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Better Safety and Emergency Focus on Severely Ill Found in Top-Performing Hospitals

Posted on: Monday, 27 February 2006, 12:00 CST

Two new findings -- concerning the impact of higher patient safety on the patient's risk of dying and differences in patient focus in the emergency department (ED) -- were released today by Solucient(R), the nation's leading source of information products for the healthcare industry. Both findings highlight major differences between high-performing hospitals and their peers.

The findings are part of the Solucient 100 Top Hospitals(R): National Benchmarks for Success, 13th Edition study which annually examines changing performance levels in U.S. hospitals across five critical performance areas: outcome of care, patient safety, efficiency, financial performance and growing community service. In addition to the new findings, the study announced the nation's new benchmark hospitals for organization-wide high performance. The 2005 list identifies benchmark-setting hospitals in five categories: major teaching hospitals, teaching hospitals, large community hospitals, medium community hospitals and small community hospitals. The 100 winners will be announced in the February 27 issue of Modern Healthcare.

Research showed that EDs at winners of the 100 Top Hospitals National award tend to have a higher percentage of patients requiring more complex treatment or admission to the hospital than EDs at non-winners. Benchmark hospitals were approximately 9 percent more likely to have higher complexity or admitted patients from the ED, after adjusting for hospital region and class.

Winners of the 100 Top Hospitals National award were also less likely to experience adverse outcomes than peer hospitals. These adverse outcomes, also known as medical injuries, can have serious and harmful consequences.

"The 100 Top Hospital award winners continue to demonstrate significant distinctions in provision of value to their communities, as shown by objective differences in clinical outcomes, patient safety, efficient operations and financial stability," said Jean Chenoweth, senior vice president of Solucient's Center for Healthcare Improvement, which is responsible for the 100 Top Hospitals program. "The heavier volumes of the severely ill treated in EDs of these high-performing hospitals may suggest different approaches to accommodating the physician office-level needs of the community -- possibly through partnerships or alternate care services to streamline EDs."

Emergency department overcrowding has become a major problem in the U.S. "Based on our research, it appears that increases in numbers of patients at both ends of the acuity spectrum contribute to ED overcrowding," explained Janet Young, M.D., M.H.S.A., senior scientist at Solucient and co-author of the study. "Some increased volume may be due to severely ill patients who can now be treated successfully in the ED, such as those with irregular heartbeat. At the other end of the spectrum, a growing number of less sick patients are now coming to the ED, particularly in areas without after-hours facilities. This is an access problem."

In addition, the new study shows objective data confirming significantly lower risk of death and lower costs when hospitals increase patient safety, as defined by the Patient Safety Indicators (PSIs) of the Agency for Healthcare Research and Quality (AHRQ), a widely accepted measure of hospital safety. The research shows that the presence of any adverse result on the PSI list significantly and negatively impacted the risk of death, patient length of stay (LOS) and cost per case. Consequences ranged from modest to severe, with the greatest impact per case seen in the following situations:

-- LOS was increased by more than 12 days for patients with PSI 7 (Selected Infections Due to Medical Care) compared to those without these infections.

-- Average cost per case was increased by almost $27,000 for patients who experienced PSI 13 (Postoperative Sepsis) versus similar non-cases.

-- The risk of death was more than 17 times higher among patients who had PSI 11 (Postoperative Respiratory Failure) than among similar patients who did not.

"This latest analysis also confirmed previous work indicating that 100 Top Hospitals have better patient safety," said David Foster, Ph.D., M.P.H., chief scientist at Solucient. "Hospitals that won a 100 Top Hospitals award in the 2005 national study had risk-adjusted PSI rates that were significantly lower than non-winners for nine of the 11 PSIs studied, while rates for the remaining PSIs were not significantly different between winners and non-winners."

Other findings of the study include:

-- If all acute care hospitals performed at the same level as the nation's benchmark hospitals, as many as 106,312 more Medicare patients could survive and an additional 117,000 patient stays could be complication-free each year -- at an estimated annual savings of $7.6 billion.

-- For the second straight year, the Midwest region was home to the highest number of national benchmark hospitals, confirming a shift from the South, which previously had the highest number of national award winners for nearly a decade.

-- For the first time, a hospital -- Evanston Northwestern Healthcare, Evanston Ill. -- has achieved national benchmark status 11 times.

-- Survival rates were higher at benchmark hospitals (96.9 percent) compared to the typical peer hospital (96.2 percent), translating into tens of thousands of lives saved.

-- The 100 Top Hospitals treated sicker patients requiring more complex treatment, yet had better patient outcomes and lower costs.

-- Salary and benefits were $1,500 per year higher per full-time staff member than at peer hospitals.

The 13th edition of the Solucient 100 Top Hospitals: National Benchmarks for Success study uses a balanced scorecard approach and scores hospitals according to nine key organization-wide measures: risk-adjusted mortality, risk-adjusted complications, patient safety, growth in patient volume, severity-adjusted average length of stay, expense per adjusted discharge, profit from operations, cash to debt ratio and tangible assets per discharge.

About Solucient

Solucient(R) is an information products company serving the healthcare industry. It is the market leader in providing tools and vital insights that healthcare managers use to improve the performance of their organizations.

By integrating, standardizing and enhancing healthcare information, Solucient provides comparative measurements of cost, quality and market performance. Solucient's expertise and proven solutions enable providers, payers and pharmaceutical companies to drive business growth, manage costs and deliver high quality care. For more information, visit www.solucient.com.

Media Notes:

More information on these studies and other 100 Top Hospitals research, including "Emergency Departments Vary Widely" and "Consequences of Medical Injuries," is available at www.100tophospitals.com. An executive summary of the 100 Top Hospitals: National Benchmarks for Success study is available to the media by emailing gsexton@solucient.com or by registering at http://www.100tophospitals.com/media/Register.asp.

For a list of this year's winners, visit http://www.100tophospitals.com/Winners/national05/benchmarks.asp

To schedule an interview with Jean Chenoweth, senior vice president, performance improvement and 100 Top Hospital programs, Solucient Center for Healthcare Improvement, contact Ginny Sexton at (847) 424-4358 or gsexton@solucient.com.

Source: Business Wire

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