Caveat Patients
Hospital-scene

For as long as I can remember, Consumer Reports has been the name most closely associated with straight up ratings of innumerable consumer products and services from dishwashers to cameras to, well, you name it.  Last week, Consumer Reports issued its first-ever review of hospitals across the country with a focus on patient safety.

If you’re a patient or you might someday be a patient, if you’re a physician or a nurse or a hospital administrator or, frankly, if you’re breathing, these results should be disturbing.

Consumer Reports (CR) explains that its review is based on the “most current data available,” including “information from government and independent sources on 1,159 hospitals in 44 states.”  That sounds pretty good, except that CR was only able to reliably consider data on 18 percent of hospitals.  Clearly, 18 percent is not good.

The goal of the CR analysis was to compare hospitals based on an assessment of patient safety.  To do this, CR looked at six issues frequently associated with patient injury: rates of hospital infections; number of re-admissions following discharge; communication errors, such as confusion over discharge instructions; numbers of CT scans ordered, because of the potential for over-exposing patients to radiation; complications; and mortality.  Rating a hospital in these categories allows some comparison of performance in terms of patient safety.

Evaluating hospitals for performance in the area of patient safety is such a worthwhile undertaking that it is utterly amazing that it has taken this long.  Trial lawyers like me, who represent patients and their families in malpractice cases, have known for many years the importance of reducing the incidence of medical errors.  Many studies have now so clearly documented the problem that there should be no ignoring the matter.  In 2010, for example, as CR notes, a Department of Health and Human Services report pointed to surgical mistakes, infections and other medical errors as the cause of death for 180,000 hospital patients a year.  More than a million others are seriously injured while they are in the hospital supposedly trying to find healing, not more pain.

Of course, the CR study has its limits.  There are many kinds of hospitals, ranging from smaller community hospitals to large, urban teaching hospitals.  But the complexities of our health care system are no reason for less transparency.  Instead, there should be more reporting, more access to this kind of information.

Consider Pennsylvania and New Jersey, two states close to where I live and practice.  CR has published its study results in its August 2012 issue and also on line.  Here is a link to the site: http://www.consumerreports.org/health/doctors-hospitals/hospital-ratings.htm.  (To access the state by state results on line requires a subscription to consumerreports.org.)

In Pennsylvania, CR reviewed 180 hospitals across the state, but was only able to obtain data in all six categories – and thus was only able to assign an overall safety rating – for 10 hospitals.  The highest ranked of those 10 hospitals, Lancaster General Health in Lancaster, PA, received a 68 out of 100 overall safety rating.   That is a fairly respectable score, considering the overall highest rating hospital in the CR analysis, the Billings Clinic, located in Montana, received an overall score of 72.

Only one hospital in Philadelphia, Hahnemann, supplied sufficient data in all categories to be fully evaluated in the CR review.  Hahnemann’s overall safety score was a pathetic 44 out of 100.   The hospital did well in some areas, such as doctor-patient communications and nurse-patient communications.  In other areas, the hospital performed dismally, based on the CR criteria.  For example, Hahnemann’s data on patient re-admissions was telling:  heart attack patients had a 20 percent chance of being re-admitted within 30 days of being sent home.  Pneumonia patients had a 21 percent chance of re-admission within 30 days.

Hahnemann should get credit for its openness and disclosure.  Hopefully, this review will motivate Hahnemann to improve its record in these categories, the better to serve its patients.  That should be enough of a reason for improving patient safety.  Of course, there is a financial incentive, too, as countless studies document the high costs associated with hospital-acquired infections, preventable re-admissions and other avoidable medical errors.

The CR team reviewed 78 hospitals in New Jersey and was able to evaluate complete data on 53 hospitals, far more than half and a far higher percentage than in Pennsylvania.

The highest rated New Jersey hospital, Deborah Heart and Lung Center in Brown Mills, received an overall safety rating of 62.  The lowest-rated hospital in the state was Kimball Medical Center in Lakewood with an overall score of just 24.  JFK Medical Center in Edison fared hardly better, with an overall patient safety score of 29.   In all, 17 of the 53 hospitals CR was able to assign an overall patient safety score failed to achieve a rating of higher than 40 out of 100, including the widely publicized Cooper Health System in Camden.

The CR medical team has done a great service with this first effort.  One can go to the website and click on any hospital and see detailed data on each hospital or one can choose multiple hospitals for side by side comparisons.  Clearly, though, there must be more.

The CR review may be a step in the right direction to making accessible information about the quality of care at hospitals, but much greater strides are needed.  More information about the kinds of factors CR considered in its evaluation will allow consumers to make more informed choices about their healthcare and will encourage poorer performers to make improvements, reduce the number of devastating medical errors and save a great deal of healthcare resources.