February 11, 2025, Issue #945

AHRQ Stats: Rates of Central-Line Associated Bloodstream Infections by Hospital Type

The rate of central-line associated bloodstream infections at any hospital type increased substantially between 2019 and 2021. Small hospitals saw an increase of 98.4 percent—the largest increase at any hospital type. Public hospitals saw the smallest increase, with rates rising by 26.9 percent in that same timeframe. (Source: AHRQ Healthcare Cost and Utilization Project Statistical Brief #314, Hospital Differences in Adult Inpatient Stays with Healthcare-Associated Infections, 2019 and 2021.)

Today's Headlines:

• Better Nurse Staffing Levels Associated With Lower Rates of Cesarean Section
• Antibiotic Overuse in Otitis Media: a Call for Better Guideline Adherence
• Analysis Finds Telepsychiatry Inequities in Youth Mental Health During Pandemic
• Upcoming AHRQ Webinars
• Healthcare Market Boundaries May Underestimate Patient Access, Competition

Better Nurse Staffing Levels Associated With Lower Rates of Cesarean Section

Adequate labor and delivery nurse staffing levels led to lower cesarean section (C-section) rates and higher vaginal birth after cesarean (VBAC) rates, an AHRQ study showed. Researchers examined the impact of nurse staffing levels during labor on rates of C-section and VBAC in U.S. hospitals. The study examined data including 2,786 nurses across 193 hospitals in 23 states. Adherence to national nurse staffing standards helped improve vaginal birth outcomes and reduce risks of complications and death associated with C-sections. The study’s authors suggested that hospitals and policymakers should prioritize adequate staffing during childbirth to improve maternal and newborn health outcomes. Access the abstract of the study published in Nursing Outlook.

Antibiotic Overuse in Otitis Media: a Call for Better Guideline Adherence

Despite national guidelines that recommend five- to seven-day prescriptions for children with uncomplicated acute otitis media, data from 2019 to 2022 showed a majority of children received treatments of longer duration, according to an AHRQ-supported review published in the Journal of the Pediatric Infectious Diseases Society. Medical records from two health systems showed that 61,612 of the treatments for children aged 2 years or older resulted in an antibiotic prescription. Of these, 75 percent were 10-day prescriptions, 20 percent were seven-day prescriptions and only 5 percent were five-day prescriptions. Researchers concluded that shortening durations of therapy for acute otitis media could reduce antibiotic exposure and should be a priority of pediatric antibiotic stewardship programs. Access the study abstract.

Analysis Finds Telepsychiatry Inequities in Youth Mental Health During Pandemic

Higher-income, urban and privately insured children were more likely to receive video mental health visits during the COVID-19 pandemic, according to a new analysis of data from AHRQ’s Medical Expenditure Panel Survey (MEPS). Nearly one-third of U.S. child and adolescent mental health outpatients in 2021 received one or more of their visits via videoconference. The study, which was published in The American Journal of Psychiatry, used MEPS data to identify the disparities in access to mental telehealthcare that occurred and particularly affected low-income, rural and racial/ethnic minority groups. The authors concluded that overcoming these disparities requires identifying and addressing barriers that impede access to telemental healthcare. Access the article.

Upcoming AHRQ Webinars

• Feb. 18, noon to 1 p.m. ET: Safety Culture: Psychological Safety (Session 1) is the first in a three-part series on safety culture in healthcare sponsored by the National Action Alliance for Patient and Workforce Safety. Presenters will discuss how clinical leaders can help create psychologically safe environments and foster strong safety culture by encouraging conversations and strategies to address workforce burnout, communication breakdowns and trust gaps.
• March 6, 2 to 3:15 p.m. ET: Factors that Impact Perinatal Care Experience and Outcomes, sponsored by AHRQ’s National Center for Excellence in Primary Care Research, will highlight research on delivering respectful maternity care, insurance disruptions on maternal healthcare and postpartum primary care coordination for people with multiple chronic conditions.

Healthcare Market Boundaries May Underestimate Patient Access, Competition

An AHRQ study revealed that commonly used geographic boundaries, like counties and service areas, may not accurately reflect patients’ travel patterns for healthcare, especially in rural areas. Researchers analyzed 2018–2021 data from AHRQ’s  Medical Expenditure Panel Survey (MEPS) and found that most patients travel less than 30 minutes for care, though those outside metro areas and those needing specific inpatient services often travel farther. However, standard market definitions, such as hospital service areas, often exclude some of the care patients actually receive, which can lead to underestimating access and competition. Larger boundaries, like those defined by 60-minute travel distances, capture more visits but risk overstating access. Researchers asserted that flexible, data-driven boundaries reflecting real travel patterns could give policymakers a clearer picture of healthcare access across regions. Access more information about the study, published in Annals of Internal Medicine.

AHRQ in the Professional Literature

CLABSI surveillance in home infusion: importance of a standardized definition for improvement. Oladapo-Shittu O, Klein EY, Shpitser I, et al. Home Healthc Now. 2024 Nov-Dec;42(6):368-70. Epub 2024 Nov 4. Access theabstract on PubMed®.

Implementation of a bundle to improve diagnosis in hospitalized patients: lessons learned. Gupta A, Quinn M, Greene MT, et al. Diagnosis. 2024 Oct 18. [Epub ahead of print.] Access the abstract on PubMed®.

Burnout in modern-day health care: Where are we, and how can we markedly reduce it? A meta-narrative review from the EUREKA* project. Linzer M, O'Brien EC, Sullivan E, et al. Health Care Manage Rev. 2025 Feb 3. [Epub ahead of print.] Access the abstract on PubMed®.

Investigating the role of the physical environment on communication patterns in emergency departments during caregiving for pediatric mental and behavioral health patients. Jiang Y, Joseph A, Gripko M, et al. Herd. 2025 Feb 6:19375867251317241. [Epub ahead of print.] Access the abstract on PubMed®.

A practical guide to participatory design sessions for the development of information visualizations: tutorial. Arcia A, Stonbraker S, Mangal S, et al. J Particip Med. 2024 Dec 13;16:e64508. Access the abstract on PubMed®.

Travel time as an indicator of poor access to care in surgical emergencies. Clark NM, Hernandez AH, Bertalan MS, et al. JAMA Netw Open. 2025 Jan 2;8(1):e2455258. Access the abstract on PubMed®.

Delayed diagnosis of new onset pediatric diabetes leading to diabetic ketoacidosis: a retrospective cohort study. Hadley SM, Michelson KA. Diagnosis. 2024 Nov 1;11(4):416-21. Epub 2024 Jun 27. Access the abstract on PubMed®.

Electronic health record alert to promote adoption of limited transthoracic echocardiograms in primary care and cardiology clinics: a mixed methods evaluation. Kalwani NM, Kling SMR, Vilendrer S, et al. Circ Cardiovasc Qual Outcomes. 2024 Nov;17(11):e010621. Epub 2024 Nov 19. Access the abstract on PubMed®.

Teamwork and implementation of innovations in healthcare and human service settings: a systematic review. McGuier EA, Kolko DJ, Aarons GA, et al. Implement Sci. 2024 Jul 15;19(1):49. Access the abstract on PubMed®.

Developing and evaluating SEE-Diabetes: a patient-centered educational decision support system for diabetes care. Narindrarangkura P, Dejhansathit S, Khan U, et al. J Eval Clin Pract. 2025 Feb;31(1):e14234. Epub 2024 Nov 4. Access the abstract on PubMed®.

Contact Information
For comments or questions about AHRQ News Now, contact Bruce Seeman, (301) 427-1998 or Bruce.Seeman@ahrq.hhs.gov.