Hospitals Take Leap on Prevention
Nearly half of Florida hospitals have earned an "A" on error prevention in a new report card from a business-backed group concerned about patient safety.
The ratings from The Leapfrog Group, released today, show Florida fifth among the states on its safety scores (see all state scores). No Florida hospitals flunked, and just three scored a D (see Florida scores).
The most-improved hospital on the Leapfrog list is Brandon Regional Medical Center, which jumped from a D to an A grade in just six months. The suburban Tampa facility is part of the HCA Healthcare chain, as are three of the four hospitals that jumped from Cs to As over the same time.
The HCA hospitals that jumped two letter grades to an A were all in Tampa Bay: South Bay Hospital in Sun City Center, Northside Hospital in St. Petersburg, and Doctors Hospital of Sarasota.
The good news was not entirely a surprise, said Dr. Larry Feinman, chief medical officer for HCA's 16-hospital Western Florida Division.
"Our company and our division and our facilities have been embarking on significant work with clinical excellence initiatives that really have improved the quality at all our hospitals," he said in an interview. "You're seeing the result of that."
Another hospital that received a two-level grade bump to an A from Leapfrog is Tallahassee Memorial, a private non-profit. That hospital's efforts to reduce the mortality rate have won praise from the Institute for Healthcare Improvement, a private non-profit in Boston.
Feinman mentioned several practices that helped reduce HCA hospital-acquired infections and improve outcomes:
-- Faster care for sepsis, a severe bacterial blood infection that can rapidly lead to death or multiple limb amputations. Such cases horrify juries and often lead to multimillion-dollar verdicts, as the malpractice insurer IronShorenotes.
Feinman said HCA's company-wide sepsis care initiative places great importance on early detection of the condition -- in the ambulance, if possible -- and rapid intravenous hydration to maintain circulation. "That's probably been the most remarkable improvement we've made over the past few years," he said.
* Reduction in unnecessary blood transfusions. While the public sees them as innocuous and beneficial, Feinman said, they can lead to complications and should not be used in patients who are stable and have a red-blood-cell count of at least 7 grams per deciliter. "You're transplanting liquid tissue," he said.
HCA practice is in line with the new clinical standards adopted by the American Association of Blood Banks, according to Medscape.
* Better management of ventilator patients. Reducing the length of time a patient is hooked up to an artificial breathing machine "remarkably improves survival," Feinman said. Strategies for weaning patients from the ventilator sooner are described here in MedPage Today.
* Clean hands. "Nobody would argue that hand hygiene is the single best way to prevent hospital-caused infections, and we expect nothing less from everyone who walks into a patient room," Feinman said.
Patients who see that a nurse or doctor has forgotten to wash their hands or use sanitizer are urged to speak up, Feinman said. A phone number to report breaches is posted in each room.
"We have 'secret shoppers'" -- staff members who are pressed into undercover duty -- "following clinicians to make sure they do wash their hands," Feinman said.
Nobody's perfect, but..."If you make a mistake once, we're going to correct you. If you repeatedly make a mistake, then you're going to get in trouble, absolutely," Feinman said.
The Leapfrog Group reported that the three hospitals given D grades in Florida were Citrus Memorial in Inverness, Munroe Regional Medical Center in Ocala, and University of Miami Hospital. Munroe and University fell from a C level in the spring.
Citrus Memorial, a public hospital owned by county taxpayers, has long been in financial trouble. Its board has agreed to lease the hospital to HCA in an agreement expected to be finalized on Friday.
Munroe Regional, a former non-profit now operated by Community Health Services hospital corporation, replied to questions about its D grade by sending a statement affirming its dedication "to creating a safe environment where patients can receive quality, compassionate care." The hospital said it has formed "performance improvement teams" that are implementing national practice guidelines aimed at reducing central line and catheter infections.
"We have seen improvements in these metrics and expect to see this progress reflected in future scores," the statement said.
The University of Miami Hospital said in a statement that its grade didn't tell the whole story.
"In recent years, the University of Miami Hospital identified and made significant improvement in several areas. In the most recent (Leapfrog) review cycle, University of Miami Hospital submitted no data in the self-reporting fields, which make up more than half of the information used to calculate a facility’s score," the statement said. "Therefore, the grade of ‘D’ is not indicative of our performance."
Nationally, the Leapfrog Group report sifted federal statistics on more than 2,500 hospitals, assigning grades based on their ability to prevent errors, injuries and infections. The group, formed to tackle a problem estimated to kill an average of 1,000 people a day in the United States, began issuing the twice-yearly reports in spring 2012.
While hospitals are reporting better adherence to safety measures, documenting their hand-washing and beefing up staffing in intensive care, the improvement in outcomes is not yet showing up, said Leapfrog President and CEO Leah Binder.
She said bloodstream infections caused by central lines did go down, but a different type of infection, following major colon surgery, went up.
Binder said the measures captured in the Leapfrog project do not cover a situation like that presented by the Ebola virus, which arrived in the United States in September when a man returning from Liberia sought treatment at Texas Health Presbyterian Hospital. Thomas Eric Duncan was sent home, but returned two days later, gravely ill, and died Oct. 8. Two nurses who treated him became infected, but both have recovered.
The Texas hospital, which received a grade of A in the Leapfrog Group report, has come in for criticism for the initial failure to diagnose Ebola and for transmission to the nurses. But the garb and protocols recommended by the Centers for Disease Control and Protection have changed since the Texas case.
"Preparedness for Ebola is a specialty in hospital safety, and different from the hospital practices we measure," said Binder. "All hospitals make mistakes. ...Texas Health Presbyterian is among the safer hospitals in the nation. Recent mishandling of Ebola cases proves that as a country our hospitals must work harder to prepare for this and any future threats."
The Hospital Safety Scores are reviewed by independent experts, and an explanation of the methodology is online at www.hospitalsafetyscore.org, Binder said. The project, including a consumer-friendly interactive tool, was funded through a grant from the Robert Wood Johnson Foundation, she said.
Overall, 31 percent of hospitals in the study were given an A. Maine had the highest percentage of hospitals with an A, at 67 percent. It was followed by Massachusetts, Virginia, and New Jersey, all with more than 50 percent. Florida came in fifth, with 47 percent.
At the other end of the rankings were North Dakota and the District of Columbia, which had no hospitals with an A grade. Other states with less than 10 percent A's were Utah, Oklahoma, Mississippi and Arkansas.