The good news is that nationwide the morality rates at hospitals have dropped an average of 10.99 percent in 2006 to 2008. The bad news is that when you rank hospitals on a five star system, with five stars being the best, and one star being the worst, you have double the risk of dying at the one star hospital when compared to a five star hospital. Meaning that at some hospitals in the country patients put themselves in danger just by walking in the door.
This is the conclusion in the12th Annual “HealthGrades Hospital Quality in America Study”, that hospitals vary greatly in the quality of care that they provide patients. About half of these hospital deaths, which were found to be excessive in poor quality hospitals, involved such common diagnosis as sepsis, pneumonia, heart failure and respiratory failure. While it is great to have high quality specialist care in a large five star hospital, all doctors should be able to competently treat such common conditions as sepsis, heart failure, pneumonia and respiratory failure without much difference in care. Albeit, many patients with the above mentioned diagnosis will require care in an intensive care unit in the hospital.
One reason for the overall decrease observed for in-hospital morality across the board, but the fact that many hospitals are doing much worse than their peers, is that hospitals follow different guidelines for conditions such as sepsis, and many lower quality hospitals, such as one star hospitals, may be delayed in adopting evidence based procedures. Indeed, as medical students I got to see care at several different hospitals, and some of these hospitals were behind in implementing new guidelines in inpatient hospital care, such as those involving preventing strokes and embolisms in hospitalized patients, as well as guidelines for patients who are suspected of having sepsis.
While such guidelines are produced by national professional organizations, in major medical journals, at the same time nationwide, individual hospitals often vary significantly in the adoption of new guidelines and new proven treatments. While such disparity has been known for years to exist between hospitals of different qualities, what could be done to improve these statistics?
One might be the adopt of a standardized electronic medical record system in the United States. While expensive to develop and install, such a system could allow for the quick assessment of hospitals treatment protocols, as well as outcomes, and perhaps could help to quickly identify some of the worst performing hospitals which then could have their records analyzed in a blinded fashion, and be given expert advice about how to decrease mortality in their hospital.
Even more so, electronic medical records allow for prompts and messages to be displayed when a patient with a certain condition or risk factor is hospitalized, thus reminding the doctor in charge of their care to implement one or more of a variety of medical protocols, all of which would be hard for any one doctor to remember.
Hopefully, the Health Grades Study will lead to future interventions to help some of the country’s poorest performing hospitals, and allow patients to receive excellent care no matter what hospital they go to.
HealthGrades: Far Fewer Deaths At Best Hospitals