Saturday, October 23, 2010

Some Serious Food For Thought For Hospital Managers. Your Safety Performance Needs Improvement!

The following appeared a day or so ago:

HealthGrades study: 'Unacceptably wide gap' between top peforming hospitals, others

October 19, 2010 | Molly Merrill, Associate Editor

GOLDEN, CO – Patients at five-star rated hospitals had a 72 percent lower risk of dying when compared with patients at one-star-rated hospitals, according to a new independent study by healthcare ratings organization HealthGrades.

Experts say this is an enormous gap that has held steady over the past years even as overall mortality rates have improved.

The "Thirteenth Annual HealthGrades Hospital Quality in America" study analyzed objective mortality and complication rates at all of the nation's 5,000 nonfederal hospitals using 40 million hospitalization records obtained from the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services.

The study, the largest of its kind, identified national and state-level trends in hospital care quality and established quality ratings for each hospital, across 26 different procedures and diagnoses. The ratings are now online, allowing individuals to compare their local hospitals.

Looking at overall trends, the HealthGrades study found that hospital mortality rates, on average, have declined by 7.98 percent over the three-year period studied, from 2007 to 2009. Of the 17 mortality-based diagnoses and procedures analyzed, only two bucked the overall trend with increasing mortality rates – gastrointestinal surgeries and coronary intervention procedures.

As part of the study, HealthGrades rated individual hospitals with a one-star, three-star or five-star rating in each of 26 procedures and diagnoses, from bypass surgery to total knee replacements. A one-star rating means that the hospital performed below average, to a statistically significant degree, when compared with the other 5,000 hospitals. A three-star rating means the hospital's performance was average, and a five-star rating means the hospital outperformed the national average to a statistically significant degree.

Lots more detail here:

The astonishing fact that emerges from all this is that if all patients were treated in 5 star organisations over 230,000 more would be saved.

There is no reason to believe we do not have similar levels of performance and variability here in Australia.

Put this together with this following and there is a partial and e-Health related explanation:

Joint Commission Touts Research on Reducing Handoff Failures

Cheryl Clark, for HealthLeaders Media , October 22, 2010

A 10-hospital collaborative to reduce handoff failures, the root cause of four in five adverse events, successfully cut by 52% the number of faulty handoffs by identifying reasons why communication fails, says Mark Chassin, president of the Joint Commission.

Chassin says that when these solutions are refined, they may become part of the commission's hospital accreditation process, with a report on their outcomes expected by mid 2011. Also in the works is the development of a way to quantify how reducing handoff failures improves outcomes, he says.

Chassin spoke during a briefing with representatives of several hospitals participating in the commission's Center for Transforming Healthcare. And during that session, many noted that lack of respect between sender and receiver, and varying cultures and focus—for example between the emergency room team and an inpatient team—may explain some reasons why information that must be conveyed is not.

"This is a ubiquitous problem," said Chassin, former Executive vice president for Excellence in Patient Care at Mount Sinai School of Medicine and former Commissioner of the New York State Department of Health.

Lots more details here:

From here we are told e-Health has a role:

Restructuring is not the answer: healthcare reform

  • OPINION: Jeffrey Braithwaite
  • From: The Australian
  • October 23, 2010 12:00AM

WE often hear about terrible things happening to ordinary people in our hospital system.

And just as regularly we hear tales of doctors and nurses stretched to their limits, and a healthcare system in crisis.

It's a strange kind of cold comfort to know that across the developed world, error rates are about the same: that of all the people who go into hospital about 10 per cent will end up being harmed.

There may be a medication error, patients could acquire an infection, fall in the shower, or suffer from surgical complications.

This sort of thing shouldn't happen, yet with more than 7 million in-patients treated in Australian hospitals last year, it is impossible to imagine a nil error rate.

But as the medical profession's primary motto is "first do no harm", 10 per cent seems unacceptable.

As we undergo national reform of our healthcare system it is useful to reflect on what effects these changes will have on this impenetrable statistic.

My concern with the federal government's health reform is that it is very top-down and it's going to take two or three years before we see a system in place where smaller groups of joined-up hospitals are looking after patients in a more focused way.

What happens in the meantime is a worry for all of us.

The reform agenda assumes people are going to work together effectively. That's a big conjecture and something health systems worldwide are struggling to achieve.

Government is doing what it always does: it looks at how things are financed, how they are structured and where all the boxes go on the organisational chart; it changes the boundaries of the health districts every few years so they are sometimes larger and sometimes smaller.

Do any of these things translate into better outcomes when it comes down to patients getting care from clinicians? Not really.

At the coalface, hospitals are being asked to tell people about errors when they are made and to explain how they happened, how hospitals are sorry for the effects, and how they plan to stop it occurring again.

This is much more important than any restructuring.

E-health initiatives play a huge role in the area of monitoring patients and in improving communication, the root cause of most errors, but we have a long way to go on that front and we've been reading a bit recently in Weekend Health about the challenges the federal government is facing in this area.

We are struggling to find a system that provides physicians timely, accurate information while safeguarding patients' privacy.

More here:

And at the end we are also told:

“The three-day National Forum on Safety and Quality in Healthcare begins in Canberra on Monday.”

I would suggest there is a pretty large elephant in the room (many too many unnecessary deaths in hospitals) here that we might want to see action on for all our sakes. (We don’t really know bad it is because the statistics are a trifle hard to come by - and politicians don’t want to scare the horses). What betting it is an ineffective talkfest as these meetings seem always to have been over the years. Maybe this time it will be different!

I note in passing the promised web site that might assist is still not operational - see for a blank look!


1 comment:

Anonymous said...

e-health plays a significant role in all of this, yet we never see a 'HealthGrades' like system or IT projects. We are still wasting millions of dollars on poorly run projects simply because we have poorly trained people running them. If we are to truly see some improvement through technology then the people implementing the technology projects better understand the real needs of the medical industry, the real needs of the patient and the real needs of the hospital business. Anything else is a waste of time.