Find Hospitals in Your State on the Map from Consumer Reports Below
Summary: Consumer Reports Health (CRH) has just released a report showing wide variation in how likely it is that a hospital patient will pick up a deadly bloodstream infection. Much depends on the culture of the hospital the patient chooses. Does the head of the intensive care unit insist that doctors and nurses all follow a protocol to prevent these infections? Does the hospital administration back him up? The CRH review of more than 1,000 hospitals show that 142 have reduced infections associated with central line catheters to zero. Only two of the 142 are academic medical centers. Why?
In a telephone interview John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center, explains the shocking fact that these infections are, accepted within the “standard of practice.” What would it take to change the standard of practice? “Doctors testifying in a malpractice suit.” I would like to think there an easier solution.
Imagine that you live in Westchester County, not far from the Bronx, and you’re girding yourself for elective surgery. It should be a routine procedure, but you can’t help but worry about the infections that patients pick up in hospitals. You know that they kill 90,000 Americans each year. You also know that when hospitals commit to patient safety, infection rates plummet. In fact, some medical centers have been able to virtually eliminate one of the deadliest—the bloodstream infections associated with central line catheters that are inserted directly into the jugular.
As you consider nearby choices, you ask yourself, where would I be safer, at New York Westchester Square (a 205-bed hospital that serves the Bronx and lower Westchester County), or at Montefiore Medical Center, (the university hospital for the Albert Einstein College of Medicine), also located in the Bronx? Or perhaps I would be better off at one of Manhattan’s illustrious hospitals: Mt. Sinai, Lenox Hill, New York Presbyterian, Beth Israel Medical Center, or NYU Medical Center?
Of course in reality, few patients pick a hospital based on blood stream infection rates. But perhaps they should. They account for 30 percent of hospital-acquired infections, and one in four patients who contract them die. Moreover, as Dr. Atul Gawande has pointed out in The Checklist Manifesto, if hospitals simply use a humble five-point checklist, the incidence of central line infections can be cut to zero. These are two solid reasons to view bloodstream infection rates as a marker, signaling a hospital’s commitment to patient safety. And Consumer Reports can tell you which hospitals tolerate high infection rates—and which ones don’t.
In New York State, Where are Infection Rates Lowest?
This week, Consumer Reports Health (CRH) released an eye-opening update to its “Hospital Ratings,” comparing bloodstream infection rates at 1,119 U.S. hospitals to national averages published by the Center for Disease control. The analysis suggests that the Westchester patient would stand the best chance of dodging the bullet if he chooses New York Westchester Square.
Click here to view CRH’s review of 178 New York State Hospitals as a PDF. In the second column, headed “Bloodstream Infections” symbols indicate where a hospital stands on a 5-point scale ranked from “better to worse.” Those with the lowest infection rates are marked with a solid red circle, hospitals with the highest infections rates receive a solid black circle. In between, a half red circle signals “better than the national average,” a clear circle means “average” and a half black circle warns that infection rates are “worse than the national average.” (In the third column, CRH uses the same symbols to indicate how well a hospital is succeeding in fighting surgical site infections. As Gawande explains in The Checklist Mainfesto, they, too, can be reduced simply by using a checklist.)
Under the heading “bloodstream infections,” New York Westchester Square in the Bronx earns a half-red circle signaling that it’s beating the national average. Meanwhile, New York Presbyterian, Montefiore, Beth Israel, and Memorial Sloan Kettering Cancer Center are marked with clear white circles, indicating “average” infections rates. By contrast, Mt. Sinai, Lenox Hill and NYU Medical Center (a.k.a. NYU Langone Medical Center) all report infection rates that are “worse than average.” (All ratings have been statistically adjusted to minimize differences among hospitals due to the types of patients they serve).
These statistics on infection rates are self-reported. New York State is one of a few states that sends inspectors to the hospital to audit the reports, and this is why I am focusing on New York. The numbers on the New York list may be more reliable than in many other states. Though when a hospital reports a high rate of infections—which many do—I would assume that it is telling the truth. (Readers who would like to see infection rates at hospitals in other states should go to the map at the end of this post.)
Surprisingly, none of Manhattan’s highly-respected medical centers garnered a solid red circle. Peninsula Hospital Center in Far Rockaway is the only city hospital with this distinction. But if you scroll down the New York State list, you will discover a number of upstate institutions did receive the highest rating including hospitals in Saratoga Springs, Rome, Poughkeepsie, Glen Cove, Ithaca and Kingston.
Perhaps it’s just too hard for busy urban hospitals that treat a wide cross-section of patients to crack down on errors? Not necessarily. “Detroit hospitals are doing very well,” points out CRH’s Santa. “Michigan paid attention to the idea of checklists.” Indeed, the CRH report shows that both Harper University Hospital/Hutzel Women’s Hospital and Detroit’s Henry Ford Hospital rank “better than average” for central line infections.
Wide Variation among Academic Medical Centers
What is striking is that medical centers with marquee names don’t consistently outrank less prestigious hospitals: “While some well-established teaching hospitals do perform well, others perform poorly, and some choose to keep their data under lock and key,” a CRH press release explains. “Most of us think of teaching hospitals as setting the standard for the right way to do things, so it’s surprising to see so many teaching hospitals near the bottom of the list,” adds Santa.
Three teaching hospitals got CHR’s lowest rating in preventing bloodstream infections: Saint Louis University Hospital, Saint Louis, Mo.; Roswell Park Cancer Institute, Buffalo, N.Y.; and Regional Medical Center at Memphis, Memphis, Tenn. In addition, CRH lists 64 teaching hospitals that ranked worse than the national average. The group includes familiar names such as USC University Hospital, Los Angeles, Calif., Hackensack University Medical Center, Hackensack, N.J., Tufts Medical Center, Boston, Mass, and University of Maryland Medical Center, Baltimore, Md.
By contrast, of the 1,119 hospitals of all types that CRH reviewed nationwide, 142 hospitals (almost 13%) reported zero central line infections. But only two of the 142 were teaching hospitals.
Why Do Some Hospitals Accept High Infection Rates?
In the past, I have been told that some brand-name hospitals don’t use checklists because they are afraid of offending powerful physicians who bring well-heeled patients to their hospitals. In a phone interview, I asked CRH’s Santa if this is true.
“The nice way to put this is to say that it’s ‘a culture problem,’” he replied. “There is no $2 million dollar machine that you can buy to solve this.” Well-endowed academic medical centers know how to spend millions on cutting edge equipment. But they’re not sure how to persuade physicians to collaborate to solve problems. After all, many of the doctors who bring their patients to the hospital are in private practice. They have “privileges” to practice at the hospital, but they are not employees.
The solutions are cheap: hand-washing, checklists. Granted, some physicians are insulted by the idea that they should use a checklist. But hospitals can insist. “I’ve been on a panel with folks in the Beth Israel System,” Santa reports. “In their ICUs it’s clear, when lines are inserted, what the protocol is. If you see someone making a mistake, you should report it, and you will be supported by the administration.”
But “hospitals that are reluctant to confront powerful doctors or nurses aren’t as good at this,” he concedes. “And it’s harder to organize doctors who are not employees to do anything . . . though I think that it’s disappointing when you hear that doctors who are not employed by the hospital are objecting to clear-cut evidence-based well-established protocols that would increase safety.”
Central Line Infections and the “Standard of Practice”
What Santa says next is so shocking that I almost drop the phone: “One unfortunate aspect of central line infections is that, ironically, the standard of practice includes accepting that they occur, and that they kill people. Not preventing them is within the standard of practice.” In some hospitals, a certain number of deaths are accepted as “inevitable.”
“Lawyers have told me that they see patients or relatives of patients who died of a bloodstream infection all of the time,” Santa adds. “The lawyers tell them, ‘You don’t have a case’.”
If they try to go to court, the hospital will say, “We don’t know who fouled your central line.” It could have been any one of a number of people. And all the doctors will testify that failing to prevent the infection falls “within the standard of practice.”
Perhaps the standard of practice should change? “You know what it would take to make that happen, don’t you?” Santa asks. “One or more of these doctors would need to testify in a malpractice case involving a central line infection.”
It would be difficult to sue an individual doctor, but it might be possible to sue the head of an intensive care unit that reports a high number of infections, holding him or her responsible for not establishing protocols that would slash the number, if not eliminate the infections altogether.
“We think that having a goal of zero is reasonable,” says Santa
I agree. But doctors shouldn’t have to sue hospitals (or other physicians) in order to make it happen. There must be an easier way.
Check Out the Hospitals in Your Area
To view infection rates in your state, click on the map above, and you will find yourself on the Consumer Reports site where the map is interactive. If you are not a Consumer Reports subscriber and want to use the map you will need to sign up for a month, at a cost of $4.95. See the red button “Subscribe Now” to the right of the map. Once you have signed up, you can click on any state, and a chart will pop up, just like the list of New York State hospitals in the PDF.