September 12, 2007
Hospital Report Card: Southampton Failing the Test
If you're having a heart attack, what East End hospital would you entrust with your care?
Or, if a loved one is suffering from pneumonia, what hospital would provide them with the best opportunity for a speedy recovery?
According to a recent study, Southampton Hospital might not be the place to go.
Recently, the New York State Health Accountability Foundation, a public-private partnership founded in 1998 and dedicated to promoting transparency in the health care system and providing employers and consumers with reliable, independent information on health care cost and quality, released their annual report cards grading New York hospitals and HMOs.
And the survey of East End hospitals yielded startling results, with Southampton Hospital failing to make the grade.
Each hospital was rated with a section on appropriate care, which shows how well each hospital is doing at ensuring patients receive recommended treatments known to get the best results. Hospitals were rated according to a green dot, meaning they scored "significantly better than the state average or 100 percent," a yellow dot, signifying they'd rated "not significantly better or worse than the state average," or with a red dot, a sign indicating that the hospital had performed worse than the state average.
And in a number of categories, Southampton Hospital received red marks on their report card.
For composite scores in overall heart attack care, overall heart failure, and overall surgical infection prevention, Southampton Hospital's scored red marks, indicating that the facility performed worse than the state average. Overall pneumonia care was indicated as not significantly better or worse than the state average.
But, when broken down into recommended specific treatments for pneumonia, however, Southampton Hospital received red marks in four categories, including blood oxygen level assessed, blood culture performed, pneumonia patients assessed and given influenza vaccine, and pneumococcal vaccine given at discharge.
Meanwhile, Peconic Bay Medical Center in Riverhead did not score significantly better or worse than other state hospitals in the categories of overall heart attack care and overall surgical infection prevention. In the category of overall pneumonia care, Peconic Bay Medical Center came out in the green, with results significantly better than the state average. But in the category of overall heart failure, PBMC scored a red mark, performing significantly worse than the state average.
Results for Eastern Long Island Hospital in Greenport indicated that in three of the four categories, the facility showed results not significantly better or worse than the state average. In the category of overall pneumonia care, ELIH performed significantly better than the state average.
At Brookhaven Memorial Hospital Medical Center, results were at opposite ends of the spectrum, with the facility performing better than the state average in overall heart attack care and heart failure but worse in pneumonia care and overall surgical infection prevention.
The report card also covered categories including mother/baby care, asthma, chronic obstructive pulmonary disease and diabetes.
In the category of antibiotics, which the organization said can reduce the risk of infection after surgery, PBMC scored below state average for pre-surgery antibiotics and Southampton Hospital and Brookhaven scored below the state average in post-surgery antibiotics. ELIH had reported too few applicable cases for each measure.
After the report card was released, Sharon DiSunno, vice president of quality management at Southampton Hospital, joined Irene Caulfield to discuss results.
"We have a problem with the way this data was collected," said DiSunno, pointing out that the study utilizes two data sources, HMO data and consumer opinion. "They're talking about clinical information – you're talking oranges and apples. I don't feel that this is a credible report."
For example, said DiSunno, in the area of heart attacks, although the hospital received scores not significantly better or worse than the state average or higher than the state average in various categories, they still ended up with an overall below average state score. "If you have yellow and green, how does that make you red? How do you get there?"
DiSunno explained that data for the study is gleaned from core measures, or standards of care, of which there are 21; in October, that number will increase to 27.
Often what happens, said DiSunno, is a physician has treated a patient appropriately, but has done a certain test in his office. "A lot of tests are done in the physician's office because they make more money that way," she said.
If the test is done in the physician's office, often information is in the office and not sent to the hospital, so that the patient's medical record can be updated. If a physician performs a test in his office but fails to write it down or update the hospital's medical record, "that's a ding for us. So even though everything is done correctly, according to the core measures, it's an error. That's why hospitals get very defensive about this."
DiSunno believes report cards for hospitals "are a good thing. I agree with what they're doing. But first, you have to make sure that everyone is using exactly the same formula, using the same words."
DiSunno said discharge sheets should be reworded so that what needs to be done is perfectly clear. "These are mechanical things that you have to do – it's up to us to try and get them fixed."
Confronted with the hospital's scores on pneumonia, Caulfield said the whole way data was collected was "vague. You can't even figure out how they're arriving at these scores."
In regard to the section about patients receiving influenza vaccinations while being treated for pneumonia, DiSunno said there are variables – some things are done seasonally, and often, a patient or doctor "can't remember. In the big scope of things," she said, the doctor is "treating the pneumonia and not going to worry about the influenza today." The doctor might decide to give the injection when a patient comes to the office.
Internally, DiSunno said Southampton Hospital has its own ratings system. "We have the real answers. On an overall basis, we're never in the red, but certainly, we could be in the yellow, where you need to do improvements – which we constantly do." DiSunno added: "We definitely have areas to improve on."
For example, she said, blood cultures being performed on pneumonia patients do have to be performed in the emergency department. But although there is a "very, very good" ER staff in place, they are "young, and were never trained to do that."
She stressed, however, that often, it is not procedures that are wrong; the problem involves physicians or staff not recording what has been done in a uniform manner. "A lot of this is about re-education of your medical and nursing staff about the correct clinical documentation. It's all about clinical documentation."
Caulfield pointed out that much of the information on the report card was from September 2006. Since then, "We have corrected some of these things."
DiSunno recognized cardiologists were testing in their offices and not sending records to the hospital; that has been corrected, "so we have all that information available."
She added, "It's a learning curve for everybody. Our goal is to do the best we can for our patients."
At Eastern Long Island Hospital in Greenport, Paul J. Connor III, President and CEO, the report is a reflection of a sampling of a hospital's charts and outcomes specific to being evaluated against standards of care. "The real test not necessarily whether we're doing poorly but how well we've been able to do against improving our particular standards."
In the case of pneumonia, ELIH scored high this year. "We did have particular clinical issues that we identified in our own process improvement. Subsequently, the good news, for our patients and us, is that we've been able to improve that process so that we've exceeded our own standards and compare well against the rest of the hospitals that participate."
Moving forward, Connor said the goal is to "improve those areas that we're sort of standing still in. That doesn't mean we're not doing well in those areas – we seem to be doing well – but we always would like to improve."
While ELIH is a smaller hospital, Connor said it is not the only reason why the facility tends to score well. "The size of our facility works well to be able to communicate, but you have to have the raw material to work with. You have to have good, competent, caring individuals. And, on your medical and your nursing staff, you have to have strong leadership to keep people focused."
In the future, Connor said technology will continue to play a significant role. Within the next month, the hospital plans to begin testing a new medication administration process featuring a bar code technology to ensure "the right medication and the right dosage is given to the right patient at the right time."
He added, "All hospitals are constantly evaluating their medication errors. The idea is to find out what causes them, to get to the root cause and to reduce those errors."
"Our focus has been and will continue to be on the improvement of the care process to ensure the best possible outcomes for our patients," Connor concluded.
Representatives from Peconic Bay Medical Center and Brookhaven Memorial Hospital Medical Center did not return calls for comment by press time.