Safety re­port: All Tri­an­gle hos­pi­tals but 1 get A rat­ings

The News & Observer - - Business - BY JOHN MU­RAWSKI jmu­rawski@new­sob­

Hos­pi­tals in the Tri­an­gle rank among the na­tion’s best for pa­tient safety, ac­cord­ing to the fall 2018 sur­vey is­sued Thurs­day by the Wash­ing­ton-based non­profit Leapfrog Group.

The Leapfrog Safety Grade as­sessed 79 hos­pi­tals in North Carolina among more than 2,600 acute care hos­pi­tals na­tion­wide, is­su­ing a com- posite let­ter grade based on 28 per­for­mance mea­sures for er­rors, ac­ci­dents, in­juries and in­fec­tions. Nearly three­fourths scored an A or a B, which was bet­ter than the na­tional aver­age. Across the coun­try slightly more than half re­ceived an A or a B.

Over­all, 43 per­cent of North Carolina hos­pi­tals got an A, 28 per­cent got a B, and 29 per­cent got a C. No hos­pi­tals in the state got a D or an F.

All Tri­an­gle hos­pi­tals but one re­ceived an A, and some did worse than the na­tional aver­age in cer­tain key safety mea­sures.

Leapfrog says that as many as 440,000 peo­ple die every year from hospi­tal er­rors, in­juries, ac­ci­dents and in­fec­tions, and a Medi­care pa­tient has a 25 per­cent chance of be­ing harmed, in­jured or dy­ing in a hospi­tal.

Be­cause the 28 safety cat­e­gories can seem over­whelm­ing, Leapfrog ad­vises pa­tients to start by re­view­ing just three mea­sures: hand wash­ing prac­tices, blood in­fec­tions and pa­tient falls. Even a hospi­tal with an over­all A grade can be worse than the na­tional aver­age in one or more of th­ese key safety met­rics.

Leapfrog let­ter grades for the same hospi­tal can vary from one rat­ing pe­riod to the next, and the scores may not re­flect a hospi­tal’s cur­rent per­for­mance level. Most of the in­for­ma­tion used to grade hos­pi­tals in the fall 2018 Leapfrog Hospi­tal Safety Grade is from 2017 and 2018. But some data on hospi­tal-ac­quired con­di­tions pa­tient safety in­di­ca­tors cover in­ci­dents be­tween 2015 and 2017.

What’s more, be­cause the let­ter grade is rel­a­tive to other hos­pi­tals, a par­tic­u­lar hospi­tal’s safety score can slip even if that hospi­tal’s per­for­mance stays the same, just be­cause other hos­pi­tals im­proved.

The only lo­cal hospi­tal to get a C in the fall 2018 rat­ing pe­riod was WakeMed Cary Hospi­tal. WakeMed Cary also got a C in the spring 2018 rat­ings, but in 2017 the hospi­tal re­ceived two A grades from Leapfrog. WakeMed Cary was worse than the na­tional aver­age in blood in­fec­tion rates, one of the key mea­sures rec­om­mended by Leapfrog.

West Paul, WakeMed’s se­nior vice pres­i­dent & Chief Quality & Med­i­cal Staff Of­fi­cer, said in an emailed state­ment that the or­ga­ni­za­tion has pro­grams in place to re­duce hospi­tal in­fec­tions, and noted that WakeMed Cary nar­rowly missed a B grade.

“Chas­ing Zero is a pa­tient safety ini­tia­tive aimed at achiev­ing zero in­stances of pre­ventable pa­tient harm within our fa­cil­i­ties,” WakeMed’s state­ment said. “WakeMed Raleigh Cam­pus re­ceived an A grade, thanks in part to small but con­tin­ual re­duc­tions in in­fec­tion rates and im­prove­ment in nu­mer­ous pa­tient safety mea­sures.”

Duke Univer­sity Hospi­tal in Durham, fre­quently rank­ing among the na­tion’s elite teach­ing hos­pi­tals, got an A in the fall 2018 rank­ing. Still, Duke Univer­sity Hospi­tal, which han­dles more com­pli­cated cases than a com­mu­nity hospi­tal, was worse than the na­tional aver­age in blood in­fec­tions and in pa­tient falls and trauma for the past two years.

In the spring, the hospi­tal re­ceived a C, and at the time, Thomas Owens, pres­i­dent of Duke Univer­sity and the se­nior vice pres­i­dent of the Duke Univer­sity Health Sys­tem, told The News & Ob­server the data in the re­port was three years old and didn’t re­flect Duke’s safety to­day. Owens also vowed to im­prove the hospi­tal’s score.

Other Tri­an­gle hos­pi­tals that got As in the fall rank­ing are: UNC Hos­pi­tals in Chapel Hill, UNC Rex in Raleigh, WakeMed Raleigh, Duke Raleigh and Duke Re­gional in Durham.

The safety score comes from data com­piled by the Cen­ters for Medi­care & Med­ic­aid Ser­vices, Agency for Health­care Re­search Quality, Cen­ters for Dis­ease Con­trol and Preven­tion, Amer­i­can Hospi­tal As­so­ci­a­tion, Health In­for­ma­tion Tech­nol­ogy Sup­ple­ment and Leapfrog’s own sur­vey.

Leapfrog scores evolve over time as new in­for­ma­tion be­comes avail­able. For the fall 2018 rat­ing, Leapfrog scored hos­pi­tals for their use of the Bar Code Med­i­ca­tion Ad­min­is­tra­tion, which is de­signed to re­duce the risk of giv­ing pa­tients the wrong drugs. Leapfrog said med­i­ca­tion er­rors are the most com­mon er­rors made in hos­pi­tals, but no Tri­an­gle hospi­tal sub­mit­ted this data this time around and it’s not in­cluded in their let­ter grades.

Leapfrog as­sesses many mul­ti­ple ar­eas of hospi­tal per­for­mance: five cat­e­gories of hospi­tal in­fec­tion, in­clud­ing bac­te­rial, uri­nary and sur­gi­cal site in­fec­tions; seven sur­gi­cal com­pli­ca­tions, in­clud­ing col­lapsed lung, blood clot, dan­ger­ous ob­ject left in pa­tient’s body and pa­tient death. Other safety prob­lems tracked in­clude bed sores and air bub­bles in the blood­stream. And Leapfrog also as­sesses train­ing, staffing and hospi­tal pro­to­cols.

Leapfrog says its safety score should never be the sole rea­son for se­lect­ing a hospi­tal, and the group ad­vises peo­ple to take the score into con­sid­er­a­tion when choos­ing a hospi­tal for planned, elec­tive pro­ce­dures. The or­ga­ni­za­tion says pa­tients should never to re­ject emer­gency treat­ment based on a Leapfrog safety score.

HARRY LYNCH News & Ob­server file photo

Con­trac­tors work on the WakeMed North Women’s Hospi­tal in North Raleigh in 2015. The only lo­cal hospi­tal to get a Leapfrog Safety Grade C in the fall 2018 rat­ing pe­riod was WakeMed Cary Hospi­tal.

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