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The Journal Gazette

Sunday, July 16, 2017 1:00 am

Drop in care ratings can't be fixed cheaply

In a hospital, everybody – worker, patient or visitor – is concerned about safety.

In fact, the U.S. government provides a website that brings together official reports and inspections to form hospital safety rankings independent of fees and advertising: Medicare Hospital Compare (www.medicare.gov/hospitalcompare/about/what-is-HOS.html).

The results of a comparison between Lutheran and Parkview hospitals are telling and can be viewed at this website: www.medicare.gov/hospitalcompare/details.html?msrCd=prnt9grp1&ID=150017, 150021

When you dig into the measurements, some differences are small – but all things considered, Lutheran ranks in the lower 40 percent with two stars and Parkview in the top 20 percent with four stars. Lutheran has done far better in the past.

Medicare safety ratings are created through studies of hospital-related com-plications. New ones are added each year or so and recently consisted of a group of measurements involving infections, surgical complications, and other serious complications (as determined by AHRQ, the Agency for Healthcare Research and Quality – see www.medicare.gov/hospitalcompare/Data/Serious-Complications.html).

It would appear that Lutheran Hospital (rated below the national average for serious complications) did relatively well for many other measures (www.medicare.gov/hospitalcompare/profile.html#profTab=3 &ID=150017&Distn=3.7&dist=50&loc=46814&lat=41.0547294&lng=-85.3032811), and so not too much should be made of this single disappointing mark.

Lutheran is also rated below average in patient experience while Parkview is rated above the national average.

How might one interpret these broad Medicare statements? How might one improve ratings?

Sometimes, a rating can depend on a single breakdown in hospital procedure or routine.

For example, a urinary catheter may be left in longer than necessary, leading to infection; or a “central I.V. line,” long dwelling in a big vein, may be used to draw blood or to inject medication without, each time, using perfect sterilization. An increase in training and better record keeping may solve such problems.

These things can happen in the best of hospitals – but they happen less often.

Other problems, such as a patient fall with injury, can correlate to low staffing. Patients may ring for nurses and be unable to wait for their attention, and so try, unwisely, to get out of bed alone – and fall on the way to the toilet.

It takes little imagination to list the negative side effects related to too few nurses – fewer room visits and observation, late medications, too little time to communicate effectively, etc.

The Lutheran Hospital staffing level could well be, on some floors, half that of Parkview's advertised ratio of 1:4; precise information would be available from Lutheran nurses and physicians.

Lutheran Medical staff doctors have estimated a shortage of as many as 400 nurses. The doctors cite low wages and higher turnover even for those who draw blood samples.

What is the likely cost to improve these ratings to return Lutheran to four-star status?

Recommendations from doctors who have been interviewed would begin with competitive wages and far better staffing ratios. Were Lutheran Hospital to hire 400 nurses at an average wage (including benefits) of $60,000, the cost would be $24 million per year or $144 million over six years. That is well within the capability of its $300 million earnings per year – if that money were not being spent elsewhere by Community Health to bail out its struggling hospitals or, for that matter, on private jets and generous administrative salaries.

In fairness, Community Health administrators have taken a pay cut (insiders.morningstar.com/trading/executive-compensation.action?t=CYH) in three of the last five years. Nevertheless, it's worth asking what else can and should be done to ensure patient safety.

How is Community Health committed, not through mere words and not six years down the line, to Lutheran Health Network's staff and physicians? Where does patient safety rank against other factors in terms of corporate priorities? And – perhaps most importantly – what investments is Community Health willing to make to ensure a higher quality of care and a stronger commitment to safety moving forward?

The only certainty is that improvement is needed at Lutheran.

And that improvement will only come if Community Health commits to making four-star patient safety its highest priority.

– Dr. William Cast for NICHE