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Financial Health Problem Analysis
Healthcare is a demanding service to the patients, which is highly focused on the quality, health, wellbeing of the patient clients. The care programs are usually knitted to provide cost-effective care that is safe, of high quality, and that is effective in contributing to the patient’s health and independence. The healthcare providers and the patient should have their efforts merged to enhance the achievement of the goals. This paper will discuss the financial impact of catheter-associated urinary tract infections (CAUTIs) on the patients and organizational budgets that also affect care quality.
In our workplace, CAUTIs are becoming a major concern for both the patients and healthcare providers due to the high levels of financially disproportionate care, influencing activities that increase the financial cost of care. Some of the adverse care processes that may have resulted from the CAUTIs among the patients include extended hospitalization, increased management cost for the CAUTIs, compensatory services to the patients for the hospital-acquired infections, and increased length of recovery period that affects their independence. All these factors have been thus contributing additional costs to the healthcare providing institution and the patient or caregiving team of the patients and therefore should be addressed by the hospital in controlling the surging budgets due to the financial implications.
Various studies have been conducted to ascertain the financial implications of hospital-acquired infections such as CAUTIs on the patient care process. The first peer-reviewed research by Hutton et al. (2018) evaluates the economic impact of catheter-associated urinary tract infections (CAUTIs) prevention programs in nursing homes. The randomized clinical trial was set in a community-based nursing home facility for patients with indwelling urinary catheters. The researchers used an infection prevention program as an intervention that would be compared to the standard care and used measurements such as costs of intervention, cost-effectiveness ratio, and general health outcomes of the patients. The research’s results indicated that the intervention contributed to less cost of care compared to the placebo. The results showed that the cost of treating the disease reduced by $54,316 in a year which amounted to a $34,037 net savings on the cost of care. The research results supported the hypothesis that CAUTIs increased the cost of care, and preventive interventions against the acquired infections would directly impact cost reduction. As seen through the study, the key cost-saving avenues were reduced CAUTI hospitalizations and reduced CAUTIs care, which impacted on $39,180 and $15,136 savings, respectively. From this research article and study, it is evident that catheter-associated urinary tract infections contribute to increased cost of care, and the application of preventive care programs would reduce the rates of infection that would reduce the cost of care for both the hospital and the individual patients.
Another article, Smith et al. (2019), discusses the hospitals’ health economic burden of urinary catheter-associated infections. The researchers used a decision-analytic model to estimate the annual prevalence of CAUTIs and central line-associated bloodstream infections (CLABSIs) and how they are closely associated with the excess economic health burden. The study researchers conducted scenario and probabilistic sensitivity analyses on health and economic benefits for catheter infections preventions. Through the model, CAUTIs were estimated to be 42,967 while CLABSIs were estimated to be 7529. The hospital-onset infections were found to be 38,084 and 2,524, respectively. According to the study results, CAUTIs contributed to 45,717 excess bed days, 1467 deaths, and 10,471 lost QALYs in a year. Every percent reduction for catheter-associated infection prevalence, there would be a £9,800 saving on direct hospital costs, which would amount to £54.4 million in a year and an additional £209.4M in economic value. The results indicate that the increased prevalence of CAUTIs and CLABSIs increases the cost of care and the general economic health burden in a country.
The healthcare organization members play a very important role in reducing the key factors that contribute to financial loss over the increased cost of care. In establishing the situation in my community hospital as a PRN nurse, I interviewed two healthcare providers; the chief nursing officer and the intensive care unit manager. Ms. Morris is the CNO of the hospital and has various responsibilities attached to the quality patient care and general managerial roles of the organizational functions. The chief nursing officer has the administrative role in maintaining quality clinical and patient care standards, including access to safe medical care, increased patient satisfaction, and reduced hospital-acquired infections through quality nursing practices. The chief nurse works closely with the management in designing quality improvement initiatives and installing the right infrastructure, among other resources, that can help improve the patient outcome. Ms. Morris also ensures proper implementation of organizational rules and policies through the administrative roles. According to Ms. Morris, addressing the issue of CAUTIs in the hospital has taken over four years since the discussion was brought on board. The chief nursing officer acknowledged that the organization only embraced one initiative of having the standard rules pinned on the doors of the care units to remind the nurses on things to follow in reducing hospital-acquired infections such as CAUTIs. The initiative was short-lived. According to her, the organization believes that some initiatives such as regular educational programs are expensive to adopt. Her perceptions on the financial impact of CAUTIs and the control measures differed with the organizational financial managers. She believed that CAUTIs contributed to increased cost of care through delayed discharge, readmissions, and litigation that are costly for the organization. Ferguson et al. (2018) support Morris’ ideology that a decrease in CAUTIs improves patient outcomes, which impacts on financial benefits to the organization. The financial team considered control initiatives expensive and ineffective in changing a “normal” occurrence in the healthcare process.
Joe is the unit manager of the ICU and is responsible for managing operations within the care unit and ensuring that the members of the ICU staff conform to the nursing and clinical standards to improve patient care. According to Joe, the organization prevented visits by non-clinical visitors to the intensive care unit to avoid contamination to the patients who require standard care for early recovery and reduced the prevalence of infections. He also acknowledged the use of mail reminders and memos on the notice boards to remind the healthcare providers of the nursing standards for controlling infections. The initiatives, according to Joe, contributed to a negligible improvement in CAUTIs. The foreseen organizational problems that block efforts to address the issue are resistance to changes and the high cost of the quality improvement initiatives. According to Vaishnavi et al. (2019), fear of change is a key contributor to adopting quality improvement initiatives in the healthcare system. Joe challenges the foreseen financial difficulties by showcasing the benefits that would be accrued on reducing CAUTIs. According to him, the hospital will reduce hospitalization, and thus beds will be occupied by new clients, readmissions will also decline, and the intervention will help control other conditions such as CLABSIs and SSIs. He observes that initiatives such as educational programs and the production of manuals may be done twice a year, thus less expensive but with positive financial savings.
The organization’s financial analysis closely links with the information from the chief nursing officer and the ICU manager. The organization receives about 4000 catheter patients for urinary tract surgery in a year. With a prevalence rate of 20%, about 800 patients develop complications related to CAUTIs. Of those diagnosed while in the hospital, about 500 are forced to have a three-day stay in the hospital for control and management. When the cause of hospitalization is established to be CAUTIs, the hospital caters for the hospital stay. Averagely, the hospital stay is $2,607, and thus the hospital usually loses $3,910,500 in a year through the extended hospital stay. According to Ferguson (2018), the CMS requires the healthcare providing hospitals to cater for expenses on the development of HAIs, including CAUTIs. About 5% of the patients are readmitted to the hospital, and according to the hospital’s policy, the patient covers 80% of the care while the hospital covers the rest. The 200 readmitted patients thus the organization lose $312,000 in a year through readmissions. Other costs associated with the CAUTIs condition include poor reputation that leads to a low number of clients, treatment procedures, and decreased trust among the patients. The minimum cost of treatment of CAUTIs, according to AHRQ (2019), is $4,694, meaning that the organization averagely loses over $5 million on treating the CAUTIs patients. Generally, the organization loses over $10 million in treating CAUTIs in a year, a cost about 500 times the cost of the common interventions for HAIs.
Various interventions should be used to counter CAUTIs and reduce financial stress to the organization. Nurse-driven protocols are one of the strategies that can effectively control CAUTIs. According to Berto (2019), the nurse-driven protocols provide the nurses with autonomy, enabling them to make decisions based on their scope of practice. This initiates a healthy working environment whereby the nurses own the responsibility and control their practice. A systematic review by Durant (2017) established that nurse-driven protocols effectively controlled CAUTIs, leading to a great reduction in the prevalence of infections in healthcare centers. This can be applied to my workplace through management, which involves a change of leadership approach in empowering the nurses to control their nursing practices. Another approach is through nurse education. Nurse education entails refreshing courses on hygiene, catheter insertions, catheter management, and other standards of practice that can enhance CAUTIs control. Through a study, Jones et al. (2019) established that regular training on catheter insertion and management contributed to a significant decrease in CAUTIs. The education program can be done for the new nurses in the hospital and twice every year as a reminder for the non-entry nurses. In collaboration with the management, the chief nursing officer should contract trainers and facilitate reading materials for the effective implementation of quality improvement initiatives. This intervention may require financing but generally cannot go beyond $200,000 in a year which is far more cost-effective than the financial constraints contributed by the CAUTIs.
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References
AHRQ. (2019). Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. Agency for Healthcare Research and Quality. https://www.ahrq.gov/hai/pfp/haccost2017-results.html
Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: a systematic review. American journal of infection control, 45(12), 1331-1341.
Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing, 38(6).
Hutton, D. W., Krein, S. L., Saint, S., Graves, N., Kolli, A., Lynem, R., & Mody, L. (2018). An economic evaluation of a catheter‐associated urinary tract infection prevention program in nursing homes. Journal of the American Geriatrics Society, 66(4), 742-747.
Jones, L. F., Meyrick, J., Barth, J., Dunham, O., & McNulty, C. A. M. (2019). Effectiveness of behavioral interventions to reduce urinary tract infections and Escherichia coli bacteremia for older adults across all care settings: a systematic review. Journal of Hospital Infection, 102(2), 200-218.
Jones, L. F., Meyrick, J., Barth, J., Dunham, O., & McNulty, C. A. M. (2019). Effectiveness of behavioral interventions to reduce urinary tract infections and Escherichia coli bacteremia for older adults across all care settings: a systematic review. Journal of Hospital Infection, 102(2), 200-218.
Smith, D. R., Pouwels, K. B., Hopkins, S., Naylor, N. R., Smieszek, T., & Robotham, J. V. (2019). Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modeling study. Journal of Hospital Infection, 103(1), 44-54.
Vaishnavi, V., Suresh, M., & Dutta, P. (2019). A study on the influence of factors associated with organizational readiness for change in healthcare organizations using TISM. Benchmarking: An International Journal.