Find out Tampa Bay hospital's quality before you check in

Themika Lewis goes over paperwork with Norine McCarthy of Tampa before she’s discharged last week from Pepin Heart at University Community Hospital in Tampa.

EDMUND D. FOUNTAIN | Times

Themika Lewis goes over paperwork with Norine McCarthy of Tampa before she’s discharged last week from Pepin Heart at University Community Hospital in Tampa.

Want to know about a hospital before you have to check in? Ask the Internet and you'll find a baffling array of ratings based on all kinds of surveys and statistics. Many extol famous hospitals thousands of miles away, but say little or nothing about the ones where your doctor has admitting privileges.

One way to cut through the confusion: Focus on the quality measurements that hospitals consider their gold standard.

The Joint Commission, the nonprofit organization that accredits most U.S. hospitals, publishes a consumer-friendly report called Quality Check. It grades hospitals on how well they follow care practices that are known to work, ranging from infection control standards to educating patients.

How well respected are these national quality goals? Here's a clue: The St. Petersburg Times talked to local hospitals, and even those that didn't do so well spent a lot more time talking about how they were working to improve than being defensive.

A hospital's performance “gives you insight into how much a hospital is committed to trying to do at least these things that people have agreed are important to do," said Elizabeth McGlynn, an associate director of the research institute RAND Health. "This idea that we can just trust the medical community to do the right thing — the measures tell us that doesn't always happen."

Quality Check offers a simplified overview of the data also used by the Centers for Medicare and Medicaid Services to compare hospitals. At a glance, you can see how hospitals compare on treating common medical conditions like heart attacks, heart failure and pneumonia.

These scores do not tell you how many patients died, or whether the best surgeons in town practice at the hospital. What they do give you is an inside look at how the hospital operates. Sort of like if parents could monitor their teens' driving habits, rather than waiting for an accident to occur.

Just as with any report card, hospitals can miss a target by just a few percentage points and receive a bad score, several local hospital officials pointed out. That's why it's wise to talk to your doctors about the ratings.

But hospitals that perform poorly can't blame their patients for being sicker than the average. These grades are based on practices that are entirely within the hospital's control.

"The hospital had an opportunity to do the right thing based on sound science," said Jerod Loeb, the Joint Commission's executive vice president for quality measurement and research. "It doesn't matter if your patient has all kinds of complicating factors. Did you do the right thing, or didn't you?"

We've highlighted how some of the Tampa Bay area's leading hospitals measure up on Quality Check in overall care for cardiac conditions and pneumonia care, and also how they did in measures to prevent surgical infection. You can find many more details about the hospital's performance in each category on the Web site, www.qualitycheck.org.

Cardiac care

Heart disease is the nation's No. 1 killer, so consumers can learn a lot from the ratings that hospitals receive for both heart attack and heart failure care.

A heart attack involves death or damage to part of the heart muscle, generally from a blockage in a coronary artery. Heart failure is a long-term, chronic condition in which the heart cannot pump enough blood to meet the body's needs. Heart attacks can lead to heart failure.

Tampa Bay's leading hospitals all performed at or above state targets in treating heart attacks in the report, which is based on data for the year ending in June 2009. Hospitals submit information for the reports updated quarterly.

Heart failure care was a different story. Three Pinellas hospitals — St. Anthony's, Morton Plant and Bayfront — shared a common problem: Not enough patients were receiving adequate discharge instructions, a key to preventing rehospitalization.

Heart failure patients can arrive at the hospital confused about the many medications they may take at home, said Denise Remus, chief quality officer for BayCare Health System, which operates St. Anthony's in St. Petersburg and Morton Plant in Clearwater.

"They're trying to tell you, 'I take this yellow pill,' so it can be difficult to assess what they're on at home," Remus said. Still, doctors must make sure whatever the patient has at home won't conflict with new medications, or the consequences can be dire.

To improve, Remus said patients are being asked to repeat back what they are supposed to be doing at home, so everyone knows the new regimen is really understood.

Hospitals that excelled on this measure, like Regional Medical Center Bayonet Point, say details are crucial. For instance, the Pasco County hospital uses large type for discharge instructions, so older patients won't struggle to read fine print.

Pneumonia care

When a patient comes into the emergency room with what looks like pneumonia, time is critical. For best results, according to the quality goals, pneumonia should be diagnosed and antibiotics begun within six hours.

Several of the region's largest hospitals, including Tampa General, St. Joseph's and University Community Hospital, have struggled to meet the deadline.

"As busy as the ERs are, sometimes it's difficult to get it precisely within those six hours," said Dr. Brad Bjornstad, UCH's chief medical officer. "People are still getting the antibiotic and they're getting good outcomes, but sometimes we don't hit that six-hour mark."

UCH met the target for 91 percent of its pneumonia patients, just below the 95 percent state average. Now, UCH's nurses can order X-rays before the patient even sees a doctor.

Tampa General met the deadline for only 70 percent of pneumonia patients. While it is working to improve, Dr. Sally Houston, chief medical officer, said doctors worry about rushing a diagnosis and prescribing medication unnecessarily.

TGH also performed poorly on counseling pneumonia patients to quit smoking and making sure they got flu shots. Hospital officials said it has nurse specialists reviewing patients' charts to make sure such steps are taken.

"I don't think we could say that we're too busy taking care of transplant patients or burn patients to make sure we give patients their vaccines," Houston said. "That's not our philosophy."

Surgical indicators

Bayfront Medical Center, another busy trauma hospital, performed poorly on several of the Joint Commission's quality ratings, including standards for preventing surgical infection.

Bayfront lagged behind other hospitals in ensuring that surgical patients are given the most appropriate antibiotic and have the medication stopped within 24 hours after the procedure.

Karen Sondregger, a nurse and Bayfront's director of quality and patient safety, said that the problem wasn't quality but that the hospital hadn't documented in patient's charts that it had taken the right steps.

"Those scores are a very important part of quality measurement. They are only a part of quality measurement, however," said Sondregger, encouraging patients to ask their doctors what they think of hospitals. She said Bayfront is working with electronic medical records to better record what it is doing.

At hospitals that consistently performed well, officials said they use the quality targets to improve patient care.

"It is a culture change and it requires a lot of resources and constant attention," said Walt Pannone, chief nursing officer at Oak Hill Hospital in Hernando County. "We have to achieve it, because bottom line, it means better care for our patients."

Times researcher John Martin contributed to this report. Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.

How does your hospital stack up?

The Joint Commission, which accredits hospitals, also grades them on how well they follow care standards associated with the best outcomes for patients. Shown here are some of the largest hospitals in the Tampa Bay area, and how they compare with other Florida hospitals on the National Quality Improvement ratings. To see more hospitals' grades and learn more, go to www.qualitycheck.org.

Key: + performance above the target range | • performance similar to target range | — performance below target range

National Quality Improvement goals Bayfront Morton Plant St. Anthony's Brandon Regional St. Joseph's Tampa General University Community Bayonet Point Oak Hill
Heart attack care + + + + + + + +
Heart failure care +
Pneumonia care +

Protecting patients in surgery

The Joint Commission's Surgical Care Improvement Project examines how closely hospitals comply with care standards that reduce the chance of infection after surgery. To see more hospitals and procedures, to go www.qualitycheck.org.

National Quality Improvement goals Bayfront Morton Plant St. Anthony's Brandon Regional St. Joseph's Tampa General University Community Bayonet Point Oak Hill
Infection prevention (overall) + + + Not Available* + + +
Colon/large intestine surgery NA
Hip joint replacement + + + NA + +
Hysterectomy + NA NA**
Knee replacement + + + + NA + +

Source: the Joint Commission, Quality Check. This is a sampling of the indicators by which hospitals were compared to others in the state.
Reporting period July 2008-June 2009.

* TGH did not report surgical indicators for this period, but will in the future.

** Bayonet Point did not see enough patients in this category for comparison purposes.

What they do best

Tampa General

Heart attack care

Bayfront, St. Petersburg

Heart attack care

Morton Plant, Clearwater

Heart attack care; surgical infection prevention

Bayonet Point, Hudson

Heart attack care; heart failure care; surgical infection prevention

Oak Hill, Brooksville

Heart attack care; pneumonia care; surgical infection prevention

Find out Tampa Bay hospital's quality before you check in 02/17/10 [Last modified: Thursday, February 18, 2010 1:01am]

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