Safety at Oregon Hospitals Improving, But Gaps Remain

More than half of hospitals in Oregon received a “C” or “D” on a report card released by an industry group last month that measured patient safety at more than 2,500 hospitals nationwide.

Overall, the nonprofit Leapfrog Group ranked 31 hospitals in the state. Five earned an “A,” one of the lower percentages nationwide, four scored a “D” and none failed.

The Leapfrog results, based on voluntary surveys submitted by hospitals across the country, includes 28 measures of publicly available hospital safety data that are combined to produce a single score representing a hospital’s overall performance in keeping patients safe from preventable harm and medical errors. 

Bethany Walmsley, executive director of the Oregon Patient Safety Commission, says that in general that Oregon hospitals have made considerable progress in recent years reducing the rates of some healthcare-associated infections, such as surgical site infections and central line-associated bloodstream infections. And, there is a greater awareness of the need for hospitals to be transparent about safety concerns and share that information.

“It's not just capturing data about preventable harm, but are we sharing that?” she said. “Hospitals are getting better and better at that.”

Still, she said, “Oregon hospitals are struggling with major safety issues.” Namely, coordination of care, also known as transitions of care, as patients are moved from one facility to another. “Communication sometimes falls through the cracks,” Walmsley said.  “The industry has a long way to go in terms of true integration.”  

Part of the problem is that many electronic medical records systems are proprietary and don't talk to each other, Walmsley said. Many hospitals in Oregon are using software from Epic Systems, but customized elements can make systems incompatible outside of an individual provider organization.

Another hurdle is that there is no single standardized definition for different patient safety measures at the federal level. That lack of consensus leads to different organizations publishing different ratings, all based on different methodologies, with no clear instruction book for patients or hospital administrators to reconcile the results.

Leapfrog isn't the only group that publishes a yardstick. The Centers for Disease Control and Prevention maintains a database of healthcare-associated infections, while locally, the Oregon Patient Safety Commission has its own measure of patient safety. Those are just some of the ratings available.

“The lack of standardization makes it difficult to make sense of ratings,” Walmsley said. “It isn't uncommon to see hospitals doing well on one survey versus another one with a different focus or that doesn't look the same. It makes it challenging for the healthcare providers to try to navigate.”

St. Charles Medical Center in Redmond is a case in point. Leapfrog gave the 48-bed community hospital a “D.” But Pam Steinke, the chief nurse executive and vice president for quality management at St. Charles Health System, pointed out that the facility has recently received two different quality awards for patient safety recently: It was one of 19 hospitals in the state to hit certain benchmarks of the Partnership for Patients program. And in October 2013, the Collaborative Alliance for Nursing Outcomes recognized St. Charles Redmond and 10 other hospitals for their reduction of critical care infections.

Furthermore, Steinke said, the St. Charles Medical Center in Bend, which received a “C” from Leapfrog, has a readmissions rate of 4.5 percent. “This is half the rate at our peer hospitals in Oregon,” Steinke said. “Our outcomes show … our commitment to hospital safety.”

The Oregon Association of Hospitals and Health Systems, which administered the Partnership for Patients program in the state, declined to speak to The Lund Report, but submitted a statement that is printed in its entirety at the bottom of this article.

The Partnership for Patients program is a two-year effort led by the national Centers for Medicare and Medicaid Services to reduce patient harm, such as hospital-acquired conditions, by 40 percent and readmissions by 20 percent.

Hospitals participating in the program adopted evidence-based practices designed to reduce harm in 10 target areas: adverse drug events, birth-related injuries, catheter-acquired urinary tract infections, central line-associated blood stream infections, falls, pressure ulcers (caused by lack of movement), avoidable readmissions, surgical infections and complications, venous thromboembolisms and ventilator-associated pneumonia.

Mercy Medical Center in Roseburg, which participated in Partnership for Patients and earned an “A” from Leapfrog, shares the frustration with the wide range of industry definitions of safety.

Dr. Jason Gray, chief medical officer at Mercy Medical Center, said the provider was focused on educating staff on everything from hand washing to reducing early elective delivery to unnecessary use of antibiotics.

“We have no magic answers,” Gray said. “We're really working on empowering the staff, nurses, physicians and technicians to own these processes and speak up if something is not right or not clear. It's blocking and tackling.”

He believes that transparency of safety data is key to improving performance, and the biggest benefit of the Leapfrog results. At the same time, however, Mercy is implementing a program, called Safety First that patients will never see, which is a 15-minute “huddle” every morning of nurses and clinical team leads designed to improve communication within the hospital.

Providence had two different hospitals earn the highest grade from Leapfrog. Michelle Graham, executive for quality and medical staff services, attributes the scores to work the provider has been doing over the past decade.

“We’ve seen dramatic results in reducing catheter and central line related infections over the past 10 years. We’ve also worked hard at engaging and partnering with our medical staff. We’ve implemented a global trigger tool, which helps us get more data to identify opportunities for improvement and measure our progress over time,” Graham said in a statement to The Lund Report.

“We’ve also seen a reduction in surgical site infection and the near elimination of retained objects in surgery. Communication also helps – for example, through our emergency department information exchanges, we’re able to let primary care physicians know if one of their patients is seen in our EDs.

We’ve even seen improvement in things as basic as hand hygiene,” she said.

The Oregon Association of Hospitals and Health Systems submitted the following statement to The Lund Report regarding hospital safety and the Leapfrog scores:

“Quality improvement and patient safety continue to be a strategic priority for our members. Across the state, hospitals are hard at work identifying areas to improve and then improving them. From the hospitals to the association to the state to the federal government, everyone is aligned in favor of improving quality in order to optimize patient safety and clinical outcomes.  For instance, we just completed a 2-year ‘Partnership for Patients’ program on elimination of hospital-acquired conditions, addressed by implementing best practices. Standardizing best practices produce reliable outcomes, which translates to better care and a better patient experience.

“With that said, it is important to note several key facts. In particular, the Leapfrog grades must be interpreted in context as with any report card. For example, some of the data used to calculate the Leapfrog grades are more than two years old, and may not reflect more recent performance improvement efforts.  Leapfrog is one of many organizations that produces hospital performance reports and rankings.  These organizations use different quality measures, timelines, performance data and methodologies to calculate scores. As a result, a hospital may perform well on one report card and poorly on another.

“Again, Oregon hospitals take quality improvements and patient safety very seriously. They work diligently to improve and will continue to do so in partnership with a variety of stakeholders.”

Christopher can be reached at [email protected]