Calling for better quality metrics, moral distress in emergency nursing, and more on pediatric antibiotic misuse

October 15, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our section at the bottom of this page



Defining and measuring quality in healthcare has long been a goal and a significant quagmire in healthcare reform. CMS has committed to making 50 percent of Medicare payments tied to quality metrics by 2018 but, as Aaron Carroll, MD, MS, explains in this JAMA Forum, that presumes we are good at measuring quality. Unfortunately this is quite far from the truth. In an open letter to the American public, members of the RightCare Alliance’s Primary Care Council bring this issue to the fore. Addressing all patients, the authors write that current metrics do not allow “us to work with you to determine what matters most to you in your care nor to help you adopt healthy behaviors that improve your quality of life. Many of the current ‘quality’ measures distract your healthcare professional from giving you the care you need.” They explain that better quality metrics could improve access and shared decision-making, and they invite patients to work with them to improve the way we measure doctors’ performance. If you are a physician or other healthcare professional and agree with this message, please sign the letter here. If you haven’t yet found an action for RightCare Action Week, this could be it!


A recent study by Lisa A. Wolf, PhD, RN, CEN, FAEN, et al. probed the experience and causes of moral distress in emergency nursing. Participants described moral distress as an “inability to perform the obligations of nursing at the social justice level” and identify its causes as being “directly related to a lack of unit support, an overemphasis on technology to the exclusion of patient interaction, and the perception of a distinct disconnection between the administrators and the practitioners delivering care.” This investigation revealed themes of a dysfunctional practice arena, nurses being overwhelmed, adaptive/maladaptive coping, and overall, a profound feeling of being unable to provide patient care as they wanted to. Specific environmental factors contributing to moral distress included excessive documentation and a focus on time-based metrics, inadequate or unsafe staffing, and patients, often poor or homeless, who are frequent utilizers of the emergency department. The authors conclude that moral distress in emergency nursing is the result of a high-demand environment with insufficient resources, and that interventions are needed at the systems-level, and require the support of hospital administrators.


Last week we told you about the online antibiotic stewardship PLEDGE, developed by the Pediatric Council of the Lown Institute to encourage more responsible prescribing to children and reduce the widespread overuse of antibiotics. The pledge is just one of the activities planned by the Council for RightCare Action Week, next week. Council members, Shawn Ralston, MD and Alan Schroeder, MD, who spearheaded the pledge, encourage others to sign the document in a Medscape piece. Coincidentally, in its current issue, Parents Magazine chose a cover piece on pediatric antibiotic use and misuse.




  • RightCare Action Week begins in three days. From October 18-24, people across the country are taking action to show what healthcare should look like. Here’s a special message from one of our favorite participants, Don Berwick, MD, former administrator of the Centers for Medicare and Medicaid Services.
  • Save the Date and a Call for Abstracts! The Lown Institute’s 4th Annual Conference, with a special pre-conference academic research day, will take place April 15-17, 2016 at the JW Marriott Chicago. We are accepting abstracts for the inaugural academic research day, April 15. In particular, we are accepting abstracts for research that enhances understanding of aspects of right care. Deadline for abstract submissions is November 15, 2015. For submission information, click here. Watch for more conference details coming soon.
  • Reminder: A regional RightCare Alliance meeting will be held in conjunction with the 2015 Family Medicine Education Consortium’s The Best Care Possible: The Right Care–Right Now–Getting Involved for Better Health, on Thursday, October 29, 8:30 am-5 pm at the DoubleTree by Hilton and CoCo Key WaterPark Boston North Shore, in Danvers, MA. Meeting leaders include Alan Roth, DO, chair, Department of Family Medicine, Jamaica Hospital Medical Center; Vikas Saini, MD, president of the Lown Institute and Shannon Brownlee, MSc, senior vice president of the Lown Institute. The event is targeted to healthcare professionals, policy makers, administrators and staff interested in improving healthcare delivery and health profession education systems. Learn more and register.






Cost of care


Cost of drugs


End-of-life care




Care delivery models


Patient experience






Evidence-based medicine


Social determinants


Dr. Lown






RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.