Hospitals back off a consumer survey in favor of other quality control efforts

BHCAG's online survey asks hospitals to list their safety practices in four areas.

It tracks whether hospitals have a computerized system that's designed to catch prescription medication errors. It looks at intensive care unit staffing and whether the hospital employs ICU specialists called "intensivists." The survey also measures how well hospitals perform high-risk procedures such as coronary artery bypass graft surgery. And it assesses whether hospitals have adopted a series of 27 nationally accepted safe practices to avoid problems like wrong-site surgeries.

The Minnesota survey is part of a national effort to catch and correct medical errors. Three Minnesota hospitals scored high enough to earn a spot among the 59 "Top Hospitals" in the nation. Mayo St. Mary's in Rochester and Children's Hospitals and Clinics in Minneapolis and St. Paul made that list.

BHCAG President Carolyn Pare says overall the survey found that many Minnesota hospitals aren't adhering to the bulk of the safety recommendations. She believes a lot more work remains to be done, which is why it's so frustrating to see hospitals dropping out of the survey.

"We're very disappointed. We aren't getting the kind of response that we would like from all of the hospitals across the state to demonstrate, re-up basically on their commitment relative to both patient safety, and first and foremost transparency," she says.

Pare suspects competing priorities are the reason that hospitals are dropping out of the survey. She says in recent years there have been more than a half dozen initiatives launched in the state to measure hospital quality and safety. But she says not all of the efforts are weighted as heavily toward safety issues as the BHCAG survey.

"From a Buyer's Health Care Action perspective it has been our resolve that you choose your priority based on the consumer. So, you look at the issue through the consumer lens. And one thing that clearly resonates with every consumer is safety," she says.

The President of the Minnesota Hospital Association, Bruce Rueben, says safety is a priority for hospitals. He points to a 2003 law that requires Minnesota hospitals to report medical errors to the state when they result in serious injury or death. The Minnesota Department of Health collects that information and publishes an annual report listing errors and the hospitals where they occurred.

Rueben says hospitals have realized that they can save a lot of lives by figuring out better ways to treat patients.

"The fact that some hospitals are no longer filling out the survey speaks to the fact that they have done it in the past, but have moved on to other efforts," he says.

Rueben says Minnesota hospitals recently wrapped up an initiative on ventilator-associated pneumonia. He says over a 15 month period of time, hospitals saw 175 fewer cases. He says that likely resulted in about 50 fewer deaths and about $7 million in health care savings.

"These are things that hospital care givers can really wrap their arms around and feel like they're truly accomplishing something," he says.

Dr. John Birkmeyer with the University of Michigan Medical School tends to agree. Birkmeyer conducted some of the original research supporting the BHCAG survey, which found that if every hospital in the nation adopted all of the survey's performance measures, hundreds of thousands of errors could be avoided and tens of thousands of lives could be saved. He also says it's important to recognize that one size doesn't necessarily fit all when it comes to hospitals.

"I think that the quality improvement efforts that are likely to be most successful are those that are born from the hospitals themselves and they fell most ownership in," he says.

BHCAG's Carolyn Pare claims it's equally important for the public and outside entities to monitor hospitals to make sure they're being open about their safety record. She worries that hospitals are too secretive and that consumers still don't have enough tools to find the information they need.

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