’t, someone else will make these metrics, and we aren’t going to be very happy with the results.”
One of the quality measures being considered for the future is delirium, he noted.
“The three biggest risk factors for delirium are old age, preexisting or current neurologic conditions, and former cognitive dysfunction. I mean, that’s like everyone I see in the hospital! If delirium becomes a quality measure that I am going to be punished for financially, I’m in big trouble,” Dr. Josephson said.
*This blog post was originally published at ACP Hospitalist*