Officials at Toledo hospitals say they were already seeking to improve areas criticized by a recent hospital safety ranking prior to the survey’s release.
Whether ranked worst in the state or mediocre in comparison, all local hospitals have room for improvement according to the report.
Consumer Reports, a nonprofit marketplace watchdog organization, released the rankings this month, which compared 1,100 hospitals across the country in six areas: infections, readmissions, communication, CT scanning, complications and mortality. The ratings were based on a 100 point scale, with the highest scoring hospital earning 72 points and the lowest receiving 25 points.
ProMedica’s Flower Hospital took the lead in Lucas County with 65 points and University of Toledo Medical Center ranked the lowest with 28 points. Mercy hospitals placed in between, with Mercy St. Vincent Medical System garnering 58 points and Mercy St. Anne Hospital collecting 56. In Maumee, St. Luke’s Hospital earned a 54.
ProMedica’s corporate director of quality, Linda Yielding, said the problem comes down to consistency.
“We can identify best practices but then everyone has to know about it and consistently apply it,” Yielding said. “There are certain things like a 15 second scrub of the hub before you inject the medication and yet sometimes people will not do that. It’s the consistent application of it that we’re trying to make sure happens every time — so that every patient gets the same practice. Every hospital struggles with that.”
ProMedica Toledo Hospital ranked on par or above average in most categories, such as avoiding surgical site infections. The hospital saw 10 such infections out of 2,453 surgeries performed between 2009 and 2010. Toledo Hospital also ranked well in appropriate use of CT scans, with only 5 percent of patients receiving double abdominal scans and 3 percent receiving double chest scans. Frequent CT scans are undesirable because of radiation’s link to cancer.
However, ProMedica ranked worse than the average hospital in communicating information about prescription drugs to patients. Confusion about prescriptions, which often leads to taking too little or too much, is the most common reason for unplanned re-admission, Yielding said.
But she pointed to one of the caveats of the Consumer Reports data: Much of the information reported covers numbers from 2010 or earlier. Check out ProMedica’s most recent policy about drug communication, she said, and you might find it merits a better ranking.
Patients at Toledo Hospital, for example, now go home with a comprehensive list of medications and dose changes. ProMedica is also working toward implementing a systemwide policy of “teaching back,” meaning that medical staff quiz patients before they leave not only on what they are taking but why, Yielding said.
‘Most recent data’
Dr. John Santa, director of the Consumer Reports Health Ratings Center, said he and his team worked with the most recent data available. He accumulated his information by combing state data, some of which is reported by health officials and some of which is taken in survey form by patients. His study could only include a small percentage of America’s hospitals because 22 states have no laws requiring health institutions to report complications, errors and infections.
The Affordable Care Act changes this in a way by requiring hospitals being paid by Medicare to report central line infections to the government. But a full year’s worth of data won’t be available until 2013.
“One of the frustrating things here are that the hospitals are saying, ‘Well this isn’t current’ but it’s the most current information that they have agreed to release and if they would be quicker we would love to print more current data,” Santa said. “We’re used to other industries commonly trying to do as little as possible to provide any information about safety problems with their products. This is how industries deal with these issues. They don’t volunteer information about problems — but it’s disappointing that it turns out to be that way in the hospital.”
Ohio’s hospitals report infections acquired while in the hospital, surgical site infections during knee replacements, cesarean sections and open heart operations. Among other data, they also have to report figures on mortality during heart surgery and information about how their employees prevent infection, according to the Ohio Department of Health.
The Consumer Reports team has been collecting hospital safety data for four years now but this is the first publication that has ranked the hospitals. Santa said the Health Ratings Center will continue to add new information as hospitals report the latest figures to the government.
Scott Scarborough, senior vice president and executive director at the University of Toledo Medical Center (UTMC), said he is skeptical of the report’s fledgling nature. The medical center was ranked 18th in the state by US News & World Report Best Hospitals from 2012-13, with 53 percent of surveyed patients indicating they would definitely recommend the medical center to a friend.
Scarborough said the US News & World Report was “more time tested” and covered a larger sample size of hospitals. The magazine surveyed nearly 10,000 specialists and collected data on about 5,000 hospitals.
The Consumer Reports low ranking of UTMC surprised Scarborough because the system typically receives high marks, he said. Scarborough questioned the validity of the report’s data collection process, pointing out that some of the areas were not adjusted for risk.
Yielding had similar concerns about risk adjustment, but said ProMedica puts some “rather high stock” on Consumer Reports, particularly because it does not require hospitals to buy information or submit information directly.
“How can Cleveland Clinic be rated No. 1 in the state on US News & World Report and Consumer Reports ranks it seventh from the bottom?” Scarborough asked. “It causes us to suspect they didn’t get it quite right on this first attempt.”
Take risk into account
Scarborough would have preferred if the Consumer Reports numbers took risk into account, noting that UTMC takes in the sickest patients in the area. University medical centers take referrals from other institutions to treat more complicated conditions because of their teaching status and the specialists that are available, he said.
On average, UTMC patients are already taking 12 different medications before they even check in, Scarborough said.
The Consumer Reports survey put UTMC at worse than average in communication about drug information, room cleanliness, appropriate use of abdominal CT scans, avoiding surgical site infections, complications and re-admissions.
Avoiding infection can be as simple as creating a culture more observant of hand-washing. The medical center is still installing new machines that automatically wash your hands with soap and water when you place them before a sensor. Also, the hospital employs one and a half staff members whose job is solely to address the prevention of infection, Scarborough said.
The medical center has focused on effectively communicating drug information since 2010, improving the system by decentralizing the pharmacy department and moving pharmacists to the patient floors.
As for re-admissions, many are planned or are because the patient is elderly and his or her body is breaking down, Scarborough said.
And how about double CT scans? He said his doctors tell him that taking two scans, one with contrast and one without, often yields more comprehensive results because they can notice different issues with both methods.
The Consumer Reports overview lists excessive CT scans as a major problem in hospitals across the country. While some of the categories in the report are, in fact, adjusted for risk, CT scans are not. And because of the radiation, Santa said he doesn’t think they should be.
Some health officials argue that surveys should not adjust for risk at all because doing so makes it easier for hospitals not to take accountability for hospital-acquired infections and complications, he said.
Santa said he understands that university medical centers see the sickest patients.
“It’s not about arguing where the data came from and who’s got the sickest patients,” Santa said. “UT should call Baylor if they have concerns about the score.”
Baylor University Medical Center scored 67 out of 100. Texas does not require hospitals to report surgical site infections, but it does require bloodstream infection reports. Baylor logged four during 2010. Ohio does not require hospitals to report bloodstream infections. UTMC reported nine surgical-site infections out of 299 from 2009 to 2010 — 130 percent worse than national rates.
The Consumer Reports data took into account discrepancies in available types of data and differing numbers of types of treatments, Santa said.
Santa started with the Health Rankings Center four years ago, after 30 years as a doctor in the state of Oregon.
“I’m afraid I would have to admit, when I was practicing I was like many other physicians in that era and I didn’t know how preventable hospital infections were,” he said. “I’m sad to say that I told many patients that, ‘you know, these things just happen.’ But they don’t just happen.”
He said a patient, regardless of risk, should never get a punctured lung during a procedure or fall while in the hospital. But, he said, the areas in which hospitals tended to perform the worst were related to communication about drugs and hospital discharge.
Address root causes
Mercy hospitals scored both above average and worse than average on infections. Nine bloodstream infections were logged in and three surgical-site infections out of 171 surgical procedures between 2009 and 2010 at St. Anne Hospital.
Mercy St. Vincent Hospital earned higher scores in those departments.
Charla Ulrich, director of quality at Mercy St. Vincent Hospital, said it is important not to make health care choices based on one survey. She pointed out The Leapfrog Group as another type of health institution scoring system that Mercy inspects.
The survey’s most recent reports indicate that Mercy St. Anne Hospital has made “some progress” at reducing ICU infections. The hospital fully meets standards in reducing hospital injuries, its steps to avoid harm and preventing medication errors. But the hospital ranked low on “managing serious errors.”
Ulrich said the hospital system looks at all surveys and rankings that are relevant to Mercy.
“Does it drive changes? Somewhat … sometimes. But overall I can’t say that it is the strongest indicator of the quality of care hospitals provide,” Ulrich said.
Santa said the health community as a whole needs to become better at addressing the root cause of errors and complications and eliminating infections and falls.
“We would acknowledge that we have set the bar high,” he said. “But even the best hospitals are re-admitting 16 to 20 percent with heart attack or failure or pneumonia, and we don’t think that’s a winning score.”
