How Safe Is Your Hospital?

FEATURE SURGICAL INFECTION Patrick Roth of Dartmouth, Mass., can’t walk unassisted since he experienced several complications after surgery. the government doesn’t adequately track it as it does deaths from automobiles, plane crashes, and cancer. It’s appalling.” How safe is That lack of information not only makes it difficult to define the extent of the problem but also makes it challenging for patients to know about the safety of the your hospital? hospitals in their communities. To address that problem, Consumer Our new Ratings find too many pose risks Reports has for the first time rated hospitals for safety, using the most current data ospitals should be places says. “That’s like wiping out the entire pop- available to us at the time of our analysis. you go to get better, but too of- ulations of North Dakota, Rhode Island, It included information from government ten the opposite happens. and Vermont. It’s a man-made disaster.” and independent sources on 1,159 hospi- Infections, surgical mistakes, Some hospitals have responded to the tals in 44 states. For this report, we also Hand other medical harm contribute to the crisis with safety initiatives such as elec- interviewed patients, physicians, hospi- deaths of 180,000 hospital patients a year, tronic prescribing to help prevent drug er- tal administrators, and safety experts; re- according to projections based on a 2010 rors and checklists to prevent infections, viewed medical literature; and looked at report from the Department of Health and with some success. Rates of central-line hospital inspections and investigations. Human Services. Another 1.4 million are bloodstream infections, for example, have Still, our Ratings include only 18 percent seriously hurt by their hospital care. And dropped by 32 percent since 2008, accord- of U.S. hospitals because data on patient those figures apply only to Medicare pa- ing to the national Centers for Disease harm still isn’t reported funny or consis- tients. What happens to other people is Control and Prevention. tently nationwide. “Hospitals that volun- less clear because most hospital errors go But more needs to be done. “Hospitals teer safety information, regardless of their unreported and hospitals report on only a haven’t given safety the attention it de- score, deserve credit, since the first step in fraction of things that can go wrong. serves,” says Peter Pronovost, M.D., se- safety is accountability,” says John Santa, “There is an epidemic of health-care nior vice president for patient safety and M.D., director of the Consumer Reports harm,” says Rosemary Gibson, a patient- quality at Johns Hopkins Medicine in Bal- Health Ratings Center. “But the fact that safety advocate and author. More than timore. Nor has the government, he says. consumers can’t get a full picture of most 2.25 million Americans will probably die “Medical harm is probably one of the three hospitals in the U.S. underscores the need from medical harm in this decade, she leading causes of death in the U.S., but for more public reporting.” PROPHETT CARRIE PHOTO: 20 consumer reports august 2012 Despite that limitation, our safety ratings provide a unique way to compare hos- Things that should never happen in a hospital pitals in your community. And they yield important insights into the state of hospi- There’s never an excuse for operating Blood clots after surgery. Some on the wrong patient or body part. But surgeries, such as those to replace tal safety nationwide—and what you need our medical experts say that several less a hip or knee, can cause blood to do to protect yourself, or someone you 5 dramatic events should also never or at clots to form in the legs. Those clots care for, when entering a hospital. least very rarely occur in hospitals. Those can break loose and travel to the lungs, include the complications listed below, a deadly complication called a pulmonary What we found which are part of our Ratings. embolism. Moving about and walking We focus on six categories in our safety Bedsores. These painful wounds, soon after surgery can help prevent Ratings: infections, readmissions, com- usually on the ankles, back, buttocks, the clots, as can blood thinners and munication, CT scanning, complications, 1hips, or other bony areas, can special stockings. and mortality. Some experts question develop if a patient is left in one position Postoperative sepsis. This those measures. Readmission rates, for too long. Frequent repositioning and occurs when a serious infection special pads, cushions, and mattresses overwhelms the body, leading to example, might be higher among hospi- 6 can prevent them. If you see early signs, failure of the kidneys, liver, lungs, and tals that care for patients with little home including patches of skin that have other organs. Make sure that everyone or community support, says David M. reddened, let the nursing staff know. who touches you washes their hands Shahian, M.D., professor of surgery at Collapsed lungs. If doctors are and that the hospital follows infection- Harvard Medical School and associate not careful, they can puncture the prevention guidelines. Early signs include medical director at the Center for Quality 2 lungs when inserting a catheter either high or low body temperature plus and Safety at Massachusetts General Hos- or needle into the chest. Your doctor rapid breathing and pulse. Treatment includes measures to rein in the infection pital in Boston. But our Ratings are “based should use an ultrasound as guidance, and control blood pressure. on the best data we have about what hap- especially if you’re at high risk because of chronic lung disease. Opening of a wound after pens to patients in hospitals,” Santa says. surgery. A wound that opens in Here are some of the most important Central venous catheter-related bloodstream infections. A doctor the days following an operation is findings from our analysis: 7 or nurse should make sure that an infection waiting to happen. Ask how Bad things happen in all hospitals, but 3 • these tubes, used to deliver medicine and to care for your surgical wound, how they happen a lot in some. The lowest- nutrients, are kept clean and are removed long it should take to heal, and what scoring hospital, Sacred Heart Hospital in as soon as they’re no longer necessary. to do if it doesn’t. Chicago, earned just a 16 on our 100-point Postoperative hip fractures. Accidental punctures or cuts. safety scale and reported a rate of blood- To prevent a fall that can break Surgeons can accidentally stream infections that was more than 4 your hip, ask for help when you 8 puncture or cut an organ or blood vessel, which can extend your hospital twice the national benchmark. The hospi- get out of bed. And don’t take more stay. Finding an experienced, skilled tal declined to comment. pain medication than you need or walk if you are groggy. surgeon might reduce the risk. • Even high-scoring hospitals can do better. Billings Clinic in Montana was at the top of our list—but it got a safety score of just 72. “The work is hard,” says Mark Ru- mans, M.D., the hospital’s physician-in- Deadly infections develop an infection. They can be devastat- chief. “We are far from perfect.” Despite worsening back pain, Patrick Roth ing, deadly even, and many can be prevent- • Some well-known hospitals have less- of Dartmouth, Mass., loved to ride his bi- ed. Dirty instruments, improperly sterilized than-outstanding safety scores. That in- cycle. But that was before back surgery in catheters or needles, and the contaminated cludes Massachusetts General Hospital, 2007 at age 65. The procedure was followed hands of doctors, nurses, or other health- Boston, with a safety score of 45; Ronald by several complications, including an in- care workers are common causes. Reagan UCLA Medical Center, Los Ange- fection with a potentially deadly bacterium We rate hospitals on infections that de- les, 43; Cleveland Clinic, 39; New York- velop after surgery as well as those caused Presbyterian, New York, 32; and Mount by central-line catheters in intensive-care Sinai Medical Center, New York, 30. ‘Medical harm is units. The catheters are IVs that deliver • Our Ratings are an important measure, probably one of drugs and nutrients but can also introduce but they’re not the only one you might in- serious infections into the bloodstream. vestigate. They don’t, for example, assess the three leading Some states require that hospitals report how successful hospitals are at treating data for surgical-site infections, central- medical conditions. So before a planned causes of death.’ line infections, or both. And some hospitals hospital stay, consult multiple sources, volunteer central-line data to Leapfrog. such as Hospital Compare (hospitalcompare. that Roth says he didn’t learn about until An estimated 290,000 surgical-site in- hhs.gov), run by the federal government, he transferred to a new hospital. Now he fections occur each year in U.S. hospitals, and the Leapfrog Group (leapfroggroup.org), rides a mobility scooter instead of a bike and Roth’s is an example of the agony they an independent organization that tracks and is learning to live with the side effects can cause. A few days after his surgery hospital safety and quality. Some of the of daily antibiotics, he says. Roth was in so much pain he had to return data we use comes from those sources. About one in 20 hospitalized patients will to the hospital. He was there for 12 days, august 2012 ConsumerReports.org 21 FEATURE HOSPITALS most of which he can’t remember because of the pain medication he was given.

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