All right, Consumer Reports has a few notes about San Francisco hospitals in another Missive from Yonkers this AM. Actually, the people at CR sound a little hacked off, and for a couple of reasons.
Item One: They’re using a hospital’s ICU Central Line Associated Bloodstream Infection Rate as a yardstick of performance. Why? Why not. Here’s how CR feels:
“The procedures needed to eliminate ICU infections are simple, low-tech, and inexpensive, requiring a change of mindset and culture. All ICUs should be able to dramatically reduce if not eliminate these infections.”
O.K., so who has a central line infection rate of zero, who’s perfect?
Saint Luke’s Hospital
Saint Francis Memorial Hospital
Saint Mary’s Medical Center
After all those Saints go marching in, which San Francisco hospitals are doing less-than-perfect but better than average?
California Pacific Medical Center-Pacific Campus
Kaiser Foundation Hospital- San Francisco
But who’s left, who in the 415 is “on the other end of the spectrum” with a reported infection rate that’s 80 percent worse than the national average when compared with similar ICUs?
UCSF Medical Center
Take a look for yourself on this almost-legible chart. Goran nasai, Gentle Reader – click to expand:
But what’s this – how about a little feedback from a California-licensed physician? Comes now Dr. Steven Suydam, who took a look at CR’s press release today and reacted thusly:
“Central line infections occur in every hospital, but some institutions, especially public academic institutions are simply more forthright about reporting them, and are more likely to have candid effective quality assurance programs in place, than private, for-profit institutions. In addition, hospitals have the latitude to classify a bloodstream infection as coming from an alternate source, if one is available, thereby avoiding the dreaded “CLABI” label. The alternative explanation, that UCSF physicians place central lines under less sterile conditions than private hospitals and maintain such lines with less care is simply nonsense.”
O.K. then. But as always, You Make The Call. It certainly would be interesting to hear about what UCSF thinks of all this. Moving on…
Widening our purview to the whole bay area gets us this:
“In the larger Bay Area, where Consumer Reports Health rated 29 hospitals, Consumer Reports found extreme variation between hospitals, even hospitals run by the same health care system. For example, Kaiser Foundation Hospitals in Hayward, Santa Rosa, Vallejo, and South San Francisco reported zero central line infections, while Kaiser Foundation Hospital in San Jose had an infection rate that was 14 percent worse than the national average and the Kaiser Foundation Hospital in San Francisco reported a rate that’s 40 percent better than average.”
Item Two: CR doesn’t like getting blown off when it goes nosing around for data. So it has lots of criticism for the way California as a state is handling reporting of statistics. The California Department of Health should have data for us by January 1, 2011, but CR isn’t optimistic about this deadline getting met.
Anyway, who’s on the Naughty List (CR’s Health Ratings Center’s Director is Dr. Santa, srlsy) with naught to report?
San Francisco General Hospital Medical Center
What’s it all mean? No se, mi amigo/a. One thing for certain though, this news release means that Consumer Reports Health wants your money. Sign up for a free 30-day trial that you’ll soon forget about until you get your credit card statement in two or three months – I don’t care what you do with your money. (Frankly, I object to the whole Consumer Reports-is-my-Bible mentality that certain people have. IMO, CR is just another data point in the constellation of information out there.)
Anyway, read the whole thing for yourself, after the jump.
Consumer Reports Health: Central-Line Infection Rates Vary in San Francisco Hospitals; Three Hospitals Report Zero Infections; Some Hospitals Not Reporting. New online hospital ratings put infection rates and other patient safety information in the public eye
YONKERS, N.Y., Feb. 2 — Hospitals in San Francisco vary dramatically in terms of how well their intensive care units (ICUs) prevent central-line bloodstream infections, a cause of death, disability, and expense in our nations’ hospitals that is largely preventable. On February 2, www.ConsumerReportsHealth.org will post hospital infection rates for 29 Bay area hospitals, including six in San Francisco, along with other critical patient safety and satisfaction information for consumers. Bloodstream infections cause at least 30 percent of the estimated 99,000 annual hospital-infection-related deaths in the U.S. and add on average $42,000 to the hospital bills of each ICU patient who gets a central-line infection.
In San Francisco, three out of six hospitals reported zero central line infections: St. Luke’s Hospital, Saint Francis Memorial Hospital, and St. Mary’s Medical Center. California Pacific Medical Center-Pacific Campus reported an infection rate that’s 43 percent better than average, meaning there were 43 percent fewer infections than the U.S. average for its mix of ICUs. Kaiser Foundation Hospital- San Francisco reported an infection rate that’s 40 percent better than average. The infection rates are for 2008.
On the other end of the spectrum, UCSF Medical Center reported an infection rate that’s 80 percent worse than the national average for its mix of ICUs. In the larger Bay Area, where Consumer Reports Health rated 29 hospitals, Consumer Reports found extreme variation between hospitals, even hospitals run by the same health care system. For example, Kaiser Foundation Hospitals in Hayward, Santa Rosa, Vallejo, and South San Francisco reported zero central line infections, while Kaiser Foundation Hospital in San Jose had an infection rate that was 14 percent worse than the national average and the Kaiser Foundation Hospital in San Francisco reported a rate that’s 40 percent better than average.
“Infection rates can vary widely from hospital to hospital and even within the same hospital chain or system,” said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. “Providing patients with infection rate information enables them to identify which hospitals are making patient safety a priority and which ones are not.” According to a related investigative report in the March issue of Consumer Reports, of the 926 U.S. hospitals whose infection rates were analyzed by Consumer Reports Health, 105 hospitals tallied zero central line infections (listed online at www.ConsumerReportsHealth.org).
“All hospitals should be aiming for zero infections,” said Santa. “The procedures needed to eliminate ICU infections are simple, low-tech, and inexpensive, requiring a change of mindset and culture. All ICUs should be able to dramatically reduce if not eliminate these infections,” continued Santa.
The Consumer Reports online ratings are based on hospitals that publicly report their infection rates as a result of state laws and hospitals that voluntarily report to the Leapfrog Group, a Washington D.C. based nonprofit, works with large employers and purchasers of health care to measure and publicly report on hospital safety and quality in 41 states in the U.S. (www.leapfroggroup.org). Citizen activists, including those working with Consumers Union, the nonprofit publisher of Consumer Reports, have helped enact laws in 27 states, forcing hospitals to publicly disclose their infection rates. To date, 17 of those states have made that information publicly available.
California has passed a hospital-infection reporting law but the state has not started disclosing infection rates to the public. Under the state’s law, the Department of Health is required to issue its first report on central line-associated bloodstream infections on January 1, 2011. “California has already failed to meet some of the initial requirements of its hospital infection law so we are concerned that it will miss the deadline for issuing its first infection rate report next year,” said Lisa McGiffert, Director of Consumers Union’s Safe Patient Project (www.SafePatientProject.org ). “Until the state makes infection rates public for all California hospitals, consumers will be left with an incomplete picture of this critical patient safety information.”
Consequently, the Consumer Reports ratings for California hospitals are based on Leapfrog data. “It is important to recognize that many hospitals demonstrate commitment to their communities by willingly reporting safety data–warts and all. Consumers should be most wary of hospitals that are asked to report by their patients (or customers), and refuse,” said Leah Binder, CEO of the Leapfrog Group. Binder noted that more than 25 hospitals in the Bay Area declined to provide their data to Leapfrog during the reporting period. A complete list of non-reporting hospitals can be found at www.leapfroggroup.org/decline.
A Central Line Associated Bloodstream Infection (CLABSI) is a type of infection caused by the presence of a central line catheter. A “central line” or “central catheter” is a tube that is placed in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications. These long, flexible catheters empty out in or near the heart so that the circulatory system can deliver what’s put in them within seconds. A bloodstream infection can occur when bacteria or other germs travel down the central line and enter the bloodstream, making the central line’s biggest virtue as a quick pathway for delivering the essentials into its biggest vice.
Since the risk of infection varies substantially across different types of ICUs, the Consumer Reports ratings are using what is known as a “standardized infection ratio,” taking into account the unique mix of ICU types in a given hospital by comparing the hospital infection data for each ICU to the national average for each such ICU type published by the federal Centers for Disease Control and Prevention (CDC). For instance, the average infection rate for cardiac ICUs nationwide is 2 per 1000 central line days (that’s the total number of days that patients are on central lines), while surgical ICUs average 2.3 infections per 1000 central line days. So an infection rate 100% above average would be 4 per 1000 days for a cardiac ICU, but 4.6 per 1000 days for a surgical ICU.
The Consumer Reports web site (www.ConsumerReportsHealth.org) currently rates more than 3,600 hospitals in the U. S. based on several criteria including patient satisfaction, intensity of care, and steps to prevent infection. This last measure, which is different from the CLABSI infection rates, assesses how well a hospital follows correct procedures to avoid surgical infections.
About the Consumer Reports Health Ratings Center
Consumers have come to trust Consumer Reports’ ratings of thousands of products and services for the expertise and independence they represent. The Consumer Reports Health Ratings Center uses similar approaches to produce ratings tables, selecting the best sources of research to rate health care services, drugs, devices, institutional providers, and eventually physicians and other practitioners. The Health Ratings Center (www.ConsumerReportsHealth.org) currently provides Best Buy Drugs (BBD) ratings on prescription medications for more than 20 common medical conditions; Ratings of more than 3,600 U.S. hospitals; Ratings for a wide array of healthy living products from fitness equipment to sunscreens; up-to-date safety information and effectiveness Ratings for thousands of natural medicines ; and treatment options for more than 200 conditions and diseases.
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