A national hospital watchdog group has ranked Maine’s hospitals the safest in the nation, just as another new report shows a drop in serious medical errors in the state.
Eighty percent of hospitals in Maine earned an “A” in the Hospital Safety Score ratings released May 8 by the Leapfrog Group, a national patient safety organization. That gave Maine the top spot over Massachusetts, which led the nation in Leapfrog’s last report card, released in November 2012.
“We continue to do well on quality-related measures,” said Jeff Austin, a lobbyist with the Maine Hospital Association. “There’s always work to be done, nobody is perfect, that’s clear. But relatively speaking, we continue to perform very strongly in national comparisons.”
Hospitals’ focus on quality is about improving care overall, rather than simply performing “better than the next guy,” Austin said.
The letter grades reflect the risk that a patient could be harmed by a preventable medical error while hospitalized. In the U.S., roughly one in four hospitalized patients suffer some form of harm, including errors, accidents, injuries and infections, according to Leapfrog, which cited a 2012 government study of Medicare recipients.
The grades are based on 26 measures of patient safety. Leapfrog assesses public data on measures including falls, bed sores and how consistently hospitals follow recommended treatment protocols, such as administering antibiotics to patients within an hour before surgery.
In Maine, 16 hospitals earned an “A” grade. Three hospitals — Maine Medical Center in Portland, Franklin Memorial in Farmington and the Augusta campus of MaineGeneral Medical Center — received a “B.” York Hospital earned the lowest grade in the state, a “C” rating.
Some hospital officials have said they suspected they were penalized for failing to participate in Leapfrog’s voluntary surveys, which the group incorporates in its assessments. Leapfrog has said that participation has no bearing on a hospital’s grade.
Nationally, Leapfrog’s review showed “only incremental progress” in addressing patient harm among the 2,500 hospitals issued a safety score.
The states with the smallest percentage of “A” hospitals included Nevada, Kansas, Oregon, West Virginia and New Mexico, which had the lowest percentage at 6.7 percent.
Leapfrog’s scores are part of a growing effort nationally to help consumers become better informed health care shoppers. The federal government also is looking more closely at patient safety data, making a push through Medicare and Medicaid to pay health care providers based on the quality of care they offer.
Part of the push to improve patient safety in Maine includes annual reporting of serious and preventable medical errors that occur at hospitals, such as medication mix ups and surgery on the wrong body part. Last year, Maine counted 146 of those errors, known as “sentinel events,” down from 163 in 2011, according to new state report.
While the total number of events dipped, they included some egregious errors. Twice, surgeons operated on the wrong part of a patient’s body. In 14 cases “foreign objects,” such as surgical tools and sponges, were left behind in patients’ bodies.
Of the 146 events that were reported, 36 involved patients who went to the hospital with an illness or injury that was not life-threatening but died unexpectedly. Injuries from falls and pressure ulcers, or bed sores, were other problem areas.
There also were three assaults on patients and four patient suicides or attempted suicides resulting in serious disability.
Though the total number of sentinel events is down, the hospital association has pointed out in the past that better reporting of errors by hospitals can lead to higher numbers.
“More events may not be indicative of worse quality,” Austin said.
Maine saw a spike in sentinel events in 2010 that continued into 2011, which last year’s report partly attributed to growing appreciation among health providers for preventing medical errors through better transparency.
The report doesn’t identify which health care facilities reported sentinel events. The program keeps reports of sentinel events confidential in an effort to encourage reporting by health practitioners that will help to remedy circumstances that allow patients to be harmed.
Patient advocate and former nurse Kathy Day argues that the report should disclose sentinel events by hospital.
“It’s important that we know what happens at what hospitals in the name of transparency and accountability,” she said. “It’s not to place blame; it’s so that we can be wise health care consumers.”
Austin said other accountability measures are in place to respond to serious medical errors, including the licensing process and lawsuits.
“We need accountability measures, and we have those,” he said. “But we also need quality improvement processes, and that’s what sentinel event reporting is about, it’s about people feeling comfortable [reporting errors].”
Day agreed that confidentiality should play a role in the process, to protect health practitioners who report medical errors.
“There should be openness among staff, no matter the level, to report these things for the benefit of patients and not have to worry about retribution,” she said.
Hospitals must follow detailed reporting requirements when a sentinel event occurs, including notifying the Department of Health and Human Services within one business day and drafting a report within 45 days describing the event and steps taken to prevent a recurrence. The sentinel event program operates independently of the licensing division at DHHS, sharing information about medical errors only when there’s an immediate safety risk.
The process does not outline any requirements for hospitals to inform patients who are involved in sentinel events. Day and other patient safety experts said they were unaware of any such disclosure requirements, though the topic is the subject of much discussion in the field nationally.
Though the release of the sentinel event report coincided with Leapfrog’s updated hospital safety scores, the two reports make for an apples-to-oranges comparison, said Lisa Letourneau, executive director of Maine Quality Counts, a collaborative working to improve health care in Maine. The Leapfrog scores reflect how well hospitals follow processes proven to improve quality, while the sentinel event report reflects the results of hospital treatment, she said.
“They really are two different kinds of measures. One’s a process measure and one’s an outcome [measure],” she said.
Hospital reporting of sentinel events leads to more transparency, which ultimately improves outcomes, Letourneau said.
The Leapfrog report followed a number of other hospital quality ratings from various groups in recent months, including Consumer Reports and the Joint Commission, a hospital accreditation organization. Health experts debate which measures best reflect patient care.