Maine’s hospitals have once again been declared the safest in the nation by an industry watchdog group, but central Maine’s largest hospital still lags in the ranking.
With a September study finding that as many as 440,000 patients are dying every year due to preventable hospital errors, nonprofit group Leapfrog seeks to drive change in hospital practices by grading hospitals on their safety levels twice per year.
Their spring report, released this week, was good news for many hospitals, but for MaineGeneral Medical Center, the largest in the area, a poor showing exposed a series of negative outcomes for patients.
MaineGeneral administrators say the hospital has improved significantly, but a lag between its performance and Leapfrog’s reporting means that positive changes are not yet reflected in the report.
In Maine, a nation-best 76 percent of hospitals received an A grade, slightly ahead of second-ranked Massachusetts, which had 70 percent, and third-ranked South Dakota, which had 67 percent.
In central Maine, Farmington’s Franklin Memorial Hospital and Waterville’s Inland Hospital each received an A from Leapfrog, while MaineGeneral Medical Center, with a new regional hospital in north Augusta, received a C.
Franklin and Inland were quick to release statements in which they welcomed the news. John Dalton, president and CEO of Inland, said the report underscored the hospital’s commitment to its patients.
“For our staff, a safe patient care environment is an absolute priority,” he said.
At Franklin Memorial, which has received a B from Leapfrog in previous years but improved to an A last year, President Rebecca Aresnault said the report would fuel continued positive changes.
“This positive affirmation by an independent reviewer only strengthens our determination to continue our efforts to excel at all levels of our health delivery system,” she said.
Increasingly, hospitals across the nation are being held accountable for mistakes that lead to infections, injuries, or even death, for their patients.
A 2010 report from the U.S. Department of Health and Human Services found that one in four Medicare patients leave the hospital with a medical problem they didn’t have when they entered. Preventable errors have become a major focus of healthcare reform, in part because of changes to the federal Medicare system that penalizes hospitals for such errors.
Steve Diaz, chief medical officer at MaineGeneral, said the hospital’s staff has made large strides in some of the areas that resulted in its C grade, and that he expected the entity to do better in the future.
“We will see the fruits of our labor in our next report,” he said. “It was difficult to see this report knowing that we’ve made these improvements.”
A closer look at the data suggests that while MaineGeneral’s patients have been more likely to suffer negative health outcomes, the hospital has good procedures in place.
About half of the grades are based on the rates of 13 different error types that actually happened at the hospitals and a higher rate of these errors is what caused MaineGeneral’s relatively low grade.
According to the report, patients at MaineGeneral are three times more likely to have foreign objects left in their body after surgery than would be the case at the average hospital.
That may sound frightening, but in fact, that actually happened to only one patient among thousands who underwent surgery at MaineGeneral over the two-year reporting period, Diaz said.
“We’re not proud of it,” he said. “We’ve learned from it, but it did occur.”
Leapfrog says that it includes that measure because when a doctor’s instruments or a surgical sponge is left inside a patient’s body, it can require additional surgeries or even cause death. The group recommends that medical teams count each instrument and sponge before and after the surgery, a practice that is used widely in operating rooms, including MaineGeneral’s.
Because Maine’s hospitals have done so well on safety, Diaz said it only takes a relatively small number of mishaps for a hospital to do poorly against the state measure.
During the study period, patients at MaineGeneral were more than four times likely to suffer serious bedsores and more than three times likely to have a surgical site infection in the colon.
“The total chance is actually small, although you can’t see it in the measures,” Diaz said.
They were also slightly more likely to have their wounds split open after surgery, have catheter-associated infections, suffer accidental cuts or tears from medical treatment, experience breathing failure after surgery and to die after suffering serious post-surgical treatable complications.
For most of the measures, the data collection period was for a two-year period ending in June of 2012, while the rest covered a span ending in June 2013, both periods that ended before MaineGeneral opened the doors of Augusta’s Alfond Center for Health in November.
Diaz said improvements will come from a combination of renewed efforts to improve staff procedures and benefits that have been built into the new hospital.
For example, he said, the new room design provides a hand bar that runs from the head of each patient bed to that patient’s bathroom, reducing the chances of someone falling.
In another improvement, patient alarms are now routed directly to the nursing staff, so that other patients won’t be disturbed by repeated loud noises. Those patients should get better rest, making them more resistant to infections, Diaz said.
Some of the advantages of the new hospital are balanced out by the adjustment period that came with merging two different cultures into one, he said.
MaineGeneral patients also did better than average on some measures. They were less likely to experience falls and trauma, less likely to have infections from central lines inserted into the heart, less likely to have their lungs collapse due to medical treatment, and less likely to have dangerous blood clots develop in their veins after surgery.
Diaz said that, while he takes summary reports from Leapfrog and other groups seriously, it is difficult to say that any small group of measures really define a hospital’s safety.
“We want that A grade as much as anybody else,” he said. “We know this is how it is and how people are judging us. But there is a disconnect that makes it hard to interpret.”
MaineGeneral received the highest possible scores for having a good leadership structure, a good culture that encourages feedback and interventions, and having a good nursing workforce. It also received top scores for identifying and mitigating risks and hazards, hand hygiene, caring for patients on ventilators, and giving patients antibiotics at the right time before surgery.
Diaz said he knows MaineGeneral’s Leapfrog score will go up, in part because the hospital does well on safety reports issued by the Joint Commission, a national healthcare organization which accredits hospitals and by the federal Centers for Medicare and Medicaid Services.
“I know that we can translate that over to Leapfrog,” he said. “That’s why I’m so confident.”
While Maine remained best in the nation, it’s 76 percent mark did represent a loss of ground against other states, down from a high of 80 percent in Fall 2012 and Spring 2013.