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Sunday, October 26, 2014

Hospital Safety In Light of Ebola Scare

Hospital Safety In Light of the Ebola Scare

Due to public hysteria and resulting quarantine for Ebola patients, family members, and anyone who may have come in contact with any of these unfortunate individuals, this is a good time for consumers to re-acquaint themselves with patient safety standards through publicly available sources. First a primer on the main causes of adverse patient safety events in hospitals in the United States. In patient safety lexicon when something goes wrong in health care treatment while in a hospital setting, this is referred to as an adverse event. There are a number of health care organizations within the nation that track patient safety information including: the Centers for Disease Control, Joint Commission for Hospital Accreditation, the National Quality Forum and several nonprofit entities. Of the nonprofit leaders, The Leapfrog Group® is known for its annual hospital quality and patient safety survey, of which over 5,000 hospitals participate. In addition to this, the Commonwealth Fund[1] has also published patient safety and health care outcome information, including the average number of safety events by category and by county.

A detailed analysis of patient safety tracking entities is provided in Unraveling U.S. Healthcare-A Personal Guide[2] and no less than three chapters detail hospital quality and patient safety, by facility and by state. However, since this is a monthly health care column and not a book, I am using Hospital Safety ScoreSM, The Leapfrog Group® annual hospital quality survey to highlight how hospitals rank which are handling Ebola patients[3]. This is meant to provide consumer information on basic patient safety rankings, so that the informed patient will use sound information and not hysteria when making health care decisions. To that end, here are the rankings, starting with Dallas Presbyterian Hospital:

Dallas Presbyterian Hospital Survey Results as of August 2013[4]
Infection rates observed in patients versus the expected rate are listed below for two common metrics
Central Line Infection Rate is .56, which nearly matches the national average of .55, which is a solid performance.
Catheter Infection Rate is .19, which is far better than the average rating of .71 for the survey respondents.
Patient Safety Processes
Computerized Order Entry-100 (out of 100)
Physician Staffing in Intensive Care Unit-100 is a perfect score
Identification and Mitigation of Risks-120 (out of a possible 120)
Hand Hygiene-30 (out of a possible 30)
Nursing Workforce-100 (out of 100)

By all measures Dallas Presbyterian Hospital is a top-notch facility in terms of patient safety, but the Ebola patient who died was treated too late, and time-to-treatment is a key statistic for improving patient survival in many clinical interventions. Additionally, the man was autoimmune suppressed and taking medication for HIV. The laboratory delay was not the fault of the hospital, which used normal protocol, but reflected the dearth of resourcing from a disease prevention level at the Centers for Disease Control and Prevention.
Only the best hospitals are now accepting Ebola patients, those trained for the most acute care, including the venerable Bellevue Hospital in New York City, Harborview Medical Center in Seattle and Emory Health Care in Atlanta. Focusing on the patient safety processes of the Leapfrog survey, here are the scores for these facilities as well:

Note: The [Leapfrog] Hospital Safety Score grades hospitals on data related to how safe they are for patients. For more information, visit”

Leapfrog Group Criteria for Emory Health Care-Atlanta[5]
Central Line Infection Rate-.522 (better than average)
Catheter Infection Rate-1.60 (much worse than the average reported of .71)
Computerized Order Entry-65 out of 100
Physician Staffing in ICU-65 out of 100
Identification and Mitigation of Risks-Did not report
Hand Hygiene-Did not report
Nursing Work force-Did not report

Leapfrog Group Criteria for Bellevue Hospital-New York City[6]
Central Line Infection Rate-.645 (worse than average)
Catheter Infection Rate-.682 (better than average)
Computerized Order Entry-65 out of 100
Physician Staffing in ICU-Categorized a 5 or the lowest score in this criteria, the average facility had a score of 31 and the top hospitals scored 100.
Identification and Mitigation of Risks-Did not report
Hand Hygiene-Did not report
Nursing Work force-Did not report

Leapfrog Group Criteria for Harborview Medical Center-Seattle[7]
Central Line Infection Rate-.46 (better than average)
Catheter Infection Rate-.71 (average)
Computerized Order Entry-50 out of 100
Physician Staffing in ICU-100 out of 100
Identification and Mitigation of Risks-120 out of 120
Hand Hygiene-30 out of 30
Nursing Work force-100 out of 100

Now that the CDC has stepped up its monitoring and support for Ebola, with airport screenings (not sure how effective this will be) and rapid lab responses for blood screenings, it is a good time to review how we resource disease surveillance in the nation. In the case of hospitals, with the exception of the Veteran’s Administration and university hospitals, most are private facilities. This means Texas Health Presbyterian Hospital in Dallas had to shell out the money for extra hazard gear, extra cleaning costs, and extra staffing for Ebola. If we are going to expect a private facility to provide this type of intensive support for prevention of highly contagious and highly fatal diseases, we need to look at how we fund these services. Certainly syphoning new Ebola patients to trauma centers is wise, but that in and of itself is not a cure, more like a Band-Aid.
Regarding the other facilities targeted for Ebola triage, of concern is the poor intensive care staffing score for Bellevue Hospital in New York City, sounds like this place could use an infusion of capital from the big apple. And it should be unacceptable for any publicly funded facility to refuse to provide patient safety reporting information on basic stuff like hand washing, identification and mitigation of safety risks, and their nursing staff standards & staffing (Bellevue and Emory). Finally, thank you to Texas Health Dallas Presbyterian for going first in this fiasco because the nation learned a lot at your expense. Clearly you run a first rate facility, based on your reported patient safety data, so maybe you can petition our federal government’s Health and Human Services for some disaster relief money.

And this is the healthpolicymaven signing off encouraging all readers to share this article virally, but with appropriate attribution for  the author of course. For more information on patient safety, read


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