Several hospitals in South Florida came in at the bottom of patient safety rankings, and a few others came out at the top, in a study performed by Consumer Reports that compared more than 2,500 hospitals nationwide.
Palmetto General Hospital in Hialeah and North Shore Medical Center scored lowest of 44 Miami-Dade hospitals, while Homestead Hospital and Palm Beach Gardens Medical Center scored highest on the publication’s composite rating of five key patient safety factors. The results of the study were released Wednesday.
At the high end of the scale, Homestead Hospital and Palm Beach Gardens Medical Center scored above 60 on a 100-point scale of overall patient-safety performance. Nationwide, Consumer Reports ranked 2,590 U.S. hospitals, whose scores ranged from a low of 11 to a high of 78. The factors rated include patient mortality, readmissions, overuse of CT scans, hospital-acquired infections, and communicating with patients about medications and discharge instructions. Even with this limited set of performance criteria — put together with information from public federal databases — the differences among hospitals were striking, and the Consumer Reports said hospitals need to disclose more information.
“We’re asking for more transparency,” said Dr. Doris Peter, the associate director of Consumer Reports Health, which performed the rankings. “We’re putting out a call to make more data publicly available, not only for consumers but also so doctors and hospitals can perform better.”
Among the Miami-Dade hospitals surveyed, North Shore reported 23 bloodstream infections in its intensive care patients over the past year, which is 86 percent worse than the comparable national rate. On the positive side, the hospital’s patients had zero surgical site infections for the same period.
Palmetto received CR's second-lowest rating in avoiding medical mortality, surgical-site infections and readmissions. In addition , CR found 207 percent more complications from knee replacements and 101 percent more from carotid artery surgeries than it considers normal for Palmetto’s patient mix. But Palmetto scored high on doctor-patient communication. Ninety-six percent of patients said the doctors always or usually communicated well.
Homestead Hospital and Palm Beach Gardens Medical Center attained CR's highest ratings for their appropriate use of CT scans. Both also got high marks for reporting zero infections during the measurement period: no bloodstream infections for Homestead patients, and no surgical site infections at Palm Beach Gardens.
“We are most concerned when a hospital has a high rate of surgical site or blood infections because these are preventable. The number of infections should be zero,” Peter said.
Large, urban hospitals struggled the most in CR’s rankings, even when their scores were adjusted for a sicker population. For example, Jackson Health System scored poorly on surgical mortality — a rating that reflects how many surgery patients died in the hospital after developing a serious but treatable complication — while its Medicare patients have an 18 percent chance of being readmitted within 30 days.
“Lots of organizations are in the business of trying to help consumers make sense of publicly reported data. In this case, Consumer Reports has not shared with us what data they're reviewing or how they're analyzing it,” said Jackson spokeswoman Jennifer Piedra. While it would be premature to comment on the ranking, Piedra said, “It is important to note that patient safety and quality are top priorities at Jackson, which is among the reasons why it is considered one of the nation's best health systems.”
On the plus side, Jackson received CR’s second-highest score for avoiding surgical site infections and the highest score for making sure CT scans aren’t over-used, two of the easiest patient safety issues for hospitals to identify and control.
The report’s preparers admit that the five patient safety criteria aren’t the only ones consumers should be aware of, but they are the ones for which reliable data could be obtained. Most of the publicly available information about hospital performance is based on billing records collected by CMS, rather than on patient and medical records, which are held in private registries. The mortality, readmission, and CT scanning applies to patients 65 or older. The hospital-acquired infection information comes from the Centers for Disease Control and Prevention and applies to all ages.
But even the limited data sets available to CR offer sobering insights. Preventable medical harm in hospitals contributes to the death of 440,000 U.S. patients each year, according to Patient Safety America, a non-profit that educates the public about risks from hospital stays. The Consumer Reports study found that for every 1,000 surgical patients who develop serious complications in a top-rated hospital, 87 or fewer die; but in a low-rated hospital, more than 132 die. And pneumonia patients are at least 40 percent less likely to die within 30 days in top-rated hospitals than their counterparts in low-rated ones.
While hospitals debate the cause of those deaths, Peter said the survey should heighten consumers’ awareness of the need to make more data publicly available.
CR analysts acknowledge that many consumers are limited to one or two hospitals within their insurance company’s provider network. In that case, they advise consumers to use the ratings to be aware of a hospital’s weaknesses — for example, poor communication about medications — and take extra steps to make sure they receive the attention they need.