Monday , January 05, 2015 - 5:44 AM
Each year, 440,000 people die in the U.S. because of medical errors, according to the Patient Safety Journal, making it the third leading cause of death in the country.
The 2014 Hospital Safety Score, a public service provided by The Leapfrog Group, a nonprofit organization committed to driving quality, safety, and transparency in the U.S. health system, recently assigned each hospital a letter grade based on their ability to prevent errors, injuries and infections.
McKay-Dee Hospital, Davis Hospital and Medical Center, and Brigham City Community Hospital all received a C grade. Ogden Regional Medical Center and Lakeview Hospital received a B grade. The only hospital in Utah to receive a D grade was Utah Valley Regional Medical Center. Timpanogos Regional Hospital in Utah County was the only Utah hospital to receive an A. No Utah hospital received an F.
Some of the reasons for these hospital errors, accidents and injuries, which were publicly reported by the hospitals, include surgical wounds splitting open, medication mistakes, patient falls, dangerous blood clots, infections from catheters, foreign objects left inside the body and collapsed lungs.
The causes are many, said Utah Department of Health patient safety director Iona Thraen. Being human is at the top of the list.
“Ask yourself how many errors you have made today, such as typos, forgotten something, took a wrong turn, got a name wrong,” she said. “This happens in healthcare as well, only the implications of human error are more serious in this kind of environment, as well as the environment is more complex.”
Thraen said systems have to recognize that human error is inevitable and create processes that prevent humans from making predictable errors. Technology can help but is not fail safe. Training is helpful but again not foolproof, especially with people rotating, working part-time, working 12-hour shifts and moving from hospital to hospital.
“The goal of patient safety is to recognize predictable errors and then create systems to prevent them from occurring,” Thraen said.
Her advice for patients?
Thraen said it’s crucial to ask questions and speak up when you don’t understand or you see something that doesn’t look or feel right.
While the Leapfrog Hospital Survey, performed by a nonprofit group to improve health care quality, is a step in the right direction to better patient safety, it relies on “incomplete sources of information” such as voluntary hospital surveys, Centers for Disease Control numbers, and Centers for Medicare & Medicaid Service statistics, Thraen said.
“These sources list general conditions and outcomes, but that doesn't adequately report all recognized preventable errors,” she said. “Many hospitals fail to report errors such as surgery on the wrong body part, foreign objects left in patients, injuries to vital organs, blood clots, infections from urinary catheters, falls that cause fractures, and hospital-acquired infections.
”State and federal governments should mandate hospital disclosure of all types of medical errors. Only then can consumers be assured of making informed choices of the safest and best hospitals and doctors.“
The Hospital Safety Score shows that while hospitals have made significant improvements when it comes to implementing processes of care and safe practices, performance on outcomes lags behind. Since April, there has been improvement in measures such as hand hygiene and physician staffing in intensive care units. However, the data shows a lack of progress on outcomes, with hospitals even declining on certain measures, such as preventing surgical site infections in patients who have undergone major colon surgery.
“While the data tells us that hospitals are improving their safe practices, it’s concerning to see them moving backwards on any measure. Patients enter a hospital trusting they’re in a safe place, but with 41 percent of hospitals receiving a ‘C,’ ‘D’ or ‘F’ grade, it’s clear that some hospitals are safer than others,” said Leah Binder, president and CEO of Leapfrog.
Binder said with over 400,000 lives lost annually and one in 25 patients acquiring an infection in the hospital, it’s crucial for consumers to be proactive about their health care.
“Consumers have largely taken the time to educate themselves about insurance plans and pricing. Now, we need patients to take the next step, putting safety first, for themselves and their families, and that means seeking out the safest hospitals in their area. The Hospital Safety Score arms consumers with that information,” added Binder.
For more information about the Hospital Safety Score or to view the list of state rankings, visit www.hospitalsafetyscore.org.
McKay-Dee Hospital public relations director Chris Dallin said McKay-Dee supports efforts such as this to provide the public with information about their healthcare.
"There is clearly room for improvement in the methodology they use. For example, because of cost, most Intermountain hospitals do not participate with the Leapfrog Group. This may result in incomplete information that skews the scoring," Dallin said. "We’ll carefully study this information to determine what improvements can be made at our facility."
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