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June 9, 2012

Regional gets ‘A,’ Union ‘B’ in safety study

Leapfrog uses public data to assign grades

Sue Loughlin The Tribune-Star

TERRE HAUTE — Terre Haute Regional Hospital received an “A” and Union Hospital a “B” in a new assessment of patient safety released by the Leapfrog Group, a national nonprofit agency that monitors health care quality.

This week, the group released its new Hospital Safety Score, which gives letter grades of A, B, C, D or F to more than 2,600 hospitals nationwide.

The score is calculated using publicly available data on patient injuries, medical and medication errors, infections and other factors.

Twenty-six measures are based on information collected by Leapfrog, Centers for Medicare and Medicaid Services and other sources.

The measures look at hospitals’ adherence to safe practices, such as entering physician orders into computer records to avoid penmanship errors and removing catheters promptly to minimize the risk of infections.

The grade also was based on hospitals’ records, including those indicating patient bed sores, infections and falls or other injuries.

Of the 2,651 general hospitals issued a Hospital Safety Score, 729 earned an “A,” 679 earned a “B,” and 1,243 earned a “C” or below.

“We’re very excited we got an A,” said Marsha Ciolli, Regional’s vice president of quality and risk management. It shows that staff and medical staff “really take patient safety to heart and do a great job of taking care of patients.”

In areas where they didn’t achieve the highest possible score, Regional will look to see where they can improve, Ciolli said. “You can’t rest on your laurels. … You have to keep upping the bar.”

While some hospitals around the country are critical of the Leapfrog grading system, Ciolli noted it’s “brand new” and some will view it with caution. “It looks like they did their due diligence to put everyone on the same playing field,” she said.

Leapfrog consulted with nine nationally known patient safety experts from institutions including Johns Hopkins and Harvard School of Public Health to design its letter-grade scoring methods.

Asked about Union Hospital’s “B” grade, Dr. John Bolinger, the hospital chief medical officer, responded, “We’d like it to be an A.” The hospital will use the tool to improve and “make our processes and patient care better.”

But it may not be realistic for all hospitals to meet all measures in the survey, he said. “This is the gold standard” and Leapfrog’s vision of what the perfect hospital would look like, he said.

For example, it calls for hospital intensive care units to have on staff their own full-time intensivist, or a board-certified critical care doctor. “Hospitals our size typically do not have that,” he said. That specialty is “very sparse,” costly and difficult to recruit, he said.

“That’s a pretty difficult criterion for most hospitals to meet,” Bolinger said.

Terre Haute does have several critical care, board-certified physicians who have outside practices and Union Hospital privileges, he said.

Ciolli agreed with that assessment. Regional does not have on staff a full-time intensivist for ICU — someone who works exclusively with ICU patients. “It would be a great standard, but it’s just not practical” except for possibly some of the largest hospitals, she said.

Another measure calls for computerized physician orders, something that Union expects to have completed in 12 to 18 months, Bolinger said. Now, physicians write their orders on paper, he said. “That’s the way most hospitals around here do it.”

But change is coming and it will help reduce the potential for errors, he said. “That’s a big, big change in the medical electronic record area,” Bolinger said. He anticipates all hospitals will have that within the next few years.

He noted that nurses “already document everything electronically.”

At Regional, computerized physician orders are used in the Emergency Department, Ciolli said. Eventually, the practice will be implemented throughout the hospital, although no date has been specified.  

Physicians would enter their orders by computer. “It’s a learning curve for everyone,” Ciolli said. “It’s a great patient safety initiative,” but there is concern it will be time-consuming for doctors.

Jeanette Spradlin, Union’s vice president of quality, had concerns that the Leapfrog data is a year old and new data will be coming out later this month. For some of the measures, improvements already have been made.

“We’ve done a lot in the last two years building that culture [of safety],” she said. As an example, a leadership team gathers at 9 a.m. each day, Monday through Friday, to talk about anything that might have happened in the past 24 hours that could create potential error or safety issues.

“It’s been a great communication tool,” she said of the meeting. The hospital has an active patient safety committee and risk management group.

“We ask patients what we could do to improve safety,” Spradlin said.

Union has put into place new practices to reduce the risk of infection, based on research that shows better methods, she said.

Spradlin and Bolinger said the grade shouldn’t be the sole criterion in choosing a hospital. People should consider whether the hospital offers the services they want as well as the recommendation of their physician.

In a sampling of a few measures for the two hospitals:

• In leadership structure and systems, Regional received 120 out of 120, while Union received 111.4 out of 120.

• In teamwork training and skill building, Regional received 40 of 40 while Union received 28 out of 40.

• Under identification and mitigation of risks and hazards, both hospitals received 120 out of 120.

• Under care of the ventilated patient, Union received 20 of 20, while Regional received 18.3 out of 20.

Hospitals that received D’s or F’s were listed as “grade pending” in the report. “Leapfrog has a policy not to give ratings for the poorest performers until they have a chance to improve,” said Leah Binder, president and CEO of the Leapfrog Group, in a telephone interview.

“The fact that we’ve made it clear that they are below a C is enough of a statement to the public that they should use caution in those hospitals,” she said.

New hospital data will be available soon, and updated grades will be made public in November, Binder said.

The Hospital Safety Score lets the public know that “some hospitals are safer than others,” she said. Many people tend to think all hospitals are similar when it comes to patient safety. “That is simply not the case,” she said.

Leapfrog says that about 400 people die every day across the United States because of hospital errors.

The American Hospital Association disputed Leapfrog’s ratings, saying in a statement that the association “has supported several good quality measures but many of the measures Leapfrog uses to grade hospitals are flawed, and they do not accurately portray a picture of the safety efforts made by hospitals.”

 The Leapfrog Group is an independent national nonprofit run by employers and other large purchasers of health benefits.

Sue Loughlin can be reached at (812) 231-4235 or sue.loughlin@tribstar.com.



Information online

• For more information on Terre Haute Regional, Union or other hospitals, go to the Hospital Safety Score website at www.hospitalsafetyscore.org.

• More information on the Hospital Safety Score can be found on Sharecare, an online resource of health questions and answers, at www.sharecare.com/group/

hospital-safety-score.

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