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