Monday, November 2, 2015

Report flunks UMMC on patient safety.

The healthcare watchdog organization Leapfrog Group gave UMMC an "F" rating on hospital safety.  Leapfrog states on its website that factors such as infection rates,  mistakes, errors, and accidents determine the score.   Leapfrog provided the following ratings to local hospitals:


UMMC: F
MBMC: C
CMMC: C
River Oaks: B
St. Dominic: C

A ratings in Mississippi
Baptist Memorial Hospital Golden Triangle
Biloxi Regional Medical Center
Baptist Memorial Hospital of Union County
Baptist Memorial Hospital - North Mississippi
Northwest Mississippi Regional Medical Center

B ratings in Mississippi
North Mississippi Medical Center - West Point
North Mississippi Medical Center - Tupelo
Merit Health Wesley
King's Daughters Medical Center (Brookhaven)
Bolivar Medical Center

C ratings in Mississippi
Merit Health River Region (Vickburg)
Southwest Mississippi Regional Medical Center (McComb)
Greenwood LeFlore Hospital
Baptist Memorial Hospital Desoto
Highland Community Hospital (Picayune)
Forrest General Hospital
Memorial Hospital at Gulfport
Garden Park Medical Center (Gulfport)
Ocean Springs Hospital
Anderson Regional Medical Center (Meridian)
Rush Foundation Hospital (Meridian)
Magnolia Regional Health Center (Corinth)
Gilmore Memorial Regional Medical Center (Amory)
Singing River Health System

D ratings in Mississippi
OCH Regional Medical Center (Starkpatch)
South Central Regional Medical Center (Laurel)
Delta Regional Medical Center (Greenville)
Natchez Regional Medical Center

F ratings in Mississippi

No other hospitals.

The report provides more details on the score received by UMMC:

Safety problems with surgery (Incidents per 1,000 patients)
collapsed lung: UMMC score 0.54, average hospital score 0.39, Best: 0.18
serious breathing problem: UMMC 20.53, average 12.08, best 4.11
dangerous blood clot: UMMC 9.91, average 4.18, best 1.17
surgical wound splits open: UMMC 2.06, average 1.7, best .086
Accidental cuts and tears during a procedure: UMMC 3.65, average 1.8, best 3.65
Death from treatable serious complications: UMMC 142.77, Average: 118.15, best 56.31

 However, the report gives UMMC high marks for using antibiotics right after surgery.  The hospital scored 98 out of 100 points while the average was 98.99 and the best score was 100. The report also rated UMMC on infections and safety problems*:

Infection in blood while in ICU: UMMC .431, average 0.45, best 0
 UTI during ICU stay: UMMC: 0.769, average 1.06, best: 0
Surgical site infection after colon surgery: UMMC 0.610, average 0.95, best 0
Dangerous object left in patient's body: UMMC 0.238, average 0.03, best 0
air/gas bubbles in blood: UMMC 0, Average 0.003, best 0
Patient falls: UMMC 0.318, average 0.55, best 0
Dangerous bed sores: UMMC 1, average 0.32, best 0.03

UMMC however, scored a perfect 100 for having staffing to prevent safety problems. 
Specially trained doctors care for ICU patients: UMMC 100, average 36.89,  best 100
Effective leadership to prevent errors: UMMC 42.86, average 113.35, best 120
Staff work together to prevent errors: UMMC 0.0, average 18.63, best 20
Training to improve safety: UMMC 24.0, Average 36.41, best: 40
Enough qualified nurses: UMMC 100, average 93.24, best: 100

Then there is the matter of UMMC using standard safety procedures.
Doctors order meds through a computer:UMMC 100, average 67.91, best 100
Correct medication info is communicated: UMMC 14.0, average 32.1, best 35
Track & reduce risk to patients: UMMC 21.82, average 112.59, best 120
Handwashing: UMMC 18.0, average 28.03, best 30.
Take steps to prevent ventilator problems: UMMC 1.67, average 18.39, best 20

The report also states that Leapfrog asked all local hospitals to provide this information to the public but they chose not to do so.   The report can be found on this web page. 

Kingfish note: Several factors about UMMC were not mentioned in the report:

1. UMMC is a teaching hospital with a medical school, nursing school, and other similar programs.
2. UMMC provides a great deal of indigent medical care in the Jackson area.
3. UMMC has a higher share of patients that do not have health insurance and probably have a higher rate of medical problems than do patients at private hospitals.

 It would be interesting to see how UMMC compares to other teaching hospitals and inner city hospitals that face the same demographics among its patients. 

*Maximum score is the best score unless otherwise stated.

21 comments:

Anonymous said...

UMMC just needs to move out of Jackson. Maybe to Rankin or Madison County.

PittPanther said...

As usual, you want good medical care, you have to head North.

And KF, don't try to excuse UMMCs failure by blaming the type of hospital they are, or worse yet, blaming the patients. I'm not sure why being a teaching hospital or dealing with indigent patients, means you can't wash your hands!

Every hospital on this list knows they are being rated constantly, and should be enforcing best practices every day. UMMC just chose not to care. Until AFTER they got exposed.

Anonymous said...

No need. The employees are already immune from liability, and UMMC's liability is capped.

Kingfish said...

Pitt, not disagreeing with you one bit. I'm not blaming patients. I am merely pointing out what the health history of patients might be and asking if that affects some of of the ratings.

UMMC scored good on some ratings and horrible on others. Was playing devil's advocate more than anything.

Anonymous said...

1) "Safety problems with surgery (Incidents per 1,000 patients)
collapsed lung: UMMC score 0.54, average hospital score 0.39, Best: 0.18" This can be affected by the types of surgery performed (foot and ankle vs heart and lung)

2) "dangerous blood clot: UMMC 9.91, average 4.18, best 1.17"
This is routine and not affected by type of surgery.

3) "Accidental cuts and tears during a procedure: UMMC 3.65, average 1.8, best 3.65" How can UMMC be below average yet the same as the best reported? One number is defintely wrong here.

4) "Death from treatable serious complications: UMMC 142.77, Average: 118.15, best 56.31" This is vague - everything is "treatable". I can't wait for the press conference/release explaining why this item is so bad.

5) "However, the report gives UMMC high marks for using antibiotics right after surgery. The hospital scored 98 out of 100 points while the average was 98.99 and the best score was 100."

KF - define "high marks" (this is an example of "spin" in reporting. "98" may indeed be considered a high mark, yet the objective truth is UMMC scored worse than the state average.

6) "UTI during ICU stay: UMMC: 0.769, average 1.06, best: 0
Surgical site infection after colon surgery: UMMC 0.610, average 0.95, best 0" Both better than the state average.

7) "Dangerous bed sores: UMMC 1, average 0.32, best 0.03" Inexcusable - can you say "One call, that's all", boys & girls?

8) "UMMC however, scored a perfect 100 for having staffing to prevent safety problems.
Specially trained doctors care for ICU patients: UMMC 100, average 36.89, best 100
Effective leadership to prevent errors: UMMC 42.86, average 113.35, best 120" So, typical for UMMC (speaking from experience) they hired a lot of bureaucrats who were ineffective when results are measured. Your tax dollars at work.

9) "Correct medication info is communicated: UMMC 14.0, average 32.1, best 35 " Uh, this is a HUGE problem.

10) "Track & reduce risk to patients: UMMC 21.82, average 112.59, best 120" This is also vague, but the numbers are pathetically below average.

11) "Take steps to prevent ventilator problems: UMMC 1.67, average 18.39, best 20" See #10

12) "Handwashing: UMMC 18.0, average 28.03, best 30." What kindergarten did their staff go to where they didn't teach this.

13) "UMMC has a higher share of patients that do not have health insurance and probably have a higher rate of medical problems than do patients at private hospitals." Undoubtedly true, probably significant, impossible to quantify. I agree they should be compared to other teaching and charity hospitals.

Anonymous said...

The problem is when dealing with indigent and low income patients, is this is the only Avenue they have fir care. Experienced Physicians are replaced with medical students or nurse practioners, all of which are supervised at a distance by a licensed physicians. We'll meaning as they are, there is a greater chance of receiving substandard care. If your worried, don't go to a teaching hospital.

Anonymous said...

11:39: So the same patients can be treated and released in the suburbs. There's an idea Jackson can support. Or is this Poe's law?

Anonymous said...

Just head to River Oaks next time you need a trauma surgeon. Let me know how that works out for you.

bn135 said...

UMMC also gets a high proportion of critical patients from across the state. It is the only Trauma Center in the state. It looks to me a little like comparing apples to oranges.

The critical, high-risk patients that UMMC treats is much higher than most other hospitals in the state. You would be shocked at how many patients come in, get treatment and leave and never keep their follow-up appointments and are shocked when they get an infection, or their condition worsens.

I would really like to see there scores vs. other teaching hospitals and trauma centers.

Anonymous said...

Both my wife and I have had surgeries at UMMC and the level of care is excellent. We have insurance and have regular doctors at University Physicians. I had a life-threatening staph infection during a surgery at St. Dominic's 15 years ago and out of concern asked my UMMC surgeon about UMMC's hospital's rate. He said it was somewhat elevated because they brought in the sickest of the sick, many having stayed in other hospitals across the state and picking up bugs there. But, he said patients who had not transferred were at little risk. I am a fan of UMMC.

Anonymous said...

12:55- When there is serious injuries, of course you go to a trauma center. Only a fool would direct the person elsewhere. Colds, minor cuts and flu symtoms don't need the ER at UMMC. River Oaks is best for orthopedics, Baptist and St Dominics are good for heart problems and stokes. LOSE a finger or get shot, it's UMC. They're setup for it.

Anonymous said...

1:52 Same with my family. Both of us have had surgeries at UMMC, and all our regular doctors are at University Physicians. We are very pleased with the care we have received.

Anonymous said...

1:03, that's a weak argument. UMMC receives funding for the trauma level that they CHOOSE to operate at. More like comparing apples to bigger, better funded apples.

Anonymous said...

Maybe IHL is not as stupid as the Defenders of the former chancellor said they were. Remember, his contract was not renewed because of issues at UMMC not the Oxford campus. Teaching hospitals are a double edged "scaple". You have access to leading treatment and operative techniques. However you may also be treated by medical students, and 1st, 2nd, 3rd, and 4th year residents. That is why they are called "teaching" hospitals! Many of the nursing staff are also students. They will make mistakes more often than experienced staff - the difference in an apprentice and a master. UMMC also has a more limited pool of talented and experienced nursing and physicians than a Nashville, Atlanta, or Charlotte. An issue of population - more people more employee choices.

Anonymous said...

I will go to UMMC before I'll return to whatever River Oaks now calls itself. Went to emerg room at 545 am. Saw 2 young docs due to shift change. Thought they were in network. Got bills covered from hospital but out of network for young and clueless docs. Long wait. Bad diagnosis. MEA doc fixed me later in day. And we live in Rankin County. Hold your comments hipsters.

Anonymous said...

Was at UMMC a couple weeks ago and there were bags of trashed stacked in the offices. They said their contract with the "trash people" had expired and they had no trash pickup. said it might be end of the year before they did? Still do not understand but saw it.

Anonymous said...

Overpaid Duane O'Neil is outsourcing their trash pickup to some outfit in New Mexico. Says it will be good for jobs in Mississippi. LMAO

Anonymous said...

I appreciated this honest answer and assessment from UMMC's CEO Lou Ann Woodward, MD
---
(part one of two) I'm sending out a VC Notes on a Monday, in addition to the usual Friday edition, to respond to a news story that appeared this weekend.
On Saturday, the Clarion-Ledger carried an article about our hospital's safety scores as published by The Leapfrog Group. We think the article was essentially accurate, but it painted an incomplete picture of patient safety at UMMC.

The Leapfrog Group has contributed to putting patient safety on the map by publishing safety scores for hospitals during the last three years. It produces numeric scores for hospitals based on two sources of information. First, it uses publicly available quality data for all hospitals, and second, it invites hospitals to take a lengthy, self-reported survey.
About half of the country's hospitals actively participate in the survey, and this is the first year that UMMC has submitted data to Leapfrog, in hopes of gaining additional insight toward our ongoing efforts to improve clinical quality. To our knowledge, UMMC is the only metro-area hospital that voluntarily submits data to Leapfrog.

There are 28 safety measures in all, covering such areas as avoidance of pressure ulcers, practicing good hand hygiene and preventing death from serious treatable complications. Leapfrog reduces these numeric scores to a report card-style rating system using A through F grades that one would commonly see in a school setting. This report card is the primary means by which it communicates hospital quality to the public.
And there lies the problem.

UMMC received an “F” in the Leapfrog report. But, as we all know, we are not an "F" hospital.

When you receive a grade of F in school, that means you failed the test or the course. UMMC and the other hospitals receiving an F did not fail anything. We simply scored marginally lower than other hospitals.
And we didn't even score that much lower. The differences in the higher-scoring hospitals and the lower-scoring hospitals for any of the metrics are not that large. In fact, we exceeded the national average in 11 of the 28 metrics Leapfrog uses.

Anonymous said...

(part two of two)

The point here is not to criticize Leapfrog, which we consider a partner helping us to achieve the very highest clinical quality, or the newspaper, which is just passing on information we believe the public deserves to have. The point is that clinical quality is a complex, multi-faceted subject that, we believe, can't be adequately or fairly reduced to a grade in a school report card format. To represent this as a “failure” to the public on such a sensitive issue is inflammatory and does not serve patients as they make decisions about their health care.

UMMC is a safe hospital. Patients can and do come to us with confidence that we are on top of our game and that they will receive superb care.
Are we perfect? No. Despite our very best efforts, we do occasionally make errors or oversights that could potentially expose patients to harm, as do all hospitals. But if you look at the Leapfrog data you will see that those instances are extremely rare.

One thing the data may not fully reflect is that we are a major trauma and referral center. We are constantly caring for the state's most critically ill and injured patients. We embrace this responsibility, but the challenges associated with it may not be completely captured in a particular survey's risk adjustment calculations.

You should also bear in mind that most of the data on which the scores are based are more than two years old. In those two years, we have made major strides in our clinical quality program.

Here are a few of the major things we've done:

Recruited Dr. Michael Henderson from the Cleveland Clinic as chief medical officer. A proven national leader in clinical quality improvement and patient safety, Mike is leading the charge to our becoming a high-reliability organization.

Identified clinical quality as our Number 1 priority for strategic investment

Required every employee to participate in error-prevention training
Begun a hand-hygiene initiative that we feel confident will dramatically improve our compliance

Begun monthly “Leadership Rounds” to promote engagement of UMMC's 150 top leaders with our clinical quality efforts

Achieved outcomes in complex transplant and congenital heart surgeries that are among the best in the country

Shifted to an electronic health record that is ensuring our performance data isn't undermined by poor coding. More importantly, our Epic EHR allows us to use data analytics to better identify and correct behaviors that result in errors.

Standardized best practices in surgery, such as “time outs” for the whole team to do final checks that the right things get done and everyone knows and agrees with the surgical plan

Leapfrog and its peers set the quality bar high, and it should be high. Our goals are zero preventable harm and progressive, measurable improvement in quality outcomes.

We also welcome the transparency that Leapfrog and other measurement groups provide. Transparency can be uncomfortable, but it will help us drive continued improvement.

In the final analysis, each of us owns our performance, and we own this Leapfrog report. Patients are at the center of what we do every day and the commitment to this improvement is the responsibility of every person who works in the hospital every day.

I know and appreciate that you have embraced this responsibility and are working very hard on behalf of our patients. I'm confident that in time, our “grade” will reflect it. And knowing that is all the motivation we need to keep moving onward toward A Healthier Mississippi.

Anonymous said...

Flagship*

Anonymous said...

Unbelievable River Region Vicksburg, MS., scored higher than UMMC. Staffing is DANGEROUS! Cant even keep travel nurses. Intimidate nurses into taking more patients than can possibly be adequately cared for. All about $$$$$! Physicians have absolutely no say in the matter. Would love to know stats on River Region's falls, infections,etc.. People, its a "training" hospital for hospital executive wannabe's. Can stats be obtained?

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