The third leading cause of death in the U.S. — just behind heart disease and cancer — is death by hospital error, according to researchers at Johns Hopkins' Armstrong Institute for Patient Safety and Quality.
If you’re older than 65, there’s more than a 14 percent chance your hospital visit will make you sicker.
And according to other patient safety research estimates, as many as 440,000 people die annually from preventable medical errors in U.S. hospitals.
That’s more than 1,000 preventable deaths a day.
But because of a lack of transparency and few reporting mandates, such errors are not always reported or tracked, leaving the public often unaware.
“It tends to happen to a patient here, a patient there," said Matt Austin, assistant professor at Johns Hopkins' Armstrong Institute, on Thursday.
Because the errors and the deaths are spread out, they tend to pass unnoticed.
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“People go to hospitals to get better,” Austin said. “Unfortunately, bad things happen … people need to be aware of a hospital’s safety record.”
In 2011 an expert panel of patient safety experts from around the country — Johns Hopkins, Harvard, Stanford, UC Davis, UCLA, Vanderbilt, the Centers for Disease Control and University of Pennsylvania — along with a national nonprofit health-care ratings organization, Leapfrog Hospital Safety Grades, began working toward a way to measure hospital safety.
Thirty safety outcome measures were identified, including infections, patient falls and deaths from treatable conditions following surgery. Over time, the measures have changed, said Austin, with 27 today.
“We started thinking about how to issue a safety rating on hospitals,” Austin said. “We define safety as ‘freedom from harm.’ ”
Following the work of the panel, the Leapfrog Group began assigning letter grades five years ago to more than 2,600 U.S. hospitals based on their performance in preventing medical errors, infections and other harms.
Grades range from A to F, and 59 hospitals have always received an “A.”
Only a handful of New York state hospitals earned an “A” grade, with the state ranking 47th out of 49. Brooklyn alone has two failing-grade hospitals.
“It’s really important for people to consider what hospital they go to,” said Erica Mobley, director of operations for Leapfrog, in a phone interview on Thursday afternoon.
“It’s possible to have world-class surgeons, but if the staff is not equipped with the right knowledge ... it doesn’t matter how great the surgery was,” Mobley said. “It’s really terrifying how many things can go wrong and do go wrong ... it really requires a strong commitment from administration and safety needs to be top of mind every day.”
Locally, Saratoga Hospital ranks among the state’s seven highest-graded hospitals and is the only one in the Capital Region to receive an “A” on their fall report card. The hospital has received an “A” for the past four grading periods.
“We are very pleased. It is a composite score of many, many activities and things that our employees, front-line caregivers, doctors do. Every single day (they) come to work with these outcomes in mind,” said Mary Jo LaPosta, senior vice president of patient care and organizational excellence, in an interview on Thursday morning. “All of these things represent a cultural commitment to safety.”
Glens Falls Hospital earned a “B” grade this fall, up from a spring “C” and two other “C” grades; Ellis Medicine in Schenectady earned a “D”; and Albany Medical Center earned a “C.” Both Ellis and Albany Medical had “B” grades in 2015.
A Glens Falls Hospital spokeswoman released a statement Thursday to The Post-Star, regarding the health grades.
“We believe that these health grades don't always show an accurate representation of an organization, as they are based on measures that don’t always portray a precise reflection of patient safety or quality, due to the way in which the data is reported,” the statement reads.
Getting to the grades
Nearly two decades ago, the Institute of Medicine shocked the medical community when it released data showing that nearly 100,000 people a year were dying from hospital errors.
Since that 1999 study, researchers have found the problems were underestimated.
In 2010, the Office of Inspector General for Health and Human Services said bad hospital care contributed to the deaths of 180,000 patients a year in Medicare alone.
By 2013, Dr. John James, a retired NASA toxicologist, spurred by his own 19-year-old son’s death from hospital error, published in the Journal of Patient Safety that about 440,000 patient deaths a year were due to preventable errors.
“The numbers are staggering,” Mobley said.
The measures created by the expert panel fall into two domains that look at how hospitals promote safety and their processes and structures.
The panel had to decide what data to use, how to apply it fairly and what to do if there was missing data for a hospital. The team decided to use national data for consistency.
“Take MRSA and C-diff infections — the numbers come from the NHSN. It is a high-risk adjustment model,” Austin said.
The NHSN is the Centers for Disease Control’s National Healthcare Safety Network, an extensive infection tracking system.
The network estimates, based on a hospital’s size and patient base, how many MRSA infections a hospital should expect. Scores are based on whether the hospital did better or worse than expected.
MRSA, or methicillin-resistant Staphylococcus aureus, is a hospital-acquired bacterial staph infection that is resistant to many antibiotics. MRSA can be found in bed linens or on medical equipment and can be spread if providers do not properly wash their hands between patients.
MRSA can cause life-threatening bloodstream infections, pneumonia and surgical site infections.
Both Glens Falls Hospital and Saratoga Hospital scored in the “red zone,” because they had more than their expected number of MRSA infections.
Conversely, at Ellis Medicine and Albany Medical Center, MRSA scores were in the green because they had fewer MRSA infections than expected.
Understanding the grades
While some measures are based on expected outcomes like infections, others are based on actual numbers out of 1,000 patients. Take, for example, death from treatable serious complications — pneumonia, heart attack, loss of kidney or liver function — after surgery. If the hospital does not properly manage these conditions, patients can die.
Glens Falls Hospital scored in the red, with 166.8. This number represents the number of surgical patients who died for every 1,000 people who had a serious treatable complication after surgery at the hospital over a two-year period.
Saratoga Hospital scored in the green, with 128; Ellis Medicine in the red with 143; and Albany Medical Center in the red with 153.
A big area for improvement at New York hospitals, especially in more urban areas, is communication, which experts say is key to better outcomes. This report card measure is based upon patients’ perspectives on care and how well patients feel their nurses and doctors explained things, listened to them and treated them with courtesy and respect.
Experts say effective communication between caregivers and patients can be reassuring to patients and can prevent errors like medication mix-ups or misdiagnoses.
Saratoga Hospital and Glens Falls Hospital both scored in the low 90s, earning them a spot in the green for communication; while Ellis Medicine was placed in the red with a score of 89; and Albany Med in the red with scores of 89 and 90.
“When dealing with patients, communication is planned, purposeful and standardized,” Saratoga Hospital's LaPosta said, adding that different resources are important, like the voice-activated communication devices caregivers wear on lanyards around their necks. That way, nurses can talk directly to a doctor about patients.
“The safest way is direct communication, it equals good outcomes,” LaPosta said.
All patient rooms at Saratoga Hospital have white boards for families, patients and staff to write notes to each other.
“Staff might write, ‘Susan likes to walk in the morning’; that way everyone knows,” LaPosta said.
Intensive care unit physician staffing, another report card measure, is one on which area hospitals scored poorly. Glens Falls Hospital, Saratoga Hospital and Ellis Medicine ranked in the “Worst Hospital Category” for this measure, each with scores of 5. Albany Med did much better with a yellow caution and a score of 45.
The best hospitals in the country had scores of 100, meaning they adequately staffed their ICUs with board-certified intensivists, who are doctors trained in working with extremely ill patients.
“The data is pretty staggering. Mortality (death) rates for patients co-managed by intensivists are 40 percent lower in the ICU,” Austin said. “We are pushing hospitals toward more board-certified intensivists in the ICU. And it provides the opportunity for the hospitals to use tele-intensivists (available through videoconferencing), who have proven equally effective.”
Nonetheless, LaPosta said Saratoga Hospital does staff its ICU appropriately.
“Twenty-four hours a day, a physician is present. We have a wonderful team of intensivists that come from critical care medicine working with our team,” she said.
After report cards are released
The report cards are just part of the picture. The real work happens every day in the hospitals. And experts caution that the grades are not necessarily pointing at doctors or specific hospitals, but rather offering a way to focus on and improve patient safety.
“I believe the report cards are important and the grades can serve as a mechanism to have a conversation with a hospital or your doctor about their safety record,” Austin said.
Mobley said she has seen a shift in hospitals toward paying more attention to safety measures.
“Improvement is possible, very achievable,” she said, pointing to Rhode Island.
In the first year the report cards came out, there were no “A” hospitals in the state. With this last round of grades, the state ranks No. 1 in patient safety.
Saratoga's LaPosta contends that, long before the Leapfrog measures existed, the hospital was engaged in looking at safety practices. For example, she said, the hospital has been tracking patient falls and putting fall prevention measures in place or more than a decade.
“We invested resources to keep patients from falling,” she said. “We are not driven by external report cards, but internally for the best care. We pay attention to outcome measures and how to get the best outcome and monitor how well we are achieving those outcomes.”
As measured on the report cards, patient fall data comes from an actual number of patient falls per 1,000 patients. Most recently, Albany Med was in the red with 0.42 falls per 1,000 patients; Ellis Medicine in the red with 0.79; Glens Falls in the green with 0.19; and Saratoga in the green with 0.27.
At Saratoga Hospital, caregivers assess a patient’s fall risk by using evidence-based practices and put protections in place designed by a fall prevention team.
“We know that the more the elderly stay in bed, they become deconditioned and disoriented, so we keep them walking every day,” LaPosta said. “We keep them up and keep them walking.”
Kathleen Phalen-Tomaselli is a features writer at The Post-Star. She can be reached at firstname.lastname@example.org for comments or story ideas.