CAN WE BELIEVE HOSPITAL STATISTICS?

Reporting of Mistakes by Hospitals Is Faulted

A.Hatocollis reports that at least in one city--New York City-- hospitals are the least reliable in the state at reporting preventable mistakes and adverse incidents for patients like heart attacks, blood clots, hospital infections and medication errors, according to a new report by the office of City Comptroller.

The comptroller also expressed concern that the New York City data on medication errors appear to run counter to the national trend, citing estimates by the Institute of Medicine of the National Academies that at least 400,000 hospital patients are harmed and 7,000 killed by medication errors annually. In contrast, the report said, from 2004 through 2007, city hospitals rarely reported medication errors: 37 that resulted in death, near death or permanent harm to patients, with 22 hospitals, including four very large ones, reporting none.

The lack of accurate reporting makes it virtually impossible for consumers to judge accurately the quality of a hospital or for the hospital to compare itself with its peers and make improvements, the comptroller’s office argues, saying the consequences include longer hospital stays and higher health-care costs. “Without the fullest possible reporting, hospitals cannot identify areas where systematic improvement may be needed,” reads the report. “Weak enforcement and flagging commitment to a broad-based effort has compromised the whole program.”

NewYork-Presbyterian/Weill Cornell Medical Center one of New York City’s major academic medical centers, reported only about 20 adverse incidents per 10,000 patient discharges, while a comparable institution outside the city, which was not named, reported about 166 incidents per 10,000, a rate more than eight times higher.

Within New York City’s 60-plus hospitals, there was great range: 17 reported no heart attacks unrelated to a cardiac procedure while one had more than 40; six hospitals reported 2 blood clots or acute pulmonary embolisms per 10,000 patient discharges while two others had more than 60 per 10,000; one major academic medical center reported 3.6 post-operative infections per 10,000 discharges and a similar hospital had 32 per 10,000. None of these hospitals were named in the report.

The report, which looks at data from 2004 through 2006, with some additional data from 2007, echoes a state Health Department study in 2001 that similarly concluded that New York City underreported adverse incidents, with 6 of the 11 city-run public hospitals among the 25 lowest reporters. The new analysis faulted the state for not being more aggressive in enforcing penalties such as fines against hospitals with lax reporting, and cited “enormous and inexplicable disparities among individual hospitals.”

A hospital’s size and the type of procedures it performs do not seem to explain the differences in reporting rates.

The report does not name individual hospitals, but the comptroller’s office separately released a list of the 12 lowest reporters in the city based on 2006 data. The top three — St. Vincent’s Midtown and Cabrini Medical Center in Manhattan, and Mary Immaculate in Jamaica, Queens — have all since closed.

The others include some of New York’s biggest and most prestigious hospitals: Lenox Hill, on the Upper East Side (No. 7); Bellevue, the flagship hospital of the city’s Health and Hospitals Corporation (10); Weill-Cornell (11); and Mount Sinai (12).

COMMENT:
It’s not difficult to believe that NYC is not an isolated city. I believe that hospital statistics reported from other cities will have to also be investigated—with severe sanctions applied to violaters.