How Well Do NJ Hospitals Make the Grade for Safety?

Beth Fitzgerald | June 7, 2012 | Health Care
A new report card shows most hospitals in New Jersey earning As and Bs, and those lagging reporting new safety measures since data was gathered

Interactive Map: Click on a dot to see how the hospital’s grade.

Source: Leapfrog Group Hospital Performance Report

How safe are New Jersey hospitals? A new report card shows most hospitals earning As and Bs — with the state overall ranking 12th in the nation for safety, according to new hospital performance data.

The letters grades were the first given by the Leapfrog Group, a national organization dedicated to healthcare quality, to rate safety issues like hospital infections, falls and surgical errors. Of the 73 hospitals rated in New Jersey, 23 received an A, and 33 were rated B. The 17 NJ hospitals earning Cs or lower have reported making progress on safety since the report’s data was gathered.

Leapfrog has been studying and reporting on hospital safety for more than a decade, and it took their safety experts nearly a year to figure out how to aggregate publicly reported data on 26 hospital safety indicators and turn that into a letter grade, said David Knowlton, chairman of the Leapfrog patient safety committee and president of the New Jersey Health Care Quality Institute.

“The odds of the doctor doing harm to you is so much less than the hospital doing harm to you, because you are in the hospital much longer than you are in the doctor’s direct care,” Knowlton said. “The doctor does a procedure on you that might take two or three hours, and you’re in the hospital for three or four days. When we looked into medical errors, it was the systems of care that caused those errors. It was rarely some doctor who didn’t do a good job of replacing your hip: It was the systems that the hospital had in place.”

State Health Commissioner Mary E. O’Dowd said the Leapfrog report “is another tool consumers can include in their discussions with healthcare professionals.”

Since 2004, when her department issued its first Hospital Performance Report, “we have seen steady improvement in the quality of care provided to New Jersey residents,” O’Dowd said. The state report provides much of the patient safety data aggregated by Leapfrog.

“We know that transparency raises the bar on performance,” O’Dowd said. “The hospital safety scores also serve as a benchmark for hospitals to assess their performance in patient safety and examine ways to improve.”

Hospitals Defend Grades

The new report card quickly drew push back from some hospitals. “A lot of the Cs do seem to be at bigger hospitals in areas where you have a lot of patients with compromised health and no insurance,” said Suzanne Ianni, executive director of the Hospital Alliance of New Jersey. And the hospitals all said steps are in place to improve their safety measures.

The report card aggregates data that hospitals report to Leapfrog along with data reported to the Centers for Medicare and Medicaid Services, the Joint Commission, which accredits hospitals, and the American Hospital Association. It considers 26 safety indicators, and included any hospital for which information was available on at least 14 of them.

Richard Mackesey, spokesman for Centrastate in Freehold, said the hospital’s C rating was based on 15 indicators. “Using only 15 indicators out of 26 is not representative of the safety here. We have continued to be recognized as a leader in this field.”

Another sticking point is that not all hospitals belong to Leapfrog, which was founded in 2000 with funding from the business community with the goal of using the leverage of large purchasers of healthcare to push for improvements. Lori Shaffer, a spokeswoman for Cooper University Hospital in Camden, which got a C, said hospitals that belong to Leapfrog reported more data than hospitals that aren’t members “We would have had a better score if you used only the measures they can get publicly,” she said.

“We work continuously to improve our quality and patient safety, and encourage the public to seek information from multiple sources, including their personal physician, when making decisions about where to seek their healthcare,” said Shaffer, who pointed to the hospital’s three-star ranking for its cardiac program from the Society of Thoracic Surgeons, its nationally recognized trauma program and an “excellent” score awarded by the Joint Commission, the hospital accrediting body, in its March 2012 survey.

Also getting a C was University Hospital in Newark, the teaching hospital of the University of Medicine and Dentistry of New Jersey. “While any medical center wants as high a grade as possible, an important reason to participate in a program such as Leapfrog is to gauge how we compare to the very best in the country and work to match those top institutions in all respects. And we are doing so,” the hospital said in a statement.

One criterion that Leapfrog emphasizes is the use of computerized provider order entry, a system where clinicians order medications and other aspects of care electronically. University Hospital did not yet have one in 2011, when this survey was taken. “That system is now being installed and will be fully operational at the hospital by the end of this year, giving clinicians another tool to provide quality patient care. “We look forward to its positive impact both on our patients and on future rankings,” the statement said.

Our Lady of Lourdes Medical Center in Camden got a C, while the grade is pending for the Lourdes Medical Center of Burlington County in Willingboro. Knowlton said a pending grade means the hospital would have gotten lower than a C. Since this is a new ranking system, Leapfrog is giving below-C hospitals six months to raise its performance before a letter grade is issued.

Lourdes spokeswoman Laurie Markin said the hospital is committed to transparency and is an active Leapfrog participant. The hospital scores high on key safety indicators like central line infections, hospital injuries and pressure ulcers. Leapfrog “not only measures what we do against tough standards, but also encourages us to work for change by providing direction for improvement efforts and the reduction of clinical variability,” she said.

Phillip S. Schaengold is chief executive of Hoboken University Medical Center, which also got a “grade pending” score, meaning the grade would have been below C. “This survey was comprised of data obtained before the current ownership group took control,” he said. “The hospital’s new ownership group has affirmed its commitment to improving HUMC to ensure that it provides the highest level of quality care. We have already begun to make significant improvements throughout the hospital, including achieving 100% compliance with the core measures for heart attack, heart failure, and pneumonia care. As a New Jersey Stroke Center, HUMC has achieved 100% of the required stroke performance indicators.”

Hoboken is owned by the same for-profit hospital group that owns Bayonne Medical Center, and which is in the process of acquiring Christ Hospital in Jersey City. Dr. Mark Spektor, chief executive of Bayonne Medical, said the hospital “delivers high quality care to all of its patients and we evaluate our performance on better established criteria, such as the state’s recent Joint Commission hospital quality survey which commended Bayonne Medical Center on the tremendous improvements in quality of care and patient safety.”

St. Joseph’s Regional Medical Center in Paterson said, “We appreciate opportunities to compare ourselves to our peer hospitals and want to assure our patients that there have been many improvements made in our processes since this period that the data has been reported.” Nancy Collins, a spokeswoman, said the data used by Leapfrog ranges from 2006 to 2010 and “does not reflect an accurate representation of the care currently provided at St. Joseph’s.”

Paul Simon, spokesman for South Jersey Healthcare, which got a C for its Vineland hospital and a B for its hospital in Elmer, pointed out that old data also doesn’t reflect initiatives that have been implemented in the past year or two. Key quality initiatives at South Jersey Healthcare include executive patient safety rounds, where top executives and board members visit clinical units to ask about safety concerns; increased use of digital technology, and a program to reduce medication errors that in some cases involves coaches visiting patients at home after discharge, to help them avoid the medical errors that often send patients back to the hospital.

Many of the “C” hospitals, including Lourdes and University Hospital, treat a disproportionate share of low income or uninsured patients, many requiring complex or difficult car, Ianni said “Leapfrog is a reputable organization and I would be would be interested to see what risk adjustments were made for the health status of patients and communities.”

Knowlton said the scores were risk-adjusted to account for the difference in the severity of the hospital’s case mix.

Ianni said on balance, New Jersey’s ranking of 12th in the nation is good news, and represents significant progress from several years back, when New Jersey ranked as low as the mid-40s nationwide on safety scores. The improvement reflects “a culture of making sure we learn from any hospital errors. It is part of the continuous effort to learn from mistakes, to get the best outcomes for everyone,” she said.

Kerry McKean Kelly, spokeswoman for the New Jersey Hospital Association, said “this is not new data, but Leapfrog is trying to present it in a new, consumer friendly way by attaching a letter grade to it. And we applaud these kinds of transparency efforts to make complicated information more digestible for consumers, but we would also point out that these are very complex issues and sometimes a single grade doesn’t tell the whole story. So our message to healthcare consumers would be to take this information but don’t use it in a vacuum, use an array of report cards and other sources of information.”

Knowlton said A grades went to big urban hospitals like Jersey City Medical Center, Newark Beth Israel Medical Center and Hackensack University Medical Center, as well as to smaller, rural hospitals like Hunterdon Medical Center, suggesting size and location are not the deciding factors. It was the same story nationally, where A-rated hospitals were found in the cities and in rural areas. Of the 2,652 hospitals rated nationwide, 729 got an A, 679 got a B and 1,243 were C or below.

Of the six hospitals in the Barnabas Health system, five got As and one got a B. “I’m honored that we did so well — and the work doesn’t end, it just keep going,” said Dr. Anthony Slonim, chief medical officer.

Barnabas deploys a variety of safeguards to reduce hospital-acquired infections. “One of the big contributors to infections during hospitalization are the use of devices” such as catheters and IV lines. “Those devices can be life saving, but at the same time they break through the normal defense mechanisms that the body has. So we want them only to be used when they are needed and only for as long as they are needed.”