Top Hospitals Have 27% Lower Mortality, Annual Study Finds

Medicare patients treated at top-rated hospitals nationwide across the most common Medicare diagnoses and procedures are 27 percent less likely to die, on average, than those admitted to all other hospitals, according to a study released today by HealthGrades, the leading independent healthcare ratings organization. Patients who undergo surgery at these high-performing hospitals also have an average eight percent lower risk of complications during their stay.

The HealthGrades Seventh Annual Hospital Quality and Clinical Excellence study identifies hospitals in the top five percent nationally in terms of mortality and complication rates across 26 procedures and diagnoses, from heart attacks to total knee replacement. Hospitals achieving this level of care are designated as Distinguished Hospitals for Clinical Excellence by HealthGrades and are identified on the organization's consumer website, HealthGrades.com. Many hospitals excel in a given service line, but what differentiates these top hospitals is their quality achievement across a broad range of procedures and treatments, HealthGrades says.

The 2009 study of Medicare patients found that 152,666 lives may have been saved and 11,772 major complications avoided during the three years studied, had the quality of care at all hospitals matched the level of those in the top five percent. The difference between these top hospitals and the rest of the pack highlights a distinct gap between them.

Individuals can see how their local hospitals are rated, and if they have been designated Distinguished Hospitals for Clinical Excellence, for free online.

"This study echoes others that have found distinct quality gaps between top-performing hospitals and others," says Dr. Rick May, MD, HealthGrades senior physician consultant and an author of the study. "Distinguished Hospitals for Clinical Excellence comprise a group of hospitals that excel across the board, not just in one or two specialties, and they should be commended for their relentless commitment to exceptional patient care."

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Medical Errors Cost $8.8B, Result in 238,337 Potentially Preventable Deaths: Study

Patient safety incidents cost the federal Medicare program $8.8 billion and resulted in 238,337 potentially preventable deaths during 2004 through 2006, according to HealthGrades' fifth annual Patient Safety in American Hospitals Study. HealthGrades' analysis of 41 million Medicare patient records found that patients treated at top-performing hospitals had, on average, a 43 percent lower chance of experiencing one or more medical errors compared to the poorest-performing hospitals.

The overall incident rate was approximately three percent of all Medicare admissions evaluated, accounting for 1.1 million patient safety incidents during the three years studied. With the Centers for Medicare and Medicaid Services scheduled to stop reimbursing hospitals for the treatment of eight major preventable errors, including objects left in the body after surgery and certain post-surgical infections, starting October 1, the financial implications for hospitals are substantial.

The HealthGrades study, which also identifies those hospitals with patient-safety incidence levels in the lowest five percent in the nation, also found:

• Medicare patients who experienced a patient-safety incident had a one-in-five chance of dying as a result of the incident during 2004 to 2006.
• Overall death rate among Medicare beneficiaries that developed one or more patient safety incidents decreased almost five percent from 2004 through 2006.
• However, four indicators, post-operative respiratory failure, post-operative pulmonary embolism or deep vein thrombosis, post-operative sepsis, and post-operative abdominal wound separation/splitting, increased when compared to 2004.
• Medical errors with the highest incidence rates were bed sores, failure to rescue, and post-operative respiratory failure and accounted for 63.4 percent of incidents. Failure to rescue improved 11.1 percent during the study period, while both bed sores and post-operative respiratory failure worsened during the study period.
• Of the 270,491 deaths that occurred among patients who developed one or more patient safety incidents, 238,337 were potentially preventable.

If all hospitals performed at the level of Distinguished Hospitals for Patient Safety, approximately 220,106 patient safety incidents and 37,214 Medicare deaths could have been avoided while saving the U.S. approximately $2.0 billion during 2004 to 2006.

“While many U.S. hospitals have taken extensive action to prevent medical errors, the prevalence of likely preventable patient safety incidents is taking a costly toll on our health care systems – in both lives and dollars,” says Dr. Samantha Collier, HealthGrades' chief medical officer and the primary author of the study. “HealthGrades has documented in numerous studies the significant and largely unchanging gap between top- performing and poor-performing hospitals. It is imperative that hospitals recognize the benchmarks set by the Distinguished Hospitals for Patient Safety are achievable and associated with higher safety and markedly lower cost. ”

The fifth annual HealthGrades Patient Safety in American Hospitals Study applies methodology developed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality to identify the incident rates of 16 patient safety indicators among Medicare patients at virtually all of the nation's nearly 5,000 nonfederal hospitals. Additionally, HealthGrades applied its methodology using 13 patient safety indicators to identify the best-performing hospitals, or Distinguished Hospitals for Patient Safety, which represent the top five percent of all U.S. hospitals.

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Greater Hospital Vigilance Urged Over Water Systems in Summer

Patients who are vulnerable to infection run a greater risk of contracting Legionnaires’ disease, a severe form of pneumonia, during warm, humid weather, according to a study published in the Journal of Infectious Diseases. The infection is caused by Legionella bacteria that can live in hospital water systems and throughout the environment.

Legionella bacteria, while usually not a problem for healthy adults, can be most serious and even fatal for patients who are immune compromised, including those in Intensive Care Units, the very young and the very old, the chronically ill, and post-surgical, cancer and transplant patients. These patients risk becoming infected through a buildup of microbes that can inhabit a hospital’s water system, where they have oftentimes become resistant to traditional methods of cleaning and disinfection.

At-risk patients can become ill through any exposure to hospital water, whether through ingestion, comforting mouth sores with ice cubes, bathing, inhalation of shower mist or being treated with equipment washed in hospital water.

“Many healthcare professionals aren’t aware of what’s lurking in their water in the summer or any season, especially the water used with critically ill and at-risk patients. As a result, countless Legionella and other harmful microorganisms that can cause serious infections go undetected,” says Janet Stout, an international expert on Legionella and other microbes in hospital water.

Stout, director of the Special Pathogens Laboratory and a microbiologist at the University of Pittsburgh, is a strong advocate for reducing the risk of waterborne infection in hospitals, nursing homes and other healthcare facilities. She is on a mission to get these institutions to test their water and then do something about it.

Speaking at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC) in San Jose, California, Stout shared stories that vividly illustrated the problem:

• A hospital’s Burn Unit treated its badly burned patients with a cooling water spray to ease their pain…until it was discovered that the water was loaded with dangerous, infection-causing microbes.
• Another hospital, attempting to prevent the spread of infection, installed non-touch faucets. But a study found that every faucet tested positive for Legionella bacteria, and that 74 percent were also contaminated with Pseudomonas aeruginosa, another bacterium associated with serious, often fatal, pneumonia.

Patients, their families and caregivers need to be aware of the potential for waterborne infection any time they are hospitalized, particularly if they are seriously ill or undergoing treatment that affects their immune systems, according to Stout.

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Study: Ladder Injuries Climbing

Falls from ladders can result in serious injury and affect people of all ages. The general public is at risk for ladder injuries, yet receives little, if any, instruction on ladder use and safety.

According to a study published in the May issue of the American Journal of Preventive Medicine and conducted by the Center for Injury Research and Policy (CIRP) at Columbus Children’s Hospital, more than 2.1 million individuals were treated in U.S. emergency departments for ladder-related injuries from 1990 through 2005. That estimate exceeds an average of 136,000 cases annually. This is the first U.S. study to use national data to comprehensively examine nonfatal ladder-related injuries.

“Individuals using ladders are often not mindful of the severe risks associated with use,” says the study’s co-author Lara Trifiletti, principal investigator in CIRP at Columbus Children’s Hospital and an assistant professor at The Ohio State University College of Medicine. “Increased public health initiatives that target men and women, especially of working age, could help reduce the number of ladder-related injuries.”

During the 16-year study period, the number of ladder-related injuries increased by more than 50 percent. Nearly 10 percent of injuries resulted in hospitalization or transfer to another hospital, approximately twice the admission rate of consumer product-related injuries overall.

Of the cases for which location of injury was recorded, nearly all (97 percent) occurred in non-occupational settings, such as homes and farms.Data showed ladder-related injuries most often occur to males, accounting for nearly 77 percent of the total cases. Fractures were the most common type of injury, while the legs and feet were the most frequently injured body parts.

“Given the 50 percent increase in the annual number of ladder-related injuries, the relatively high hospital admission rate, and the predominance of injuries in non-occupational settings, increased efforts are needed to prevent ladder-related injuries in and around the home,” says co-author Gary Smith, director of CIRP at Columbus Children’s Hospital and an associate professor at The Ohio State University College of Medicine. “Ladders should be treated with the same respect and caution as any potentially dangerous tool, such as a power saw.”

Data for the study were obtained from the National Electronic Injury Surveillance System (NEISS) of the United States Consumer Product Safety Commission. The analysis included cases of nonfatal ladder-related injuries treated in emergency departments across the country during the 16-year study period.

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Overcrowded Hospitals May Risk Adverse Events on Busiest Days

Hospitals that operate at or over their capacity may be at increased risk of adverse events that injure patients, according to a study led by investigators from Massachusetts General Hospital (MGH) and Brigham and Woman's Hospital (BWH). The report in the May issue of the journal Medical Care suggests that efforts to meet two primary challenges facing hospitals today – reducing costs and improving patient safety – may work against each other.

"While financial and political pressures to make health care more efficient are leading to increased hospital occupancy and greater patient turnover, patients and policymakers are quite rightly demanding that health delivery systems be made safer," says Joel Weissman, of the MGH Institute of Health Policy, the report's lead author. "Our study suggests that pushing efficiency efforts to their limits could be a double-edged sword that may jeopardize patient safety."

In order to examine their hypothesis that increased workload could raise the likelihood of adverse events, the investigators examined data from four hospitals in two states – two large urban teaching hospitals and two suburban teaching hospitals – over the 12 months from October 2000 through September 2001. To compile patient care information they reviewed patient charts and billing records on almost 25,000 patients, selecting 6,841 for comprehensive review, and analyzed that data against information on hospital workloads and staffing patterns, with a focus on variations within each hospital.

From the nearly 7,000 records receiving detailed review, 1,530 adverse events – defined as preventable injuries not resulting from patients' underlying medical condition – were identified. The most common such events were wound infections and adverse drug events. At three of the four hospitals, the rate of adverse events did not appear to increase at times of peak workload. But at the fourth – a major urban teaching hospital with consistently high occupancy rates, exceeding 100 percent for more than three months – workload increases and higher patient-to-nurse ratios were associated with more adverse events.

"While we looked at only four hospitals, which limits the ability to generalize these findings, the hospital where we found a relationship between working conditions and adverse events was disproportionately crowded for much of the study period," says study co-author Eran Bendavid, MD. "That suggests hospitals operating at the high end of their capacity may need to examine safety systems with an eye towards coping with periods of high stress."

Formerly with the MGH Institute of Health Policy, Bendavid is now at the Center for Health Policy at Stanford University.

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New Report Portrays Patient Safety, Health Care Quality Performance of U.S. Hospitals

Hospitals across the United States have significantly improved the quality of care provided for patients suffering from heart attacks, heart failure, or pneumonia over the past four years, according to a new report from the Joint Commission. The Joint Commission is a non-government organization that accredits US hospitals.

The report details the performance of accredited hospitals against standardized national performance measures and the Joint Commission's National Patient Safety Goals.

"Improving America's Hospitals: A Report on Quality and Safety" also shows, however, that the effectiveness with which hospitals carry out safe practices and provide patients proven treatments for common clinical conditions varies by state.

These variations spotlight clear opportunities for hospitals to strengthen their efforts in delivering safe, effective care. For example, the Joint Commission report found that almost all heart attack patients are receiving the life-saving benefits of aspirin when they arrive at the hospital, yet many heart failure patients do not receive specific discharge instructions about their condition and necessary follow-up care when they leave the hospital. Hospital performance in complying with National Patient Safety Goal requirements has also been variable. Most hospitals do well in using objective methods to identify patients before undertaking treatments, but many are finding it challengingto put processes in place to avoid medication mix-ups.

The Joint Commission is issuing this detailed report as part of itsongoing efforts to stimulate continuous quality and safety improvement andto empower consumers with information that will make them more activeparticipants in their health care. This report, which is the first of whatis to become an annual report, covers the time period from 2002 through 2005.

"The real and potential improvements in patient safety and health care quality identified in this report underscore the value of ongoing measurement of hospital performance against standards and performance measures," says Dennis O'Leary, M.D., president, the Joint Commission."This is the kind of information that will truly create informed consumers who can ask good questions about their care and even become involved in hospital performance improvement processes."


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Newsweek Cover: Failing Our Wounded

Recent revelations about the decay and mismanagement at Walter Reed Army Medical Center in Washington, D.C., were especially shocking because it is one of the most prestigious U.S. military hospitals. But a Newsweek investigation--which focused not on one facility but on the services of the Department of Veterans Affairs, a sprawling 235,000-person bureaucracy--found that the VA system is unprepared for the scope of the task at hand and ahead.

Around 50,000 service members so far have been banged up or burned, lost limbs or sacrificed something less tangible inside them in the wars in Iraq and Afghanistan. And a new study projects that at least 700,000 moreveterans from the global war on terror will flood the system in the coming years. In the March 5 cover story, "Failing Our Wounded" (on newsstands Monday, February 26), national security correspondent Dan Ephron and Assistant Editor Sarah Childress paint a grim portrait of an overloaded bureaucracy cluttered with red tape; veterans having to wait weeks or months for mental-health care and other appointments; families sliding into debt as VA case managers study disability claims over many months, and the seriously wounded requiring help from outside experts just to understand the VA's arcane system of rights and benefits.

Tonia Sargent, whose husband, Kenneth--a Marine master sergeant who had been in the corps for nearly 18 years--nearly died in a sniper attack in Najaf in 2004, says no one ever sat her down and explained the benefits and how to access them. Her husband's brain injury made him often incapable of understanding his own care. Key decisions fell to her alone. It's a "don'task, don't tell system," she says. The Sargent's story, and the stories of many other veterans, is raising concerns that the United States is failing to meet its most basic obligations to those who fight its wars, Newsweek says.

"In no way do I diminish the fact that there are veterans out there who are coming in who require treatment and maybe are not getting the treatment they need," White House Deputy Press Secretary Tony Fratto tells Newsweek. "It's real and it exists."

Dr. Michael Kussman, the VA's acting under secretary for health tells Newsweek that the department is trying to reach veterans earlier, as they approach their date of discharge, and that he does not believe Iraq and Afghanistan are straining resources severely.

"The impact on the VA so far has been relatively small," Kussman says. "It has not kicked the system over in our budget and in our ability to absorb it."

But the number of veterans has to grow and critics worry the VA is in a state of denial. In a broad sense, Newsweek reports, the situation at the VA seems to mirror the overall lack of planning for the war. "We know the VA doesn't have the capacity to process a large number of disability claims at the same time," says Linda Bilmes, a Harvard public-finance professor who last month released a 34-page study on the long-term cost of caring for veterans from Iraq and Afghanistan.

Veterans' support groups and even some former and current VA insiders believe there's a reluctance in the Bush administration to deal openly with the long-term costs of the war, Newsweek says.

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