Judges’ comments:
In a two year examination of every in-patient hospital admission in Nevada going back a decade, 2.9 million in all, the Las Vegas Sun uncovered almost 4,000 cases of preventable harm. In 350 cases, the patient died. Over a week-long series, readers learned the personal stories of many of these injured patients and the hospitals where they had been treated. The result of this gripping series? Within weeks of publication, Nevada hospitals began sharing internal quality information with the public. With user-friendly interactive tools available on the Sun’s website, consumers can now see how their own hospital fares on many fronts–from hospital-acquired infections to preventable injuries. An outstanding combination of computer-assisted reporting and quality story telling.
1. Provide the title of your story or series and the names of the journalists involved.
“Do No Harm: Hospital Care in Las Vegas” by Marshall Allen and Alex Richards
See this entry.
See the project on the web.
2. List date(s) this work was published or aired.
“Health Care Can Hurt You” — June 27, 2010
“A Hidden Epidemic” — Aug. 8, 2010
“Patients At Risk Under the Knife” — Sept. 19, 2010
“Why We Suffer” — Nov. 14, 2010
“How To Put Patients First” — Dec. 26, 2010
3. Provide a brief synopsis of the story or stories, including any significant findings.
“Do No Harm: Hospital Care in Las Vegas” used investigative journalism, computer-assisted reporting, statistical analysis and new media tools to break through a wall of bureaucracy and complicated data to tap meaningful information about local hospital care. As part of a two-year investigation, Sun reporters Marshall Allen and Alex Richards obtained and analyzed a state record of every Nevada hospital inpatient visit going back a decade — 2.9 million in all. Nevada has kept the records since 1986, but it’s the first time they’ve been analyzed for the public’s benefit. The Sun’s analysis of 2008 and 2009 hospital records identified: ” 969 cases of preventable harm, including bedsores, infections, falls and other trauma. ” 2,010 infections from lethal superbugs — antibiotic resistant bacteria that proliferate in hospitals. ” 710 accidental surgical injuries. In 356 of the cases, the patient died in the hospital. This information has never before been made public by any organization — and is in fact hidden from consumers throughout the United States. The Sun also exposed that hospitals have lobbied to keep this information hidden from consumers, and are not employing best practices to prevent the injuries and infections. Allen interviewed more than 250 doctors, hospital administrators, nurses, academic experts and patients and wrote what is essentially a root cause analysis of the Las Vegas hospitals. He found that Las Vegas is the only urban area in the nation without an academic medical center, and has the highest concentration of for-profit hospitals of any metropolitan area in the country. Then he traveled to Chicago to report on a hospital that takes a radical approach to protecting patients and preventing harm, to highlight that not all hospitals take such a lackadaisical approach toward the problem. The Sun imposed transparency and accountability on the hospitals in Las Vegas. If the newspaper’s methods were duplicated in other states, the same could be done nationally.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Careful negotiations for public records were the early key to the project’s success. The Sun negotiated with the state, under state public records laws, for the release of the hospital inpatient database. The
Sun asked the state to donate the 11 years of data for free, and wrote an addendum to the use agreement that would allow the Sun to use the data for journalistic purposes: analyzing the data and run its findings by experts in order to fulfill its public service mission. The state’s approval of the Sun’s request gave the newspaper data that identified longitudinal problems with the quality of care in Las Vegas hospitals. The Sun’s reporting also included records requests to the state of Nevada and the federal Centers for Medicare & Medicaid Services for inspection reports, and mining the state’s archives of minutes and transcripts from public meetings where hospital lobbyists have argued against transparency efforts.
5. Explain types of human sources used.
Allen interviewed more than 250 doctors, nurses, hospital administrators, medical consultants, academics, politicians and patients for this project. The depth of reporting provided an abundance of sources and an ability to write with an authoritative voice about the quality of hospital care in Las Vegas.
6. Results (if any).
The Las Vegas Sun accomplished within weeks of publication what elected officials could not do in eight years — force hospitals to share internal quality information with the public. Before the Sun published “Do No Harm: Hospital Care in Las Vegas,” the public was able to learn more about the odds of a slot machine than the quality of care provided by a hospital. The hospitals have long fought to keep it that way. Because of the Sun’s investigation: ” Four of the 13 Las Vegas hospitals publish their sentinel events and other quality information, including infections rates on their website. ” Three proposed new laws are being drafted for the 2011 legislative session that would increase transparency and accountability for hospitals in the realm of reporting infections and injuries that take place in their facilities. ” State regulators are investigating the apparent under-reporting by hospitals of sentinel events — cases where patients are harmed in the hospital — which was exposed by the Sun. In addition, regulators now use the hospital inpatient data — which they had never before analyzed — to inform their routine inspections of hospitals. The state epidemiologist is now using the Sun’s methods to analyze inpatient data for investigations of infectious diseases. ” In November, more than 200 health care providers and consumer advocates attended a state-sponsored summit to fight the deadly bacterium methicillin-resistant Staphylococcus aureus, known as MRSA. The state announced grants up to $30,000 for health care facilities to reduce infections. The public outcry is still ongoing. At the Nov. 16 MRSA summit patients learned how to become active in the legislative process, so the patient safety movement looks to continue in the coming months. In addition, regulators and journalists in other states are inquiring about the Sun’s methods. More than 40 states keep similar data, so the Sun’s analysis could be duplicated around the country.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No corrections or clarifications were necessary. No one has challenged the accuracy of the reporting.
8. Advice to other journalists planning a similar story or project.
Go for it! More than 40 states have inpatient hospital data that’s similar to the information the Sun used for this project. This type of project is complicated, but provides an unprecedented opportunity to inform consumers about the health care they receive, and impose transparency and accountability on the health care system. It’s our hope that other journalists will pursue this same type of analysis, and we’re sure they will have similar results. This effort was unique in that we could find no other organization, journalism or otherwise, that had conducted this type of analysis of inpatient hospital records. It took months of painstaking CAR work to clean up the data, and the Sun identified many dirty parts of the data set that needed to be cleaned up before doing its final analysis. The Sun needed to develop an understanding of hospital payment codes to mine the data for information. One of the biggest challenges was identifying the most meaningful way of presenting the information to the public. The inpatient data could be analyzed dozens of different ways to produce dozens of different stories. The Sun’s goal was to identify the information within the data that was most relevant to readers, and then restrict the presentation to these elements. Be warned that this project was incredibly controversial to the hospitals, who tried to pressure the Sun’s publisher and editor into softening the stories. After the stories ran, hospitals took out ads in the opposing newspaper to counter the project, and one hospital CEO sent a letter to every legislator in the state, and all the doctors on his staff, criticizing the project. That same CEO later changed his mind about the project, and sent another letter retracting his criticism. The president of the local medical society criticized the Sun in three consecutive newsletters he sent to the medical community. And attorneys from local hospitals sat in conference rooms scrutinizing the stories.