At Missouri Baptist Hospital in St. Louis it only takes 90 seconds to save a life.
While all hospitals keep staff on-call for emergencies, Missouri Baptist has implemented a rapid response program through which anyone — even family members — can summon a team of clinicians to the bedside of a distressed patient within 90 seconds.
Dr. John Krettek, the hospital's medical director, says that nationwide, since 80 percent of patients who have a heart attack while in the hospital die in the hospital, it's important to intervene before that or another acute event occurs. The physician's assistant, respiratory therapist and nurse who make up the critical care team and tend to the patient are trained to prevent that from happening.
Missouri Baptist imported the idea from Australia, and Dr. Krettek says the hospital's overall emphasis on safety is evident not only in its innovative programs, but also in its numbers. According to internal data, only 48 percent of patients die as would be expected given their diagnoses.
With outcomes like these, it's no surprise that Missouri Baptist was designated by HealthGrades, a private hospital rating company in Golden, Colo., as one of the safest in the country.
Behind the numbers
In its seventh annual study of "quality and clinical excellence," HealthGrades has identified 270 hospitals out of 5,000 that collectively had a 28 percent lower mortality rate and 8 percent lower complication rate than the national average. The list reflects the top 5 percent of hospitals nationwide.
"What's very impressive is that when you look at statistics at high-performing hospitals," says co-author Dr. Rick May, it's clear that "they don't get [the HealthGrades distinction] by chance. They do it by being extremely focused."
Access to hospitals with such positive outcomes could be life-saving. If all facilities performed at this level, argue the study's authors Dr. Rick May and Dr. Samantha Collier, 152,600 lives might have been saved and 11,700 hospital complications might have been prevented between 2005 and 2007, the years for which HealthGrades used data.
Improved safety rates clearly benefit patients, but they may also benefit the bottom line. Though the company did not make a link between lower complication and mortality rates and lower premiums for medical malpractice insurance, improved safety rates may persuade underwriters to view the hospital as low-risk. They may also decrease the number of medical malpractice claims, which cost insurers $7.1 billion in 2007, according to the National Association of Insurance Commissioners.
Though many nonprofit organizations and companies offer information on hospital outcomes, HealthGrades is one of the only private companies to designate top performers. It does so by collecting an astounding amount of data on patient stays.
For this study, it used administrative coding from more than 41 million Medicare patient records. The authors evaluated 26 common inpatient procedures and diagnoses and were able to determine outcomes in each case. The results are controlled for increased risk among populations with respect to factors like age, gender and sicker patients.
Thirty-five states had at least one hospital that earned the HealthGrades designation, but some areas did much better than others. Baltimore and Chicago each had five hospitals on the list, including Good Samaritan and Swedish Covenant Hospital, while Los Angeles had three, including Cedars-Sinai Medical Center. Hospitals in Philadelphia failed to make the list, but Pennsylvania had a strong showing with 19 hospitals.
One pattern that emerges is that prestigious academic medical centers do not always register the best outcomes, at least according to HealthGrades. For example, the University of Pittsburgh Medical Center's Presbyterian Hospital is on the list, but the various hospitals associated with the top-ranked medical school in the state, the University of Pennsylvania, are not.
There are parallels in other metropolitan areas where community hospitals are producing superior outcomes. St. Louis is home to the Washington University School of Medicine, regularly ranked as one of the nation's top medical schools. Yet its main teaching hospital, Barnes-Jewish, is not on HealthGrades' list. Instead, its sister hospital Missouri Baptist receives the distinction. Other marquis names missing are Johns Hopkins in Baltimore and Brigham and Women's Hospital in Boston.
"There will always be some big-name hospitals that are dedicated to quality that rise to the top because of their outcomes," says Dr. May of HealthGrades. "What I think is more impressive is that there are lesser-known hospitals that get great results."
One example is Lancaster General Hospital in Lancaster, Pa. It beat Pennsylvania State University's hospital in nearby Hershey, which often appears in other rankings including U.S. News and World Reports' Best Hospitals, a survey of doctors that measures reputation. ("We're constantly trying to make our outcomes better," says Penn State, Hershey, spokeswoman Danielle Ran, who said she was not familiar with how HealthGrades comes up with its list.)
Lancaster General's chief quality officer, Norma Ferdinand, says the hospital’s success is due to vigilant transparency. The hospital gives its staff access to internal reports that include "fall rates" for patients cared for by every nursing station, complication rates for every cardiac surgeon, and similar measures in other parts of the hospitals. If quality is slipping anywhere, it's visible to everyone.
At St. Vincent's Medical Center in Jacksonville, Fla., similar data are posted in the various lounges so staff members can compare their performances with other hospital departments. The hospital has also undertaken a series of initiatives to improve care, including a program to rapidly identify heart attack victims and get them to a cardiac catheterization lab within 90 minutes of arrival. In the lab, a catheter is inserted into the heart to unblock the blood vessels.
The average "floor to balloon" time now averages between 70 and 90 minutes, says Dr. Phil Perry, chief medical officer for St. Vincent's HealthCare, who adds that feedback to ER physicians helped convince staff members to adhere to the new program rules. The feedback wasn't praise, but an X-ray of the blocked blood vessels before and after catheter insertion. "It's a dramatic thing to see," he says, "and it's helped drive change."
Be a better health consumer
Despite the strong evidence pointing to different outcomes at different hospitals, the majority of patients are unwitting health consumers, says Dr. Gregg Meyer, vice president of quality and safety at Massachusetts General Hospital. (The hospital also made HealthGrades' list.)
Aside from independent ratings, Meyer urges patients to consider a handful of other indicators in assessing the quality of care at a hospital. A top physician, he says, will have data to demonstrate his or her success rate in treating patients. The best hospitals will be willing to share statistics on its performance, and consumers shouldn't hesitate to ask.
Some hospitals — Mass General included — have made their internal data available online so consumers can evaluate important things like patient experience, pain management and heart attack treatment.
But perhaps most important is a hospital's willingness to admit its mistakes.
"What you want is an organization that has a high rate of reported safety events and does something about them," Meyer says. It may be counter-intuitive, but "it's a great thing because ... they wouldn't bother reporting if they didn't know they were going to do something about it."