We analyzed reams of federal data and compared metro Atlanta hospitals against their peers nationwide for this exclusive story assessing the safety of your hospitals.
Metro Atlantans face risks of medical errors and life-threatening infections that are above national averages when they are admitted to some of the area’s most prestigious hospitals, according to a study of new federal data.
These conditions occur only a few times per year at most hospitals, according to the statistics, which cover Medicare patients treated between October 2008 and June 2010. Even so, the last thing hospital patients expect is that a hospital will make them sick. Or worse.
The new data show most Atlanta hospitals had at least one case of a potentially deadly catheter-related bloodstream infection — commonly referred to as a “central line” infection — and Emory University Hospital posted the highest rate in the state and one of the highest in the nation, the report shows.
In terms of numbers, not rates, the 36 central line infections reported at Emory gave it the fourth-worst ranking among about 3,300 hospitals in the nation. Other outliers included University Hospital in Augusta, which recorded the second-highest number of catheter-related urinary tract infections in the country with 77.
Data contested
The data also show eight cases of foreign objects being left in patients after surgery in metro Atlanta hospitals — including two cases each at Emory University Hospital Midtown and WellStar Kennestone Hospital. And the statistics show at least one patient fall or trauma — including fractures, dislocations and burns — at almost every Atlanta area hospital, with some of the highest rates at Piedmont Fayette Hospital and Northside Forsyth Hospital.
The new statistics offer consumers a first-ever look at how well metro Atlanta hospitals are doing at protecting patients from potentially deadly threats; Georgia does not require hospitals to publicly report infection rates and medical errors. While the data are based on Medicare records, experts say the numbers shed light on the conditions all patients face when admitted to a hospital.
Many hospitals contend the data are unfair for comparing facilities, because the statistics are derived from Medicare billing records that are dated, imprecise and not adjusted to account for hospitals whose beds are filled with extraordinarily sick patients.
But experts say it’s crucial to publicize information about medical errors and infections because many hospitals still aren’t doing enough to combat preventable conditions. While most patients leave hospitals unscathed, one recent study found that 1 in 7 Medicare patients was harmed while hospitalized. An estimated 1.7 million infections are picked up in hospitals every year, leading to about 100,000 deaths.
“Too many Americans are being harmed by the care that is supposed to help them,” said Dr. Donald Berwick, the nation’s Medicare and Medicaid chief, during a forum at the Carter Center last week. Berwick is a pediatrician and former professor at Harvard Medical School.
At the same forum, Yolanda Chancellor of Atlanta told the story of a few of those Americans with a stack of 15 cards. Each was the funeral service program of a friend or relative who had died in recent years. In all 15 cases, she said, the deaths were linked to infections acquired in hospitals or the failure to properly diagnose or treat an illness.
“He’s gone, and it’s because of inadequate health care,” she said tearfully, while holding up the program from her boyfriend’s funeral. The man she described as the love of her life died after a series of hospitalizations and infections. “It just should not happen.”
Emory’s performance
As Emory Healthcare’s chief quality officer, Dr. William Bornstein spends every day helping the highly regarded teaching hospital keep patients safe while they receive some of the most advanced care available in Georgia.
“Our aspiration is for these things to never happen,” Bornstein said.
But for most of the eight “hospital acquired conditions” measured in the Medicare data, the rates are higher at Emory’s hospitals than they are at other hospitals in the nation. Emory’s flagship hospital on Clifton Road posted rates greater than the national average for six of the eight conditions. Emory University Hospital Midtown exceeded national averages in five of the eight measures.
The incidents were still relatively rare. The data reported just four cases of pressure ulcers — bed sores — developed at Emory University Hospital and four cases of problems from poor blood-sugar control. But that was the largest number in both categories reported for any Atlanta hospital.
Bornstein raised questions about the accuracy of the data, saying Emory relies on its own measurements, which he said are more up to date and precise. He also said the federal report may reflect the complex nature of Emory’s patients more than it suggests shortcomings in the quality of care.
“Saying that we’re above average, I’m not sure that’s a surprise given that we treat the sickest patients on the planet,” he said.
Emory has undertaken aggressive programs to lower rates of central-line bloodstream infections and pressure ulcers and, according to internal data the hospital gave the AJC, it is making progress in both areas.
Emory said the program aimed at bed sores, a breakdown in the skin that can happen to patients who stay in the same position for too long, reduced the incidence in one of its intensive care units from 18 percent in January 2010 to zero in reports filed for both April and July of last year.
Patients were spared the painful condition and the effort also saved money. Emory said the average cost of treating a pressure ulcer is more than $43,000.
“When you’re being operated on and getting medical care, given the nature of that, there are some risks,” Bornstein said. “Overwhelmingly the benefits exceed the risks, but we need to seek to drive those risks down.”
Hospitals around the state contacted by The Atlanta Journal-Constitution said they have improved their performance on many of the problems described in the data. University Hospital in Augusta said it was surprised when it learned it ranked high nationally for one type of infection, and that it had since focused on the problem while also making sure that it was submitting accurate information to Medicare.
The Georgia Hospital Association said it has worked for more than a decade to help hospitals improve quality, with infections getting special attention recently. “There is still a lot of work to be done, but when you look at what’s currently being done and where we were 10 years ago on this, we have come light years,” said Kevin Bloye, a spokesman for the association.
Central line infections
Sometimes the solutions are relatively simple — like making sure doctors and nurses wash their hands before seeing a patient.
But even when science has shown that a straightforward checklist can dramatically cut infection rates, it’s not always easy to make sure that every doctor, nurse, technician and pharmacist covers all the bases for every patient during every hour of every shift. Even getting patients to follow the rules can be tough.
In some cases, though, hospitals are learning that they can do better on safety issues than they ever thought possible. Take bloodstream infections associated with central lines.
Central lines are catheters similar to IVs, but they are placed in larger veins and can be left in place longer than a regular IV. About 250,000 patients a year get a central line infection, and between 30,000 and 60,000 of them die as a result. For years, doctors believed these infections were an inevitable cost of doing business. But a study in Michigan, led by Johns Hopkins’ Dr. Peter Pronovost, proved that belief wrong.
Pronovost developed a five-step checklist for placing a central line catheter in patients in intensive care units: doctors must wash their hands; clean the patient’s skin with the appropriate cleanser; wear a mask, hat, gown and gloves and put a sterile drape over the patient; avoid placing a catheter in the groin; and remove it as soon as possible.
When Pronovost began his pilot study, Michigan’s infection rate was worse than the nation’s. After 18 months, most of the ICUs had virtually eliminated the infections — a result that continued three years later.
“These things don’t just save infections,” Pronovost said, “they save lives.”
Many of the infections that kill people in hospitals are bloodstream infections, he said. “This is a public health problem of the magnitude of breast cancer and the cure is completely within hospitals. We’ve shown it.”
While the system appears to be a simple checklist, Pronovost said it’s much more. The protocol includes tasks for hospital CEOs and ICU directors as well as the doctors and nurses on the floor. “It was a huge culture change,” he said.
When he travels to hospitals, he asks the nurses whether they would speak up if they saw a senior doctor failing to comply with a protocol. “Uniformly, they say, ‘Are you nuts, Peter?’ ” he said.
But once that culture shifts, he said he sees remarkable results — even when very vulnerable patients are involved.
“There is no doubt that sicker patients are at more risk, but what we have seen is even at academic medical centers, most ICUs can go over a year without infections,” Pronovost said.
Some of his most important work, he said, is convincing hospitals that eliminating the infections is possible. Hospitals around the country have enrolled in Pronovost’s program. WellStar Kennestone Hospital in Marietta is among them.
The hospital registered an infection rate above the national average in the new CMS (Centers for Medicare & Medicaid Services) data. But it started using the checklist during the period covered by the data, said Dr. Marcia Delk, WellStar Health System’s chief quality officer. The results? At Kennestone, the central line infection rate has been cut in half when compared to the rate in the Medicare data. Some units at both Kennestone and at WellStar Cobb Hospital have now gone a year without a central line infection.
And Delk is not yet satisfied. “Our goal is to get as close to zero as we can with those infections,” Delk said.
While many hospitals across the country are seeing their numbers shift as a result of Pronovost’s work, not all have adopted the system at the same time that other well-established protocols continue to be ignored by some players in health care.
“What other industry would tolerate the wanton violation of a standard that kills as many people as breast cancer?” Pronovost said.
Bad deal for patients
In late 2008, the Medicare program started hitting hospitals in the pocketbook when they made mistakes. The agency stopped paying hospitals for the extra care associated with a list of conditions the hospitals could have prevented.
Tommy Malone, one of Georgia’s top medical malpractice attorneys, applauded the change, saying that for years hospitals and doctors made money for fixing their own mistakes when insurers and government programs covered the extra costs of care. It was analogous, he said, to taking a car in for an oil change and then getting a bill for $10,000 in body work after the mechanic allowed the car to fall off the lift. “That’s exactly what we have had in health care,” he said.
The change sent a message to hospitals. But the feds now want to see more results. This spring, the U.S. Department of Health and Human Services kicked off a campaign to decrease preventable hospital-acquired conditions by 40 percent and to reduce hospital readmissions by 20 percent.
“If we do that, care gets better and costs fall,” Berwick said.
Meeting the goals would save up to $35 billion in health care costs — including up to $10 billion for Medicare, according to HHS estimates.
Publishing the data on hospital-acquired conditions is another part of the strategy.
While many hospitals are critical of the new federal data, they are also reluctant to share their internal performance statistics.
But Piedmont Healthcare is not. It posts its data on its hospital websites and includes comparisons to a group of similar hospitals.
Dr. Matthew Schreiber, Piedmont Hospital’s chief medical officer, said consumers deserve to know how the system is performing.
“If you’re going to be spending 16 percent of your gross domestic product on something, you should know what you’re getting,” Schreiber said.
Piedmont ties salaries to how well the hospital does at keeping patients safe — even for top executives who don’t order a single test or diagnose a single patient. “That’s everybody’s job,” Schreiber said.
The hospital’s efforts are paying off, he said. Mortality rates for patients with severe sepsis — a dangerous infection — declined by 30 percent over the last two years.
“When you look at our data, the thing that pleases me is you see this improvement quarter after quarter,” he said.
Pronovost said that requiring hospitals to report quality data does come with a risk. “You increase the incentives to game the system,” he said.
In an ideal world, health care providers would simply embrace what works. But Pronovost said researchers have found that some hospitals will not implement effective safety programs unless they face the pressure of public disclosures about their performance.
“To me, the public deserves this,” he said.
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