Studies explore efforts to measure, improve hospitals' surgical outcomes

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Oct 20 2010

Hospital Compare, an HHS website that allows patients to compare hospitals online using various indicators of quality, is intended to help them choose better facilities for their medical care. But a new report in the Archives of Surgery says the website doesn't help Medicare beneficiaries in need of certain high-risk surgeries find better facilities.

Kaiser Health News: The Centers for Medicare and Medicaid currently require hospitals to report on their level of compliance with safety measures designed to reduce post-surgical infections. "If hospitals are forced to publicly report the measures they're taking … the thinking goes, they'll have a stronger incentive to comply with recommended safety measures, and thereby reduce the number of preventable deaths from surgical complications." Researchers found that a higher level of compliance with those safety measures didn't necessarily correlate with better post-surgical outcomes (Miles, 10/18).

Los Angeles Times: "It turned out that patients were just as likely to die within 30 days of their surgeries in the 'safe' hospitals as in the 'unsafe' ones," with the exception of patients who had an aortic valve replacement. "What's more, patients experienced fewer complications in hospitals that did the worst job complying with the safety measures, and more complications in hospitals with the best compliance records." Researchers noted that the government's hospital rating system is faulty because it only collects data on safety measures that are "important but don't have a huge impact on mortality." They concluded that "perhaps the government - and patients - would be better off with other kinds of safety data" (Kaplan, 10/18).

The Wall Street Journal: "Doctors and hospitals resist being measured publicly on death and complication rates, as comparisons that are fair to all kinds of hospitals are difficult. It involves 'risk-adjusting' results so that hospitals aren't punished for taking the frailest and sickest patients." Other studies have arrived at similar conclusions: "A 2006 University of Pennsylvania study … concluded Medicare's 'performance measures are not tightly linked to patient outcomes.'" Medicare officials said that the study took place in the early stages of its process measurements, and they anticipate "reporting more outcome measures in the future" (Burton, 10/18).

PBS Newshour: "Most hospitals have been required to report some quality measures to Medicare in order to receive their full annual payment update since the Medicare Modernization act of 2003. But beginning in October 2012, the health reform law will actually begin to tie hospitals' Medicare reimbursements to how well they do on quality measures - though the details of what those measures will be is still being worked out" (Winerman, 10/18).

Another new study in the Archives of Surgery suggests that surgical errors, such as operating on the wrong patient, occur more frequently than one might think.

Health.com/CNN: A new study suggests that surgical errors are more common than one might think. "Over a period of 6.5 years, doctors in Colorado alone operated on the wrong patient at least 25 times and on the wrong part of the body in another 107 patients, according to the study. ... [S]o-called wrong-patient and wrong-site procedures accounted for about 0.5 percent of all medical mistakes analyzed in the study." Those figures are much higher than previous estimates, the researchers say. After analyzing 27,370 records from a database of medical errors maintained by a company providing malpractice insurance to Colorado physicians, they discovered that "[a]ll of the mistakes could be traced back to some form of miscommunication" (Gardner, 10/18).

The New York Times: "In the worst case reported, a chest tube was inserted into the wrong lung — the healthy one — and it collapsed, killing the patient. In other cases, surgeons removed a healthy ovary, operated on the wrong side of the brain, fused the wrong vertebrae and did procedures on the wrong eye, knee, foot, elbow and hand. … The mix-ups often started in the internist's office" (Rabin, 10/15).

Reuters: The mix-ups happened "despite the widespread use of a protocol" to ensure that pre-surgical briefings, called time-outs, took place before each procedure, "and making sure that doctors are dealing with the right patients." One doctor explained that reducing errors meant changing the strictly hierarchical culture of the operating room, and encouraging patients to ask their team for a briefing discussion before the surgery (Joelving, 10/18).

The Hill: Meanwhile, Donald Berwick, the head of the Centers for Medicare and Medicaid Services, said that improving the U.S. health care system will "depend on how well government and the private sector work together toward common goals." The agency's "Triple-Aim" is to "to promote better care, ensure better health outcomes and lower costs simultaneously" (Lillis, 10/18).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.