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Glossary of Terms

Glossary of terms related to quality and patient safety

When searching the internet for information related to healthcare outcomes and quality of care, consumers will find a variety of terms used to reference health conditions, hospital procedures, quality of care processes/measures, and organizations involved in overseeing healthcare quality assurance.  Listed below are definitions for some of the most common terms and acronyms by organizations reporting healthcare quality.

Term

Definition/Explanation

Abdominal Aortic Aneurysm (AAA) Repair

Abdominal Aortic Aneurysm (AAA) repair entails a grafting procedure for a weakened, bulging wall of the aorta, the vessel that carries blood from the heart through the abdomen into the legs.

Accreditation

An evaluative process in which a healthcare organization undergoes an examination of its policies, procedures and performance by an external private sector organization ("accrediting body") to ensure that it is meeting predetermined criteria. It usually involves both on- and off-site surveys.

Acute Care Hospital

An acute care hospital provides inpatient medical care and other related services for surgery, acute medical conditions or injuries (usually for a short term illness or condition).

Acute Myocardial Infarction (AMI)

AMI is a condition (also called a heart attack) that occurs when the arteries leading to the heart become blocked and the blood supply is slowed or stopped. When the heart muscle can't get the oxygen and nutrients it needs, the part of the heart tissue that is affected may die.

Angioplasty

In angioplasty, also known as percutaneous coronary intervention (PCI), a catheter is used to insert a balloon that is inflated to open a blocked blood vessel.

Angiotensin Converting Enzyme (ACE) Inhibitor

An ACE inhibitor is a medicine used to treat heart attacks, heart failure, or a decreased function of the left heart. They stop production of a hormone that can narrow blood vessels. This helps reduce the pressure in the heart and lower blood pressure.   ACE inhibitors started within 24 hours after a heart attack may increase survival rates and slow down the further weakening of the heart.

Angiotensin Receptor Blocker (ARB)

An angiotensin receptor blocker is a medicine used to treat patients with heart failure and a decreased function of the left heart. ARBs block the action of a hormone that can narrow blood vessels. This helps reduce the pressure in the heart and lower blood pressure.

Antibiotic

An antibiotic medicine is used to fight bacteria in the body.

Aspirin at Arrival / Discharge

Aspirin can help keep blood clots from forming and reduces the risk of death for a patient having a heart attack.  In addition, taking aspirin after discharge may help prevent additional heart attacks and reduce the risk of death for patients who have had a heart attack.

Atherectomy

An atherectomy is a procedure in which a blade or laser on a catheter cuts through and removes blockages in blood vessels. It is one of several procedures used to open a blocked blood vessel.

Beta Blocker at Arrival / Discharge

A beta blocker is a type of medicine that is used to lower blood pressure, treat chest pain (angina) and heart failure, and to help prevent a heart attack. Beta blockers relieve the stress on the heart by slowing the heart rate and reducing the force with which the heart muscles contract to pump blood. They also help keep blood vessels from constricting in the heart, brain, and body.  Beta blockers reduce the risk of death for a patient having a heart attack and also benefit patients undergoing surgical procedures.  Additionally, beta blockers prescribed at discharge may help prevent future heart attacks and death.

Blood Culture

A blood culture is a blood test that shows if there are bacteria in the blood, and what type of bacteria it is. It helps your doctor decide which antibiotic to use to treat a bacterial infection.

Board Certification

Being board certified indicates that a doctor has received special training and passed an advanced exam in a particular area of medicine. Primary care doctors as well as specialists may be board certified.  Board certification is different than licensing. Every physician must be licensed by the state to practice medicine. However, a physician may practice a specialty without being board certified.

California Department of Health Services (CA DHS) Licensing & Certification Program

The CA DHS Licensing & Certification Program licenses 30 different types of healthcare facilities and providers to legally do business in California, certifies to the federal government healthcare facilities and providers that are eligible for payments under the Medicare and Medicaid (Medi-Cal) programs, accepts and investigates complaints regarding concerns expressed about care provided by these health facilities and providers, and conducts certain other activities related to the provision of healthcare services in California.

Carotid Endarterectomy

A carotid endarterectomy is a procedure to restore adequate blood flow to the artery which supplies blood to the brain, which can help prevent a stroke.

Centers for Medicare & Medicaid Services (CMS)

CMS is the federal agency that runs the Medicare program for the elderly aged and disabled. In addition, CMS works with the states to run the Medicaid program for low-income individuals. CMS works to make sure that the people in these programs are able to get high quality healthcare. Also see the term DHHS.

Certification (Medicare-Certified)

State government agencies inspect healthcare providers, including hospitals, nursing homes, dialysis facilities and home health agencies, as well as other healthcare providers. These providers are certified if they pass inspection. Being certified is not the same as being accredited. Medicare or Medicaid only pays for care provided by certified or accredited providers.

Clinical Practice Guidelines

Clinical Practice Guidelines are documents that help physicians and their patients make decisions about appropriate healthcare for specific medical conditions. Clinical practice guidelines briefly identify and evaluate the most current information about prevention, diagnosis, prognosis, therapy, risk/benefit and cost/effectiveness.

Clot Busting Medications (Fibrinolysis, Fibrinolytic Drugs)

Fibrinolytic drugs are “clot-busting” medicines that can help dissolve blood clots in blood vessels and improve blood flow to your heart. They are important for treating heart attacks. If you have a heart attack, your doctor may give you a fibrinolytic drug, perform a percutaneous coronary intervention (PCI), or both.

CPOE

Computer physician order entry (CPOE) systems are electronic prescribing systems that intercept errors when they most commonly occur — at the time medications are ordered. With CPOE, physicians enter orders into a computer rather than on paper. Orders are integrated with patient information, including laboratory and prescription data. The order is then automatically checked for potential errors or problems. Benefits of CPOE include prompts that warn against the possibility of drug interaction, allergy or overdose; accurate, current information that helps physicians keep up with new drugs as they are introduced into the market; drug-specific information that eliminates confusion among drug names that sound alike; improved communication between physicians and pharmacists; and educed healthcare costs due to improved efficiencies.  (Source:  Leapfrog Group)

Coronary Artery Bypass Surgery (CABG)

Coronary Artery Bypass Surgery (CABG) is performed to bypass blockages or obstructions of the coronary arteries, the blood vessels that supply the heart with oxygen and nutrients.

Craniotomy

A craniotomy is the surgical removal of a section of bone (bone flap) from the skull for the purpose of operating on the underlying tissues, usually the brain.

Department of Health And Human Services (DHHS)

DHHS is a division of the U.S. government that administers many of the social programs at the Federal level dealing with the health and welfare of the citizens of the United States. Centers for Medicare and Medicaid Services (CMS) is an agency within DHHS.

Deaths, Observed (also referenced as Observed Mortality)

Observed deaths (observed mortality) reflect the actual number of reported deaths in a specific population during a specific time period (in-hospital, 30-day, 6-month, 1-year, etc.)  For example, if a hospital treats 100 pneumonia patients during the year and three patients die while in the hospital, the hospital’s in-hospital death rate for pneumonia patients for that year would be 3%.

Deaths, Expected (also referenced as Expected Mortality)

Expected deaths (expected mortality) refer to the number of patients who died within a specific period, adjusted using statistical methods for the fact that different patients have different chances of dying due to individual risk factors.  The statistical adjustment for expected deaths considers the number of deaths for a larger population (such as all U.S. pneumonia patients), adjusted for relevant individual factors such as age and presence of other health problems.  A hospital that treats a higher volume of frail patients would have higher expected deaths than hospitals treating healthy patients.

Esophageal Cancer Resection

Esophageal cancer resection is the surgical removal of a cancerous portion of the esophagus, the tube that carries food and liquids from the mouth to the stomach.

Evidenced-Based Medicine

Evidence-based medicine is the practice of medicine or the use of healthcare interventions guided by or based on scientific evidence, and the avoidance of interventions shown by scientific evidence to be less effective or even harmful.

Evidenced-Based Hospital Referral

Evidence shows that the quality of care for patients with certain conditions or procedures is related to the number of patients treated at that hospital for those conditions or procedures. Treatment of a higher number of patients for a particular procedure or condition often results in better overall results, especially for risky or extremely difficult procedures.  This is known as evidence-based hospital referral.  (Source: Leapfrog Group)

Health Maintenance Organization (HMO)

A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides health care coverage that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. Unlike traditional indemnity insurance, care provided in an HMO generally follows a set of care guidelines and is provided through the HMO's network of providers. Under this model, providers contract with an HMO to receive more patients and in return usually agree to provide services at a discount. This arrangement allows the HMO to charge a lower monthly premium.

Heart Failure Discharge Instructions

Prior to discharging heart failure patients from the hospital, the hospital staff should provide clear instructions to help patients manage heart failure symptoms in the future.  Patients who receive and follow discharge instructions may experience improved quality of life and have a reduced risk for re-hospitalization.

Heart Failure Patients Given an Evaluation of Left Ventricular Systolic (LVS) Function, or LVF Assessment

An evaluation of the LVS function, also referred to LVF assessment, tests how the left chamber of the heart is pumping.

Intensive Care Unit (ICU) “Intensivists”

Intensivists are physicians familiar with the complications that can occur in the ICU and, thus, are better equipped to minimize errors.  A growing body of scientific evidence suggests that quality of care in hospital ICUs is strongly influenced by (i) whether "intensivists" are providing care and (ii) the staff organization in the ICU.  (Source:  Leapfrog Group)

Intensive Care Unit (ICU)  Survival

ICU Survival reflects survival rates for intensive care patients, who require the highest levels of medical treatment.

Influenza

Influenza is a serious and sometimes deadly lung infection that can spread quickly in a community. Symptoms include fever—often a high temperature of more than 102° Fahrenheit (38.9° Celsius), headache, muscle aches and pains, chills, cough and chest pain when you take a breath (“pleuritic chest pain”). Although most people recover from the illness, the Centers for Disease Control and Prevention (the CDC) estimates that in the United States more than 200,000 people are hospitalized and about 36,000 people die from the flu and its complications every year.

Influenza Vaccination (“Flu Shot”)

The main way to keep from getting flu is to get a yearly flu vaccination. Scientists make a different vaccine every year because the strains of flu viruses change from year to year. Nine to 10 months before the flu season begins, they prepare a new vaccine made from inactivated (killed) flu viruses. Because the viruses have been killed, they cannot cause infection. The vaccine preparation is based on the strains of the flu viruses that are in circulation at the time.

Hospitals should check to make sure that pneumonia patients get a flu shot during flu season to protect them from another lung infection and to help prevent the spread of influenza in the community. You can also get the vaccine at your doctor's office or a local clinic, and in many communities at workplaces, supermarkets, and drugstores. You must get the vaccine every year because it changes.

Inpatient Hospital Services

Inpatient hospital services are provided to patients admitted to a hospital that may include bed and board, nursing services, diagnostic or therapeutic services and medical or surgical services.

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)

JCAHO is an organization that evaluates and accredits healthcare organizations and programs in the United States. JCAHO is an independent, not-for-profit organization. JCAHO looks at how well a hospital treats patients and how good a hospital's staff and equipment are. A hospital is accredited by JCAHO if it meets certain quality standards. These checks are done at least every 3 years. Most hospitals take part in these accreditations.

Left Ventricular Function (LVF) Assessment

An LVF assessment evaluates how well the heart is pumping.

Measurement

Measurement is the process of collecting data to assess performance conducted at a single point in time or repeated over time.

Medicare-Certified Hospital

In order to receive any payment from either the Medicare or Medicaid programs, a hospital must meet a set of basic standards for quality of care, called "conditions of participation". Medicare-certified hospitals are reviewed periodically (every three years) to assure that they are continuing to provide services of acceptable quality.

Medicare also considers or "deems" hospitals as Medicare-certified that meet the accreditation requirements of the JCAHO or the American Osteopathic Association. Most short-term acute care hospitals in the United States choose to be Medicare-certified, either directly or through accreditation.

ethicillin-Resistant Staphylococcus Aureus (MRSA)

Methicillin-Resistant Staphylococcus Aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. (Source: CDC)

Mortality, Observed (also referenced as Observed Deaths)

Observed mortality (observed deaths) reflects the actual number of reported deaths in a specific population during a specific time period (in-hospital, 30-day, 6-month, 1-year, etc.)  For example, if a hospital treats 100 pneumonia patients during the year and three patients die while in the hospital, the hospital’s in-hospital mortality rate for pneumonia patients for that year would be 3%.

Mortality, Expected (also referenced as Expected Deaths)

Expected mortality (expected deaths) refers to the number of patients who died within a specific period, adjusted using statistical methods for the fact that different patients have different chances of dying due to individual risk factors.  The statistical adjustment for expected deaths considers the number of deaths for a larger population (such as all U.S. pneumonia patients), adjusted for relevant individual factors such as age and presence of other health problems.  A hospital that treats a higher volume of frail patients would have higher expected mortality than hospitals treating healthy patients.

Mortality, Medical

Medical mortality is the aggregate survival rate for medical patients with a diagnosis of acute myocardial infarction (with transfers), congestive heart failure, acute stroke mortality, gastrointestinal, hip fracture or pneumonia.

Mortality, Post-Surgical

Post Surgical mortality is the aggregate survival rate for all patients undergoing any surgical procedure except those for trauma or major burns.

Organ Conversion Rate

The organ conversion rate is the gold standard measure to assess organ donation effectiveness. It is the number of donors who actually give organs as a percentage of all the potential donors on the list.

Outcome Measures

Outcome measures are designed to reflect the results of care, rather than how frequently a specific treatment or intervention was performed.  The outcome is the change in a patient’s health status that can be attributed to the care received, such as a given healthcare service, prescription used or medical procedure.

Oxygenation Assessment

Oxygenation assessment is a test that measures the amount of oxygen in your blood to see if you need oxygen therapy.

Pancreatic Cancer Resection

Pancreatic cancer resection is the surgical removal of a tumor from the pancreas, the organ that secretes digestive substances and produces several important hormones.

Patient Bill of Rights

A Patient Bill of Rights outlines what patients should expect during a hospital stay with regard to rights and responsibilities. Most hospitals provide you with a copy of the Patient Bill of Rights upon admission to the hospital.

Peer Review

Peer review involves a medical professional’s work being checked or examined by another medical professional of equal training (peer).

Percutaneous Coronary Interventions (PCI) within 90 Minutes

The procedures called Percutaneous Coronary Interventions (PCI), such as angioplasty and atherectomy are among those that are the most effective for opening blocked blood vessels that cause heart attacks. Doctors may perform a PCI, or give medicine to open the blockage, and in some cases, may do both.  Having the procedure within 90 minutes of the onset of a heart attack reduces the risk of death.  Patients can receive either PCI or anti-clotting therapy, but not both.

Plan of Care

Created with your physician and hospital staff, a plan of care outlines what services you will receive to reach and keep your best physical, mental, and social well being. The hospital staff keeps your doctor up-to-date on how you are doing and updates your care plan as needed.

Pneumonia

Pneumonia is an inflammation of the lungs caused by a viral or bacterial infection. This fills your lungs with mucus and lowers the oxygen level in your blood. Symptoms can include fever, fatigue, difficulty breathing, chills, a "wet" cough, and chest pain.

Pneumonia (pneumococcal) Vaccination

Vaccine given to prevent pneumonia, estimated to protect against 80% of bacteria causing pneumonia.

Pneumonia Patients Assessed and Given Influenza Vaccination

An influenza shot can help prevent Influenza in the future, even for patients who have been hospitalized for pneumonia.

Pneumonia Patients Assessed and Given Pneumococcal Vaccination

A pneumonia (pneumococcal) shot can help prevent pneumonia in the future, even for patients who have been hospitalized for pneumonia.

Pneumonia Patients Given Initial Antibiotic(s) within 4 Hours After Arrival

Timely use of antibiotics can improve the treatment of pneumonia caused by bacteria.

Pneumonia Patients Given Oxygenation Assessment

Having enough oxygen in your blood is important to your health.

Pneumonia Patients Given the Most Appropriate Initial Antibiotic(s)

Antibiotics are medicines that treat infection, and each one is different. Hospitals should choose the antibiotics that best treat the infection type for each pneumonia patient.

Pneumonia Patients Whose Initial Emergency Room Blood Culture was Performed Prior to the Administration of the First Hospital Dose of Antibiotics

A blood culture tells what kind of medicine will work best to treat your pneumonia.

Point of service (POS) Health Plans

Point of service (POS) health plans are physician-coordinated managed care plans that give members the opportunity to access care from out-of-network providers. At enrollment, members select a primary care physician (PCP) who is responsible for all referrals within the POS network.  If patients choose to go outside the network for healthcare, they are usually subject to a higher share of the cost of care, including a deductible and a co-payment that is a higher percentage of the physician's charges.

Post Surgical Management (Temperature and Blood Sugar)

Post Surgical Management (Temperature and Blood Sugar) reports how well patients having surgery are optimally maintained related to two vital functions – body temperature and blood sugar levels, at critical time points following the operation. Note: these measures report on those selected surgeries where evidence/experts have identified that maintenance of body temperature and blood sugar are at highest risk.

Primary Stroke Centers

JCAHO’s Certificate of Distinction for Primary Stroke Centers recognizes facilities that make exceptional efforts to foster better outcomes for stroke care.  Achievement of certification signifies that the services provided have the critical elements to achieve long-term success in improving outcomes.  It is the best signal to the community that the quality of care provided is effectively managed to meet the unique and specialized needs of stroke patients.  Fewer than 10 percent of all hospitals in California are qualified as a JCAHO Primary Stroke Center.

Process of Care Measures

Process of care measures show, in percentage form or as a rate, how often a healthcare provider gives recommended care; that is, the treatment known to give the best results for most patients with a particular condition.

Prophylactic Medications

Appropriate antibiotics, or prophylactics, given just before surgery, can substantially reduce the rate of surgical site infections, which account for approximately 15% of hospital-acquired infections.  It is considered a best practice, therefore, to give appropriate prophylactic antibiotics prior to incision for surgeries for conditions including heart disease and deep vein thrombosis (DVT).

Provider

A doctor, healthcare professional hospital or healthcare facility.

Safety Culture

Safety Culture is an environment that supports and promotes safety at every level of the organization – from board members and senior management to frontline staff. Aspects include acknowledging safety concerns, encouraging error reporting, using teamwork to find solutions, and devoting resources to make positive changes.

Quality

Quality healthcare is how well a doctor, hospital, health plan, or other provider of healthcare, keeps its members healthy or treats them when they are sick. Good quality healthcare means doing the right thing at the right time, in the right way, for the right person and getting the best possible results.

Quality Assurance

Quality assurance is the process of looking at how well a medical service is provided. The process may include formally reviewing healthcare given to a person, or group of persons, locating the problem, correcting the problem, and then checking to see if the changes worked.

Respiratory Complication Prevention

For patients requiring mechanical breathing support, respiratory complication prevention reflects the compliance rate with practices (processes) that help prevent certain medical complications.

Risk-Adjusted 30-Day Death (Mortality) Rates

30-day Risk-Adjusted Death (Mortality) Rates represent the number of patients who died within 30 days of discharge after hospital stay for a surgery or other cause.  The death rates for hospitals are adjusted after considering the fact that different patients have different chances of dying due to individual risk factors.  Thirty-day mortality is frequently used as an outcome measure because this is the time period when deaths are most likely to be related to the care patients received in the hospital. Deaths that occur outside the hospital within 30 days are included along with deaths that occur in the hospital, because some hospitals discharge patients sooner than others.

Surgical Care Improvement Project (SCIP)

The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations committed to improving the safety of surgical care through the reduction of postoperative complications.  Although some surgical complications are unavoidable, surgical care can be improved through better adherence to evidence-based practice recommendations.

SCIP-Surgery Patients Who Received Preventative Antibiotic(s) One Hour Before Incision

Getting an antibiotic within one hour before surgery reduces the risk of wound infections. Hospitals should check to make sure surgery patients get antibiotics at the right time.

SCIP-Surgery Patients who Received the Appropriate Preventative Antibiotic(s) for Their Surgery

Specific antibiotics are recommended to help prevent wound infection for certain types of surgery.  Inappropriate use of broad spectrum antibiotics or prolonged courses of prophylactic antibiotics puts all patients at even greater health risks due to the development of antibiotic-resistant pathogens.  (Source: IHI)

SCIP-Surgical Patients with Hair Removed Appropriately

Scientific evidence has demonstrated that shaving surgical sites before operations, rather than removing hair with clippers or by other methods, increases the risk of sometimes deadly infections.  The IHI indicates hair removal, when necessary, should be performed with clippers right before surgery, that hospitals should establish protocols for when and how to remove hair in affected areas, that patients should be provided with educational materials on appropriate hair-removal techniques to prevent shaving at home, and that shaving heart surgery patients for electrocardiograms conducted shortly before surgery should be avoided.  (Source: IHI)

SCIP-Surgery Patients Whose Preventative Antibiotic(s) are Stopped Within 24 hours After Surgery

It is important for hospitals to stop giving preventative antibiotics within 24 hours after surgery to avoid side effects and other problems associated with antibiotic use. For certain surgeries, however, antibiotics may be needed for a longer time.

SCIP-Cardiac Surgical Patients with Postoperative Glucose Control

Medical literature shows that the degree of hyperglycemia (high glucose) in the postoperative period is correlated with the rate of surgical site infection in patients undergoing major cardiac surgery, and that stringent glucose control in surgical intensive care unit patients reduces mortality.  Glucose control is defined as serum glucose levels below 200 mg/dl, collected once on each of the first two postoperative days. (Source: IHI)

SCIP-Colorectal Surgical Patients with Normothermia in PACU

Medical literature indicates that patients undergoing colorectal surgery have a decreased risk of surgical site infection if they are not allowed to become hypothermic during the perioperative period.  Anesthesia, anxiety, wet skin preparations, and skin exposure in cold operating rooms can cause patients to become clinically hypothermic during surgery.  Controlling these exposures, therefore, may be beneficial to patients. (Source: IHI)

Smoking Cessation Advice

Smoking is linked to heart disease, pneumonia and other conditions. Quitting may help improve a patient's condition.  Therefore, hospitals and other healthcare providers should advise patients to quit smoking and provide information about resources to help patients quit prior to discharging patients from the hospital.

STEMI Receiving Center

Certification granted by the Los Angeles County Department of Health Services Emergency Medical Services Agency.  When paramedics in Los Angeles County identify patients suffering from a common type of heart attack known as ST-elevation myocardial infarction, or STEMI, through a field electrocardiogram (EKG), they will transport those patients directly to the nearest STEMI Center for treatment.

Survival Rate

Survival rate reflects the actual number of patients in a specific population during a specific time period (in-hospital, 30-day, 6-month, 1-year, etc.) that survived their treatment or condition. For example, if a hospital treats 100 pneumonia patients during the year and 97 patients are discharged from the hospital alive, the hospital’s survival rate for pneumonia patients for that year would be 97%.

Trauma Center, Level I

A Level I trauma center has a full range of specialists and equipment available 24-hours a day and admits a minimum required annual volume of severely injured patients.  Additionally, a Level I center has a program of research, is a leader in trauma education and injury prevention and is a referral resource for communities in neighboring regions (community outreach).

Treatment

Treatment is something done to help with a health problem. Typically, there is more than one way to treat a health problem. For example, medicine and surgery are treatment options.  Patients and their physicians decide together the best option to treat a specific condition.

Ventilator-Associated Pneumonia (VAP)

Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia occurring in people who are on mechanical ventilation through a tube for at least 48 hours. VAP results from infection which floods the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere.   Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.  Hospitals achieve lower rates of VAP when they perform the "ventilator bundle", a series of interventions related to ventilator care that, when implemented together, will achieve significantly better outcomes than when implemented individually.  (Source: IHI)

Vancomycin-Resistant Enterococci (VRE) Infections

Enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). Most VRE infections occur in hospitals.  Hospitals that take appropriate steps to minimize these infections experience improved patient outcomes. (Source: CDC)