Study ranks NMC high in surgery care

The Covington News - - FRONT PAGE - GABRIEL KHOULI gkhouli@cov­news.com

Pa­tients plan­ning to have surgery might want to pick up the Septem­ber is­sue of Con­sumer Re­ports mag­a­zine be­fore choos­ing a hos­pi­tal.

New­ton and Rock­dale med­i­cal cen­ters both ranked among the top hos­pi­tals in Ge­or­gia at re­duc­ing the length of hos­pi­tal stays for surgery and avoid­ing surgery deaths, ac­cord­ing to a re­cent study by Con­sumer Re­ports mag­a­zine.

The study an­a­lyzed Medi­care data for pa­tients 65 years and older from 2009–2011 for nearly 2,500 hos­pi­tals across the coun­try, and looked at 27 cat­e­gories of com­mon sched­uled surg­eries, fo­cus­ing on the five most fre­quent surg­eries: back surgery, re­place­ments of the hip and knee and surgery to re­move block­ages in ar­ter­ies in the heart (an­gio­plasty) or neck (carotid artery surgery). Other surg­eries af­fect­ing nearly ev­ery part of the body — brain, heart, lungs, stom­ach, neck, in­testines, breast and prostate — were also ex­am­ined.

High marks in surgery

New­ton and Rock­dale med­i­cal cen­ters both earned above-aver­age rat­ings in how their pa­tients per­formed dur­ing and af­ter surgery, ac­cord­ing to the re­port.

Over­all, New­ton Med­i­cal had 65 per­cent fewer ad­verse events — which cov­ers both pro­longed stays and deaths — than pre­dicted. Among the five most-fre­quent surg­eries stud­ied, New­ton had only enough data for knee re­place­ments, where it had 52 per­cent fewer ad­verse events than pre­dicted. Rock­dale Med­i­cal had 47 per­cent fewer ad­verse events, but didn’t have enough data in any of the five most com­mon surg­eries.

Dr. John Santa, an in­ternist and pri­mary care doc­tor and di­rec­tor for Con­sumer Re­ports Health

Health Rat­ings Cen­ter, said the study fo­cused on the five most fre­quent surg­eries be­cause they had the most data and showed the most variation among hos­pi­tals. Only seven hos­pi­tals in Ge­or­gia earned above-aver­age rat­ings, in­clud­ing Athens Re­gional Med­i­cal Cen­ter.

“Hos­pi­tal staff, ad­min­is­tra­tors and physi­cians all fo­cus on one thing: what is best for our pa­tients,” said Patty Waller, New­ton Med­i­cal’s as­sis­tant ad­min­is­tra­tor of pa­tient care ser­vice. “Most peo­ple ap­pre­ci­ate pos­i­tive re­in­force­ment, and to be rec­og­nized for the work that our teams put into hard­wiring safety in our daily rou­tines is cer­tainly a pos­i­tive re­in­force­ment.”

She said “at­ten­tion to de­tail and team­work” were among the spe­cific ele­ments that led to the high rat­ing.

“Like air­line pi­lots, we have check­list that we go through each and ev­ery time a pa­tient goes to the op­er­at­ing room. Ev­ery­one works to­gether as a team and any one of the team mem­bers has the abil­ity to halt the process if they feel any­thing is out of place,” Waller said.

The data was an­a­lyzed by health con­sult­ing firm MPA (Michael Pine and As­so­ciates). How to use the data

While Con­sumer Re­ports of­fi­cials ac­knowl­edge the study’s lim­i­ta­tions, they say their study is one of the few pub­licly avail­able sources of surgery data and can of­fer at least some guid­ance.

“This isn’t per­fect data; it has its lim­i­ta­tions, but we think that it is the best data that is avail­able pub­licly, be­cause there isn’t re­ally any data out there,” said Santa, not­ing the data is in­di­rect but gives in­di­ca­tions of some­thing go­ing amiss. “We look at like­li­hood of ei­ther dy­ing or a pro­longed length of stay, which means some­thing hap­pened; we don’t know what hap­pened.”

Santa urged con­sumers to look at other web­sites to com­pile as much data as pos­si­ble, in­clud­ing The Leapfrog Group and the fed­eral govern­ment’s Hos­pi­tal Com­pare web­site at medi­care.gov/ hos­pi­tal com­pare.

Santa said each group has its own data and other meth­ods of mea­sur­ing hos­pi­tals, so it’s im­por­tant to use all re­sources avail­able.

Prospec­tive pa­tients can also ask their doc­tors and hos­pi­tals for in­for­ma­tion di­rectly. He said pa­tients should ask their sur­geon for his surgery re­sults data, and if the sur­geon re­fuses to give it, the pa­tient should go some­where else, Santa said. They can also ask the hos­pi­tal to talk to an­other pa­tient who had the same surgery.

“You like to find out what it was like for them,” Santa said. “Most pa­tients don’t un­der­stand how much prepa­ra­tion is needed to man­age things af­ter the surgery. You’re not go­ing to be able to drive for a while in many cases (af­ter a knee or hip re­place­ment).”

He said some­times sur­geons are more op­ti­mistic than they should be.

Pa­tients also need to make sure com­mu­ni­ca­tion is hap­pen­ing be­tween their pri­mary care physi­cian and their sur­geon or spe­cial­ist.

Fi­nally, con­sumers should make sure the sur­geon is in good stand­ing with the state’s li­cens­ing board.

Santa said many small and medium-sized ru­ral hos­pi­tals were able to do a good job in surgery com­pared with big­ger hos­pi­tals; the rea­son might be that they fo­cus on fewer ar­eas where they can ex­cel.

“Many com­mu­nity hos­pi­tals, in the sub­urbs and ru­ral ar­eas — those hos­pi­tals re­al­ize they can’t do ev­ery­thing that the big hos­pi­tals do, so they de­cide what things they can’t do well and what (they can) do well,” Santa said.

How­ever, he noted that the Con­sumer Re­ports study was de­signed to put larger and smaller hos­pi­tals on the same foot­ing, by look­ing at “aver­age Joe” pa­tients, not the tough­est cases, which of­ten get sent to big hos­pi­tals, be­cause they are the only ones who can han­dle such cases. How it ranks While New­ton Med­i­cal ranked high in surgery re­sults, it did have some mixed re­sults in terms of com­mu­ni­ca­tion, the state of hos­pi­tal rooms and scan­ning prac­tices, ac­cord­ing to Con­sumer Re­ports’ anal­y­sis of Hos­pi­tal Con­sumer As­sess­ment of Health­care Providers and Sys­tems sur­vey data col­lected by the fed­eral govern­ment, which can be found at the Hos­pi­tal Com­pare web­site.

New­ton Med­i­cal was among the best in com­mu­ni­ca­tion be­tween doc­tors and pa­tients and nurses and pa­tients, with 96 per­cent and 95 per­cent, re­spec­tively, of pa­tients com­mu­ni­cat­ing well, and it was above aver­age in terms of pain con­trol (92 per­cent said their pain was con­trolled well), help from hos­pi­tal staff (90 per­cent said help was pro­vided quickly) and room quiet­ness (90 per­cent said the area around rooms was quiet at night). How­ever, the hos­pi­tal was be­low aver­age in terms of com­mu­ni­ca­tion about drug in­for­ma­tion (83 per­cent said new med­i­ca­tions were ex­plained) and room clean­li­ness (83 per­cent said room and bath­rooms were clean), while it was among the worst in com­mu­ni­ca­tion about hos­pi­tal dis­charge (76 per­cent said they were told what to watch for af­ter leav­ing hos­pi­tal).

The hos­pi­tal also ranked be­low aver­age in how of­ten it had pa­tients un­der ab­dom­i­nal and chest scans. Con­sumer Re­ports said 17 per­cent of the hos­pi­tal’s pa­tients re­ceived dou­ble scans, mean­ing one CT scan with con­trast and one with­out, which Con­sumer Re­ports said “can ex­pose pa­tients to un­nec­es­sary ra­di­a­tion.”

New­ton Med­i­cal was aver­age in avoid­ing read­mis­sions, as heart at­tack pa­tients had a 19 per­cent chance of be­ing read­mit­ted; the per­cent­ages were 19 per­cent for pneu­mo­nia pa­tients and 23 per­cent for heart fail­ure pa­tients. For com­par­i­son, Rock­dale Med­i­cal fared sim­i­larly in com­mu­ni­ca­tion and room con­di­tions, though it was above aver­age in ab­dom­i­nal scan­ning and among the best in chest scan­ning and be­low aver­age in read­mis­sion rates for heart at­tack, heart fail­ure and pneu­mo­nia pa­tients.

Clearview Re­gional Med­i­cal Cen­ter in Mon­roe didn’t have enough data to be ranked in surg­eries, but it had over­all be­low aver­age marks in com­mu­ni­ca­tion and room con­di­tions and among the worst read­mis­sion rates, while its ab­dom­i­nal scan­ning rate was aver­age ..

On an over­all safety ba­sis in the state, St. Mary’s Health Care Sys­tem in Athens (a score of 71) was ranked the top hos­pi­tal, fol­lowed by Athens Re­gional Med­i­cal Cen­ter (66).

Rock­dale Med­i­cal had a score of 43, while New­ton Med­i­cal and Clearview Re­gional didn’t have enough data for an over­all safety score.

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