Analysis of Hospital Systems Finds Inconsistency on Patient Safety
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(HealthNewsDigest.com) – YONKERS, NY — A new analysis of academic medical centers in the United States reveals that consumers can’t always count on teaching hospitals when it comes to patient safety. While some well-established teaching hospitals do perform well, others perform poorly, and some choose to keep their data under lock and key. The analysis by Consumer Reports Health looks at hospitals’ infection rates for central-line associated bloodstream infections (CLABSI), the most deadly type of hospital-acquired infection. Full Ratings for more than 1,119 hospitals in the U.S. are available at www.ConsumerReportsHealth.org, along with Ratings for surgical-site infections for hundreds more.
“Most of us think of teaching hospitals as setting the standard for the right way to do things, so it’s surprising to see so many teaching hospitals near the bottom of the list,” said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. “We are also concerned about the large number of hospitals that choose not to share their data.”
In a review of teaching hospitals—looking at those that are members of the Council of Teaching Hospitals—Consumer Reports Health found that, compared to last year, when Consumer Reports Health first reported Ratings for these deadliest of infections, there had been no improvement on this criterion. In the latest Ratings, 2 hospitals (1%) report zero bloodstream infections, while last year’s report found that 4 hospitals (2%) had reported zero. “Eliminating bloodstream infections should be the goal of every hospital, whether it’s a teaching institution or a community hospital. The process is simple, low tech and low cost, but it does require a commitment from the top down to affect a significant change in the hospital culture,” said Santa.
Of all U.S. hospitals rated for central-line infection rates, 142 (12.7%) hospitals reported zero central-line bloodstream infections, a modest improvement since Consumer Reports Health first reported these rates. At that time, 105 (11%) hospitals reported zero bloodstream infections. Only 36 (34%) of those zero-reporting hospitals maintained zero bloodstream infections in CRH’s current report. Most of those hospitals were small to medium size.
“There’s a tendency to think of the large urban hospitals as being the best in terms of delivering patient care and safety, but the top performers include many community hospitals that tend to be on the smaller side,” said Santa. A list of academic medical centers that received CRH’s lowest and highest Ratings, plus a list of academic medical centers that have not agreed to disclose their bloodstream infection rates, is available on request.
The only national source of voluntary hospital reporting is the Leapfrog Hospital Survey, run by the Leapfrog Group, which works with large employers to encourage hospital transparency. According to Leapfrog CEO Leah Binder, hospitals that decline to report to Leapfrog should be identified. “Consumers have every right to know how well hospitals are handling patient safety and whether it’s a priority for them to share that information publicly. We worry about the hospitals that don’t report because we wonder, what are they trying to hide?”
Consumer Reports Health has also updated its hospital Ratings to now include information on surgical site infections (SSI) for 577 hospitals. After bloodstream infections, SSIs are the second most common hospital-acquired infection, accounting for about one sixth (17%) of all hospital-acquired infections. Of the hospitals rated on this criterion, 11% received CRH’s highest mark for controlling surgical site infections and 8% received the worst Rating.
Analysis of Hospital Systems Finds Variation on Patient Safety
In a separate analysis that will accompany the hospitals Ratings, Consumer Reports Health notes that there is wide variation within hospital systems when it comes to patient safety. CRH took a close look at 61 systems with at least five hospitals that publicly report data on central-line associated bloodstream infections. Some of the systems include well-known hospital brands such as Baylor Health Care, the Cleveland Clinic, the Henry Ford Health system, and the Mayo Clinic.
“The big takeaway for consumers is that you can’t judge a hospital’s commitment to patient safety based on the flagship hospital,” said Santa. Most noteworthy, was the performance of the Cleveland Clinic, one of the most famous hospitals in the country, whose cardiology department consistently ranks No. 1 with US. News & World Report. Looking at its eight hospitals that reported central-line bloodstream infections, including the flagship in Cleveland, the system reported an overall rate 41 percent worse than the national average.
“It’s worth noting, however, that many systems that did poorly also had standouts, including two of the Cleveland Clinic Hospitals—Euclid Hospital and Huron Hospital, which both reported zero infections,” said Santa. Other examples of variation include the Kaiser Foundation Hospitals, which had an overall infection rate that was 36 percent lower than average, but its South San Francisco Medical Center had a rate almost three times higher than the national average. And the nation’s largest hospital system, the Hospital Corporation of America, headquartered in Nashville, TN, had an infection rate close to the national average. But one of its hospitals, Lake City Medical Center in Florida, had a rate 4.5 times higher than the national average.
The report notes that data on bloodstream infections is available for more than 1,500 hospitals in the U.S., which represents a little over a quarter of hospitals. While the number of hospitals reporting data has gone up in recent years, there needs to be more pressure from the federal government to require hospitals to report information on bloodstream infections. Health-care reform could be one potential remedy to this problem. More details are available in the full report online at www.ConsumerReportsHealth.org.
About the Ratings
The Consumer Reports Health calculations are derived from data from hospitals that publicly report central-line bloodstream infection rates in their intensive care units as a result of state laws and hospitals that voluntarily report to the Leapfrog Group, a Washington D.C. based nonprofit that works with large employers and purchasers of health care to measure and publicly report on hospital safety and quality. A central-line associated bloodstream infection (CLABSI) is a type of infection that involves a central-line catheter or tube that doctors place in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications to critically ill patients. These infections are fatal for up to 25% of patients who acquire them.
Consumer Reports Health has also updated its hospital Ratings to now include data for surgical-site infections for 577 hospitals in ten states that publicly report these infections as required by their states. An infection is considered to be a surgical-site infection if it occurs within 30 days of the surgery, or within one year if an implant is in place and the infection appears to be related to the surgery. Examples of surgeries include knee prosthesis, hip prosthesis, vaginal hysterectomy, abdominal hysterectomy, coronary bypass, colon surgery, cesarean section, hernia repair, spinal fusion, and gallbladder surgery. More details about how the Ratings are derived are available online at www.ConsumerReportsHealth.org.
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