By Rose Hoban NC Health News
North Carolina hospitals continue to improve on safety according to new rankings from the Leapfrog Group, a national organization that grades more than 2,600 hospitals in the 50 states and Washington, D.C., based on how they prevent medical errors, injuries, accidents and infections. [Outer Banks Hospital is not included in this survey. Not all hospitals get a grade. Small, “critical access hospitals” in rural communities are excluded, as are pediatric and other specialty hospitals.]
Although most hospitals in the state had either an A or B rating, North Carolina’s overall national ranking fell, an indicator that nationally, more hospitals are responding to the need to improve patient safety.
“Most people don’t realize that hospital errors are the third leading cause of death in this country, behind just cancer and heart disease,” said Erica Mobley, a spokeswoman for the Leapfrog Group. “Studies show that medical errors are total up to 400,000 people every year.
Unfortunately, that is something that is very prevalent and we want people to be aware of some of the hazards that are happening at their local hospitals.”
The measures rely on data such as the number of people who develop infections in the hospital, how many are readmitted within 30 days of discharge, and whether staff reliably wash their hands along with hospital safety protocols.
Of the 78 hospitals rated in North Carolina, 33 received an “A” and 25 received a “B”. There was only one “D”-rated hospital: Sentara Albemarle in Elizabeth City, which was cited for having an unacceptable rate of bedsores, patient falls and handwashing. You can search other Sentara hospital at the website.
No hospital in North Carolina received an “F” grade.
North Carolina has continued to drop in it’s overall ranking in the U.S. In 2015, the state ranked 8th in the nation for top-performing hospitals, in 2016, that ranking had dropped to 10th in the nation. This year, the ranking dropped again, down to 12th in the country.
Not all hospitals get a grade. Small, “critical access hospitals” in rural communities are excluded, as are pediatric and other specialty hospitals. In all, 78 North Carolina hospitals were rated, two fewer than last year.
Sunlight as disinfectant
Leapfrog uses a methodology devised by a panel of academic experts to comb through publicly reported data every six months and distill it into a single letter grade.
The analysts at the organization calculate that if all of the hospitals were able to achieve an A score, some 33,459 lives could be saved each year across the country.
Data for the scores come from both publicly available data and from the hospitals themselves.
“We look at 27 different measures of patient safety,” Mobley said. “Most of the data that we use comes from Medicare – hospitals have to report to the federal government in order to get paid by Medicare and then the government makes that available to research groups like ours for analysis and public reporting.”
Leapfrog also surveys the hospitals themselves to ask what practices they’re implementing to improve safety, but not every hospital responds to that survey. So, the group also looks at data from an annual survey conducted by the American Hospital Association to round out their analysis.
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“Using all these different data sources, we look at processes and procedures that hospitals have in place to prevent errors, as well as the rate at which errors actually occur in that hospital,” Mobley said.
Leapfrog says consumers can use the rankings to find how well a hospital does in preventing infections and encouraging handwashing; in entering prescriptions through a computer (which reduces transcription errors); and in the availability of qualified nurses.
Mobley explained that the number of hospitals rated may fluctuate from year to year, particularly those that might have lower patient volume and so might not meet the reporting requirement for one of the measures. So some hospitals fluctuate in and out from reporting cycle to cycle.
This year, because of “a data discrepancy issue,” Mission Hospital in Asheville did not receive a rating this fall, Mobley said, but the hospital received an “A” rating last fall.
Several of the hospitals receiving “D” ratings last year, such as Haywood Regional Medical Center in Clyde and Rutherford Hospital have improved to a “B” rating this year.
“What we’ve learned is that transparency has a real impact on patient safety,’’ Leapfrog Group president Leah Binder said in a statement. “By making the Hospital Safety Grades public, we’ve galvanized major changes in these states and many communities.”
Hospitals feel more lukewarm about being rated by organizations such as Leapfrog, which was started by a group of employers and health care experts after a landmark report, “To Err is Human,” published by the National Academies of Sciences in 1999. The report found that tens, if not hundreds, of thousands of hospital patients died annually as the result of preventable medical errors.
“Unfortunately, many quality ranking reports raise more questions than answers and add to an already long list of rating systems that attempt to simplify the complexity of delivering high-quality care,” said North Carolina Hospital Association vice president Julie Henry in an email.
“In addition, many of these ratings systems do not account for the social determinants of health that impact health status in the diverse communities across our state. NCHA urges healthcare consumers to talk with their care providers about their own unique health picture and about what this data may mean for them and their care.”
Mobley said the intent is not to punish hospitals, but to encourage them to do better.
“I don’t think anyone goes into medicine thinking I really want to hurt people,” she said. “People who work in the medical procession are well intentioned and really do want to provide the best care to their patients, but the systems aren’t really well set up prevent things from happening.”
She also acknowledged that sometimes patients have no choice about where they receive care, either they have an emergency and end up in the closest facility or they are unable to travel for care. So, there are some simple things patients can do to protect themselves.
“One thing we suggest that people do is to have a family member or friend with them at all times. When you’re in the hospital, you’re not operating at 100 percent so it’s good to have someone there to look out, pay close attention, listen and speak up if they see something wrong,” she said.
The best thing Mobley said patients can do is to encourage their caregivers to wash their hands before touching them. Research has shown handwashing is one of the most effective ways of reducing infections in health care facilities.
“It seems like something that is so simple, but doctors and nurses are very busy and are responsible for seeing a lot of patients,” she said. “So it’s OK to say to a doctor or a nurse, ‘Hey, I might have missed this, have you washed their hands?’ and asking them to do that again.
“Any doctor or nurse who really respects their patients should be more than willing to do that quickly to assure their patients that they are giving them their best care.”
She also said that for most situations, using antibacterial hand gel is a good substitute.