Rep. Scalise’s care puts rat­ings for Level 1 fa­cil­i­ties on dis­play, which can be mis­lead­ing as mis­sions vary

USA TODAY International Edition - - NEWS - Jayne O’Don­nell @ jay­neodon­nell USA TO­DAY

The trauma cen­ter where Louisiana Rep. Steve Scalise has been treated since his gun­shot wounds last month is ranked low even when com­pared with other Level 1 trauma cen­ters, in­clud­ing some in other di­verse ur­ban ar­eas such as Wash­ing­ton, D. C.

Pa­tients who are taken to a Level 1 trauma cen­ter have about a 25% bet­ter chance of sur­vival over other hos­pi­tals, ac­cord­ing to a 2006 study in the New Eng­land Jour­nal of Medicine. These hos­pi­tals, in­clud­ing Scalise’s Med­star Wash­ing­ton Hospi­tal Cen­ter, treat the most se­ri­ously in­jured pa­tients.

Yet 34 Level 1 trauma cen­ters across the U. S. get A grades for safety from the Leapfrog Group and they in­clude hos­pi­tals in Bos­ton, Philadel­phia, Cleve­land and Prov­i­dence, R. I. Wash­ing­ton Hospi­tal Cen­ter gets a D.

Leapfrog doesn’t sep­a­rate out trauma cen­ters in its rat­ings, but did an anal­y­sis of Level 1 trauma cen­ter grades for USA TO­DAY.

“It stands to rea­son that of all the pa­tients in the hospi­tal, trauma pa­tients would be the most vul­ner­a­ble to short­falls in hospi­tal safety and thus trauma cen­ters should be lo­cated in the safest pos­si­ble hos­pi­tals,” says Leapfrog CEO Leah Bin­der.

Trauma sur­geons have mixed views on whether these grades mat­ter.

Trauma sur­geon Ronny Ste­wart, who chairs the Amer­i­can Col­lege of Sur­geons’ trauma com­mit­tee, is among the skep­tics about the value. He says ACS ver­i­fies when trauma cen­ters meet “rig­or­ous na­tional stan­dards” for “con­tin­u­ous qual­ity im­prove- ment.”

“Once peo­ple are get­ting a pub­lic grade, some hos­pi­tals do pay more at­ten­tion to it than oth­ers,” says Ste­wart, “But the way we ( ACS) ap­proach it, leads to proven im­prove­ments in out­come.”

Leapfrog’s safety grade “fo­cuses only on the bad things pa­tients want to avoid, like med­i­cal er­rors and in­fec­tions,” says Bin­der. “These prob­lems are all too com­mon, with more than 500 peo­ple a day dy­ing from pre­ventable er­rors in hos­pi­tals.”

Wash­ing­ton Hospi­tal Cen­ter is among just 12% of Level 1 trauma cen­ters in the coun­try that get a D rat­ing. Nearly 17% scored an A, about 29% a B and about 42% a C.

Wash­ing­ton Hospi­tal Cen­ter also scores two out of five stars in the Cen­ters for Medi­care and Med­i­caid Ser­vices’ Hospi­tal Com­pare rat­ings. Mas­sachusetts Gen­eral Hospi­tal, which also in­cludes a Level 1 trauma cen­ter, gets four out of five stars from CMS and an A from Leapfrog.

Even among Level 1 trauma cen­ters, “not all of us do the same type of trauma,” says Ja­son Smith, a trauma sur­geon who is the new chief med­i­cal of­fi­cer at Univer­sity of Louisville hospi­tal. Hos­pi­tals “see a very dif­fer­ent vol­ume and type of pa­tients.”

Other chal­lenges: Hospi­tal data doesn’t dis­tin­guish well be­tween types of pa­tients. For ex­am­ple, an el­derly per­son who falls and breaks a hip is iden­ti­fied with the same di­ag­nos­tic code as a per­son who is shot and breaks a hip, says Smith.

Leapfrog uses Medi­care data which “ap­plies highly so­phis­ti­cated risk- ad­just­ment for­mu­las to its mea­sures,” says Bin­der.

“I would love to fix and change ev­ery­thing at once, but you have to iden­tify the ar­eas ... where there is the big­gest bang for the buck,” Smith says.

Thomas Scalea, physi­cian- inchief at Bal­ti­more’s R Adams Cow­ley Shock Trauma Cen­ter, down­plays the sig­nif­i­cance of qual­ity rat­ings.

“There are many ways to game that sys­tem so you look bet­ter than you ac­tu­ally are,” he says.

For ex­am­ple, Scalea notes, “if every­one dies early, you don’t have in­fec­tions.” Sim­i­larly, he says, if hos­pi­tals don’t draw blood cul­tures, they’ll never find in­fec­tions but that wouldn’t be a “good way to take care of pa­tients.”


Thomas Scalea is a pro­fes­sor at the Univer­sity of Mary­land med­i­cal school and the physi­cian- in- chief of the R Adams Cow­ley Shock Trauma Cen­ter in Bal­ti­more.


Leah Bin­der

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