Tag Archives: hospital data

Report: Calif. hospital chain profited from ER admissions

After months of investigation and updates, California Watch reporters Christina Jewett and Stephen K. Doig have unleashed their full report on California hospital chain Prime Healthcare Services and its knack for turning around failing hospitals by apparently pushing for the admission of ER patients who are insured by Medicare or insurance giant Kaiser Permanente, then keeping them in the hospital.

The report includes hyperlink sourcing, a raft of related documents and a great explainer on how they assembled the numbers behind the story. The duo took advantage of court testimony, sources and reams of public records.

The reporters say that evidence points to “an orchestrated campaign of admitting Medicare and Kaiser patients – moving them from the emergency room to a hospital bed – in the interest of changing the fortune of a money-losing hospital.”

State data shows that after the hospital chain took over 11 hospitals beginning in 2005, the percentage of Medicare patients who were admitted from the emergency room to Prime hospital beds increased from about 45 to 63 percent.

That 40 percent increase contrasts with other California hospitals that saw an average 8 percent decline from 2005 to 2009 in Medicare patients moved from the emergency rooms to hospital beds, data shows.

And, as you’ll see throughout the story, the interviews and anecdotes back up the numbers.

Tina Buchanan, the hospital’s former chief nursing officer, testified that [Prime founder and chairman Dr. Prem Reddy] began to require emergency room staff to put a yellow sheet of paper on each patient record that listed their health insurance status.

She said he would go through the “goldenrods,” as the papers were called, and point out the Medicare or Kaiser patients and say, “Make sure you get this one admitted.”

“If it was … an uninsured patient, he would tell them, ‘Get them out of my hospital,’ ” Buchanan testified.

There’s plenty more where that came from, but I will just leave you with this editor’s note, which appears alongside the main story.

It came to our attention late Friday that Prime Healthcare had issued a press release saying it had taken legal action against California Watch. We have not been served and can’t fully comment until we have reviewed any legal filings. In our dealings with Prime over the course of the past several months, the company has yet to present to us a single factual error that has merited correction or clarification. We continue to stand by our reporting.

Alarm fatigue hurts patient care, overwhelms nurses

In the wake of several high-profile incidents, The Boston Globe‘s Liz Kowalczyk has assembled a thorough investigation of alarm fatigue in hospitals. Alarm fatigue, for the record, is the idea that the huge arsenal of patient monitors in any given hospital floor are going off so often that nurses become slower in their responses to the alarms. For example, in one 15-bed unit at Johns Hopkins, staff found that, on average, one critical alarm went off every 90 seconds throughout the day.

With the help of ECRI, Kowalczyk has managed to attach some numbers to the issue.

The Globe enlisted the ECRI Institute, a nonprofit health care research and consulting organization based in Pennsylvania, to help it analyze the Food and Drug Administration’s database of adverse events involving medical devices. The institute listed monitor alarms as the number-one health technology hazard for 2009. Its review found 216 deaths nationwide from 2005 to the middle of 2010 in which problems with monitor alarms occurred.

But ECRI, based on its work with hospitals, believes that the health care industry underreports these cases and that the number of deaths is far higher. It found 13 more cases in its own database, which it compiles from incident investigations on behalf of hospital clients and from its own voluntary reporting system.

Kowalczyk also looks at potential solutions to the problem and how some institutions are trying to make changes to eliminate alarm fatigue, including cutting back on unnecessary monitors and having monitor warnings appear on nurses’ pagers or cell phones.

To back up the numbers, Kowalcyzk got some telling quotes from frustrated nurses.

“Yes, this is real, and, yes, it’s getting worse,’’ said Carol Conley, chief nursing officer for Southcoast Health System, which includes Tobey Hospital. “We want to keep our patients safe and take advantage of all the technology. The unintended consequence is that we have a very over-stimulated environment.’’

“Everyone who walks in the door gets a monitor,’’ said Lisa Sawtelle, a nurse at Boston Medical Center. “We have 17 [types of] alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes . . . background.’’

Kowalcyzk’s investigation points out that, while alarms do tend to go off when there’s a real problem, it appears that they do so at the expense of also going off when there isn’t.

Monitors can be so sensitive that alarms go off when patients sit up, turn over, or cough. Some studies have found more than 85 percent of alarms are false, meaning that the patient is not in any danger. Over time this can make nurses less and less likely to respond urgently to the sound.

For more specifics on device design issues, see the final subheading, titled “Looking for solutions.”

For a one year, the Joint Commission made routine alarm testing and training part of their accreditation requirements, but dropped the stipulation in 2004 when it felt the problem had been solved.

Other parts of the series:

Hospitals to start reporting infection data Jan. 1

Hospitals are set to begin reporting information about hospital-acquired bloodstream infections to the federal government on Jan. 1, with the data becoming available to the public later in the year through the Hospital Compare website, according to an article by Tony Pugh of McClatchy Newspapers. Pugh also reports that hospitals will start reporting on surgical site infections in 2012.

The article includes a graphic that shows what states currently require public reporting of hospital-acquired infections.

While reporting to Hospital Compare will be voluntary, hospitals that fail to comply will “lose 2 percent of their Medicare funding beginning in fiscal year 2013.”

There are nearly 250,000 catheter-related bloodstream infections a year in U.S. hospitals, contributing to roughly 31,000 patient deaths annually. There are more than 290,000 surgical site infections a year, contributing to more than 8,200 deaths.

(Hat tip to FairWarning.org)

Reminder: AHCJ has compiled easy-to-use Excel spreadsheets of much of the data currently available from Hospital Compare. The up-to-date files, available to AHCJ members, are designed to allow you to compare more than three hospitals at a time – unlike the Hospital Compare look-up tool – using spreadsheet or database software to filter, sort and use other analysis tools with precision. You can look at hospital mortality and readmission data, as well as patient satisfaction.

AHCJ will be looking at making the new infection data available to members similar to what it offers for the mortality, readmission and patient satisfaction data.

AHCJ also has tip sheets to help you understand and analyze the data:

Indiana numbers show preventable errors down

The Indianapolis Star‘s Daniel Lee reports that, according to the state’s newly released 2009 numbers, preventable medical errors are down in Indiana. There were 94 reported errors last year, down from 105 each in 2007 and 2008.

Part of the decline can be attributed to the health department’s Indiana Pressure Ulcer Initiative, which appears to have helped bring bed sore occurrences down 33 percent from 2008.

The initiative, which began in June 2008 and runs through September, focuses on improving hospitals’ systems for assessing risk factors for patients developing bed sores. Efforts have included in-person and online prevention training for hospital personnel.

The real story is the Indiana error numbers, which are wonderfully extensive. They’re broken down by condition (28 different serious errors), location and specific facility.


Conference presentations

AHCJ articles

Globe photographer finds medical records in landfill

The Boston Globe‘s Liz Kowalczyk tells the story of how one of the paper’s staff photographers stumbled upon a massive medical privacy breach while dumping his trash.


Photo by D’Arcy Norman via Flickr

As Tinker Ready points out on Boston Health News, it’s a reminder that stories are everywhere … and shredders are not. Kowalcyzyk traced the documents to a billing intermediary.

Kowalcyzk uses the landfill scene to demonstrate just how difficult it is for hospital officials to keep confidential information from slipping through the cracks.

The photographer said he saw health and insurance records from at least four hospitals and their pathology groups — Milford, Holyoke, Carney, and Milton — mostly dated 2009. The Globe notified the hospitals. It is unclear how many other hospitals’ records might have been discarded in the dump.

(Hat tip to Tinker Ready)