Cedars-Sinai Medical Center has been given a grade of “C” in a non-profit organization’s analysis of the safety of hospitals, an analysis that has been contested by Cedars-Sinai.
The annual Hospital Safety Grade report from Leapfrog Group scores hospitals on how safe they keep their patients from errors, injuries, accidents, and infections. Leapfrog is a not-for-profit organization founded more than a decade ago by major employers and private health care experts. Since 2012 it has conducted biannual studies of safety in which nearly 2,000 hospitals participate free of charge. In addition to information from its surveys, Leapfrog uses information from Medicare in conducting its analysis.
Leapfrog analyzes hospital safety practices in five categories – infections, problems with surgery, practices to prevent errors, safety problems, and leadership, training and responsiveness of hospital staff.
In the Infections category, Cedars-Sinai ranked well in terms of preventing infection of blood, infection in the urinary tract, and MRSA infection. MRSA (Methicillin-resistant Staphylococcus aureus) is a staph bacteria resistant to many antibiotics that can be found in bed linens or medical equipment and on the hands of medical providers who do not wash them between patients.
However Cedars ranked average in its prevention of infection by Clostridium difficile (C. diff), a bacteria that can cause diarrhea, abdominal pain, loss of appetite, and fever. Leapfrog’s report states that “C. diff can spread via contaminated equipment or by providers who fail to properly wash their hands between patients.” It notes that most C. diff cases occur in patients taking or having recently taken antibiotics, and fully killing the bacteria in an infected patient can be very difficult.
Cedars had a below-average ranking in preventing surgical site infection after colon surgery. “This infection happens after surgery in the part of the colon where the surgery took place,” the Leapfrog report states. “These infections can be very serious, and may spread throughout the body. A patient with this type of infection often faces a long recovery in the ICU. Some people even die from the infection.”
PROBLEMS WITH SURGERY
In the Problems with Surgery category, Cedars ranked only above average in three of the seven areas assessed – incidents of surgical wounds splitting open, deaths from serious treatable complications, and serious breathing problems after an operation. However, it ranked worse than average in subcategories such as “dangerous object left in patient’s body,” “dangerous blood clot,” and “accidental cuts and tears.” It was ranked as average in “collapsed lung,” which describes incidents of air leaking out of the lung and into the area between the lungs and the chest wall when a doctor or nurse is inserting a catheter, a feeding tube, or even a pacemaker.
PRACTICES TO PREVENT ERRORS
In the “Practices to Prevent Errors” category, Cedars ranked below average in four of six subcategories and declined to report information to Leapfrog in two others. One of the low-ranking subcategories examined the likelihood of doctors ordering medications through a computer rather than by writing a prescription. Computerized physician order entry systems alert a doctor if the prescription could cause harm and help reduce medication errors. Another subcategory concerns safe medication administration, where Cedars ranked low in use of barcodes on medication that a nurse would scan and compare with a patient’s ID bracelet to ensure that the medication is being given to the right person.
Cedars ranked just slightly below average in the “Communications about medicine” subcategory, which ranks hospitals according to feedback from patients about how well hospital staff explains the purpose of a new medication and what side effects it might have. It also ranked just below average in “communication about discharge,” which is a measure that summarizes “how well the hospital staff communicated with patients about the help they would need at home after leaving the hospital” and what symptoms that should watch out for.
According to Leapfrog, Cedars declined to provide information on what policies it has implemented to train employees on cleaning their hands before touching a patient to prevent transmission of germs. Leapfrog reports that Cedars also declined to report whether it regularly surveys its staff on the “culture of safety” to measure how well staff works together to keep patients safe and to create plans to improve.
In the Safety Problems category, Cedars declined to report whether it regularly assesses areas of the hospital where an error has occurred and trains staff to prevent common errors. It ranked average in steps it takes to prevent patient falls from beds. Cedars ranked slightly above average in taking steps to ensure that patients don’t suffer serious bed sores and in safely inserting catheter and other tubes so as to avoid creating an air or gas bubble in the blood.
DOCTORS, NURSES, HOSPITAL STAFF
In the “Doctors, Nurses and Hospital Staff” category, Cedars ranked high in efforts it makes to ensure that nurses communicate well with patients and that doctors take time to communicate with patients. It also ranked above average in overall responsiveness of hospital staff and in ensuring that it staffed intensive care units with physicians trained in critical care medicine. Cedars declined to respond to Leapfrog’s questions about whether it had enough nurses on staff and whether hospital leaders are aware of patient safety problems and work with staff to fix them.
A spokesperson for Cedars-Sinai disputed the validity of the Leapfrog report. “Cedars-Sinai continues to have concerns about the value and validity of Leapfrog’s hospital survey and therefore does not participate in the process.,” the spokesperson said in an email to WEHOville. “The annual survey, parts of which are used to calculate Leapfrog’s Hospital Safety Grade, penalizes hospitals that do not participate. Only about half of U.S. hospitals complete the survey.
“A more reliable and accurate measure of Cedars-Sinai’s quality can be found through reputable sources such as CMS’s Hospital Compare, the federal government’s site for evaluating hospitals. According to Hospital Compare, Cedars-Sinai remains a top performer across U.S. hospitals in important safety metrics, including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI) and MRSA bloodstream infections.
“In February 2019, CMS rated the overall hospital quality at Cedars-Sinai Medical Center as five stars, its highest quality rating. In 2018 Cedars-Sinai earned the highest ranking from the federal government for its rate of patient survival 30 days after hospitalization for treatment of three common conditions: pneumonia, heart failure and heart attack. The medical center is one of only three hospitals in the U.S. to achieve this accomplishment for 10 years in a row.”
Cedars-Sinai’s “C” grade is consistent with that in the spring and fall of 2018. However, it had a “B” grade in the fall of 2017.
Among other nearby hospitals, Kaiser Permanente Los Angeles Medical Center at 4867 Sunset Blvd. got a “B” ranking from Leapfrog. The University of California Ronald Reagan UCLA Medical Center at 757 Westwood Plaza got an “A” ranking, up from a “C” ranking in 2015 and an “F” in 2012.
Olympia Medical Center, another nearby hospital, is not included in the Leapfrog rankings. “As per expert panel guidance, the Leapfrog Group has minimum data thresholds for hospitals to receive a grade,” says Leapfrog’s website. “Hospitals missing more than seven of 13 process measures or more than five of 15 outcome measures are not graded. This means some general hospitals that should be graded are not.”
CORRECTION: An earlier version of this story said that Cedars-Sinai Medical Center ranked below average in three of the seven areas assessed in the Problems with Surgery category – incidents of surgical wounds splitting open, deaths from serious treatable complications, and serious breathing problems after an operation. In fact, Cedars-Sinai ranked above average in each of those categories. The story has been updated to reflect that.