St. Mary's dinged in safety report
Essentia St. Mary's Hospital in Detroit Lakes got hammered pretty hard in a recent Consumer Reports magazine special report on safety in Minnesota hospitals.
But the hospital says a simple clerical error was at least partly to blame for its poor ratings, since it made the hospital's infection rate appear wildly higher than it actually is.
St. Mary's was given a safety rating of 37 --second to last out of 36 Minnesota hospitals rated in the August issue.
The ratings were based on four factors: Infection rate, rate of readmission to the hospital, communication (or how well doctors prepared patients for discharge), and proper use of powerful scanning devices like CT scans.
The low rating took Essentia St. Mary's hospital administrators by surprise, and they started digging into the monthly data they send to the state. The Consumer Reports study was based on that data.
"We were taken aback," said Essentia St. Mary's Hospital President Peter Jacobson. "Usually we take a great deal of pride and passion in the high quality of care for our patients -- it was a bit startling."
To gauge how well Minnesota hospitals were preventing infections, Consumer Reports looked at two common surgeries -- knee replacements and vaginal hysterectomies.
It took the number of those two procedures and the number of infections that resulted and used that to rate hospitals on infections.
Essentia St. Mary's received a full black circle in that category -- the lowest score on the magazine's five-point scale.
Hospital staff went over the data. They looked at knee operations: There were 171 knee surgeries done in 2010 and 2011, and one resulted in an infection, in January of 2011.
The smoking gun
Then they looked at hysterectomies and they found the problem. There were 89 hysterectomies done at Essentia St. Mary's in 2010 and 2011, and only one infection --in August of 2010.
But the data used in the Consumer Reports study showed eight infections from hysterectomies.
The hospital employee who sent the data to the state for December of 2010 had reported seven hysterectomies and seven infections.
There had actually been seven hysterectomies and zero infections that month. That was enough to inflate the number of infections eightfold.
"We discovered a significant error that actually occurred in the data we sent in ourselves," Jacobson said.
Consumer Reports will amend its report online once the state receives the corrected data, Jacobson said.
"It will make a substantial difference (in the hospitals' overall safety rating)" he predicted. "The infection rates in our facility are substantially lower than the national average."
The Consumer Reports survey did not look at central line infections in Minnesota hospitals, because the state does not require hospitals to provide that data, said Kim Kaiser, media relations specialist for Essentia Health.
But Jacobson said Essentia St. Mary's also does a good job of preventing that type of infection. There have not been any so far this year.
And from now on, Jacobson said, "two pairs of eyes" will check data sent to the state.
A low infection rate is important because infections, either from surgery or central-line catheters -- can cause serious complications and even death.
Jacobson said Essentia St. Mary's takes patient safety very seriously and has implemented all CDC and state health department guidelines on infection prevention.
"That's obviously not something that we want people in the community believing -- that we have a high rate of infections," he said. "We do everything we can to prevent infections from occurring and our results are much better than the national average."
The hospital has an infection prevention specialist and an infection prevention committee.
Overuse of CT scans?
While a data-entry error may be responsible for Essentia St. Mary's poor infection rating, a middle-rating on high-radiation scans is also cause for concern -- if only because the vast majority of Minnesota hospitals rated by Consumer Reports received positive ratings in that category.
CT scans can help doctors pinpoint the problem, but they also hit a patient with a very high dose of radiation -- equivalent to between 100 and 500 chest X-rays.
Consumer Reports cites a 2009 study that says over-use of CT scans might contribute to an estimated 29,000 future cancers a year.
Hospitals were rated on the number of chest and abdominal CT scans ordered twice for the same patient -- once with contrast and once without.
St. Mary's received a clear circle -- or three out of five points -- in that category. Most Minnesota hospitals received a full red circle or half red circle -- the best and second best ratings in that category.
Only two Minnesota hospitals in the survey fared worse in the scans category -- and they both received black circles, the worst possible score.
"We have great confidence in the medical judgment of all physicians -- inside and outside of Essentia Health -- who order scans for patients at St. Mary's," Jacobson said.
"The Consumer Reports survey looked at combination CT scans (one with contrast dye, one without) of the abdomen and of the chest," he added.
"In both cases, lower scan rates are better than high ones. For abdominal scans, we were below national rates but above state averages. We were above both state and national averages for chest CT scans.
"Now that we know our rates for some scans are higher than state averages," Jacobson said, "I have asked our resident radiologist and our hospital chief of staff to look closely at this data to determine if we should modify any of our protocols."
Essentia St. Mary's received a clear circle -or three out of five points -- in the readmissions category. That was as good or better than everyone else in the nine-state region surveyed by Consumer Reports. No hospital was in the red.
According to Consumer Reports, readmissions, or having to return to the hospital soon after going home, can be a sign that something went wrong during the initial stay, such as an infection.
The more often a patient returns to a hospital, the more likely something will go wrong. Research suggests up to three-quarters of readmissions may be preventable.
St. Mary's received a half-black circle -- or four of five points -- in the communication category. That, too, was about the same as everybody else in the nine-state region. None were in the red in this category either.
Doctor-patient communication about new medications and discharge plans is important, Consumer Reports says, because drug problems in hospitals are common and sometime serious. And poor discharge planning can lead to readmissions.
Jacobson said Essentia St. Mary's is very concerned about patient safety.
"We participate in at least five safety improvement projects sponsored by the Minnesota Hospital Association. They've been very proactive and we participate in every one of them," he said.
The hospital also has discharge advocates for high-risk patients with chronic illnesses like diabetes to make sure they understand their medications, have follow-up appointments scheduled, have transportation to get to those appointments, and are actually taking the medications as prescribed.
Those nurses talk to the patients during in-person visits and follow-up with phone calls, Jacobson said.
The hospital has improved its patient communications through an electronic medical records system, he added, that prints an after-visit summary listing all medications, future tests and upcoming appointments.
In the end, openness is the best way to ensure quality health care, Jacobson said.
"To really improve quality and safety you have to engage the public and staff in quality and safety -- and the best way to do that is clarity in the system -- good and bad," he said.
"We need to make sure we all understand the data behind safety -- not hold it in a black box in the quality department, but share it with all our employees and community members."