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Safety study puts HRH in midrange / January 14, 2013
A national non-profit group that tracks hospital safety has assigned a ‘C’ grade to Halifax Regional Hospital, putting the local hospital in the middle of the pack among providers in the region.

The grades were issued by The Leapfrog Group, a national nonprofit organization whose mission is to promote improvements in safety, quality, and affordability of health care.

Person Memorial Hospital in Roxboro, N.C. received a B grade, while Granville Medical Center in Oxford, N.C., Maria Parham Hospital in Henderson, N.C. and Centra Southside Community Hospital in Farmville each received C’s. Also earning C’s were Centra Lynchburg General Hospital and Virginia Baptist Hospital in Lynchburg. Community Memorial Healthcenter in South Hill earned an A.

The grades, which draw on data that health care providers report to the federal government and other sources, reflect hospitals’ success in preventing medical errors, injuries, accidents and infections among patient populations. It also measures hospital performance, according to Leah Binder, president and CEO of The Leapfrog Group, “in the very basic blocks of medical care, such as hand-washing, computerized medication control, and nurse staffing levels.”

43 percent of Virginia hospitals received an A grade, placing Virginia eighth in the U.S. with the highest number of top-rated hospitals. Nationally, 30 percent of more than 2,600 hospitals that were evaluated received an A rating. 38 percent —1,004 hospitals in all — got a C rating.

The Leapfrog Group said the ratings are a way to provide the public with information they can use to protect themselves and their families — although some hospital officials have questioned the merits of the study, saying it penalizes institutions that do not participate in Leapfrog’s voluntary reporting system, which is separate from the data that hospitals report to federal agencies such as the Centers for Disease Control and Center for Medicare and Medicaid Services.

Hospital officials also have criticized Leapfrog for using a methodology that fails to reflect the overall quality of care provided by institutions.

In developing the report, Leapfrog cites a 2010 federal study that found that infections, surgical errors and other medical harm contribute to the deaths of 180,000 Medicare patients annually, and harm to an additional 1.4 million Medicare patients.

One of the panelists who compiled the hospital safety scores, Dr. Peter Provonost of Johns Hopkins Medicine in Baltimore, has called medical errors “probably one of the three leading causes of death in the U.S., but the government doesn’t adequately track it as it does deaths from automobiles, plane crashes, and cancer. It’s appalling.”

The Hospital Safety Score looks at 26 measures. Halifax Regional Hospital ranked among the best performing hospitals in three areas, with no or very few patients experiencing the following problems:

Foreign object retained in patient after surgery

Air embolism (air or gas bubbles blocking the bloodstream)

Stage 3 and 4 Pressure Ulcers (bed sores)

The local hospital was better than average in the following categories: minimizing collapsed lungs due to medical treatment; minimizing post-operative pulmonary embolism and deep vein thrombosis; patients receiving the right antibiotics.

Halifax Regional scored near average on a number of other measures, including patients receiving antibiotics within one hour prior to surgical incisions; antibiotics being properly discontinued after routine use; timely removal of urinary catheters; and avoiding accidental cuts or tears from medical treatment.

The South Boston hospital was flagged for the relative lack of electronic prescribing equipment that catches errors in drug orders; ICU physician staffing and few intensivists on staff who are familiar with the complications that can occur in the ICU; and a relatively high rate of falls and trauma.

On the falls and trauma measure, Halifax Regional received a score of 1.472, compared to a national average of 0.54.

Sherri Bee, clinical director of Cardiovascular Services & Quality at Halifax Regional, said the hospital does not participate with Leapfrog, because its measures are geared more toward large teaching hospitals. However, HRH does regularly monitor for quality: “Leapfrog also picked only a few core standards by which hospitals are measured. These do not give a full picture of a hospital’s performance overall,” she said.

For example, Halifax Regional recently started using a computerized system for entering prescription information into patients’ medical records, she said, and this fact is not reflected in the score because the system was put in place after the scoring was completed.

“We are always looking at how we can improve and provide the best care for our patients,” said Bee.

She added that Halifax Regional, like most hospitals, reports not just safety standards, but “ten domains of care” to the Center for Medicare and Medicaid Services [CMS]. The domains measure overall patient satisfaction by looking at safety issues, cleanliness, communication and responsiveness.

CMS is the organization from which Leapfrog drew much of its data, and Bee said Halifax “is above the database mean in all CMS areas except one.”

The lone CMS-reporting area where Halifax is deficient, she said, occurs when patients are asked if they would recommend Halifax for a particular treatment that is not offered at the hospital. “The patient says no, because it is not offered. CMS still records that as a negative response,” Bee explained.

Specific areas where Halifax measures above average in the CMS data include: cleanliness, pain management for patients, communication about medicines, overall communications from doctors and nurses to the patients, and with providing discharge information, she said.

The Leapfrog hospital safety score was compiled by a panel of nine top experts in patient and hospital safety, including Harvard University’s Drs. Ashish Jha, Sara Singer, and Lucian Leape, University of Michigan’s Dr. John Birkmeyer, Stanford University’s Dr. Arnold Milstein, John Hopkins University’s Peter Pronovost, University of California/Davis’ Patrick Romano, Vanderbilt University’s Tim Vogus, and University of California/San Francisco’s Robert Wachter.

The hospital safety reports, searchable by zip code, are available at Leapfrog’s report website:

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